Micah Weinberg

Viewpoints: Finding the benefits in reforming health care

Published: Tuesday, Jul. 23, 2013 - 12:00 am | Page 9A

How will the Affordable Care Act affect me and my family? The answer, like the law itself, is complicated. There will be as many stories about health reform as there are families. But I'm confident that most of these stories will be good.

I say this both as a health policy wonk, with my own health policy consulting firm, and as a husband and father. My wife and I live in Sacramento, and we have a 5-year-old son. My wife also happens to have a pre-existing health condition. It's nothing life-threatening, but it's just serious enough that she has been turned down for regular health insurance coverage. As many as a third of Americans face a similar issue, according to the Government Accountability Office.

Finding affordable, high-quality health coverage for my family has been, even for me, an "expert" in the area of health insurance, complicated and frustrating. So I work with a health insurance broker to understand my options.

Currently, we have COBRA coverage for my wife, a type of health insurance you can get for 18 months after you've left employer-sponsored health coverage. It costs us $655 per month. Then, since I don't have an employer to provide coverage, I buy a separate policy in the so-called "individual market" to cover myself and my son. That costs $482 per month. Our coverage, a pair of similar PPO (preferred provider organization) products through Blue Shield of California, is good for what we pay, but not extraordinarily so.

Will my life get less complicated and frustrating on Jan. 1, 2014, the day that health reform coverage starts? I believe it will.

One major improvement is that our premium payments will drop.

In California, a "silver" level Blue Shield PPO plan in the Sacramento region will cost us $997 per month for the whole family, about $140 per month less than we now pay for roughly the same level of coverage. I will also be able to purchase one health insurance policy for my three-person family instead of worrying about what to do when my wife's COBRA coverage runs out. If one of us has a medical issue, our premiums won't go up. And if one of us has a serious hospitalization, the medical bills won't bankrupt my family.

One major benefit of the Affordable Care Act is that it caps total out-of-pocket, annual spending on medical care at $6,400 for an individual and $12,800 for a family.

My wife and I make enough money that we will not receive any financial assistance from the federal government for purchasing health insurance. But health care reform was not passed solely to help the poor or unfortunate. The law is designed to make sure that even those of us who are relatively well off, like my wife and me, don't end up vulnerable when we switch jobs or choose, as I do, to be entrepreneurs.

For working-class and low-income Americans, premiums are capped on a sliding scale, so a family of four with a household income of, say, $60,000 would pay $4,913 per year, or $409 per month, for my plan. The federal government would provide a subsidy of $7,051 to cover the rest. If that family were to choose the most affordable policy available in the region, an Anthem Blue Cross PPO at the "bronze" level, it would cost them only $162 per month. Since Obamacare raises revenue to cover the cost of these subsidies, it is not projected to increase the national debt significantly, if at all.

None of this means free health care is on the way. On the contrary, everyone with insurance will pay a significant amount in out-of-pocket costs if they access care, and everyone is required to have health coverage. And some people – in particular younger, more affluent men – will pay significantly more per month. But, because of health reform, millions of terrible moments – of frustration, of panic, even of bankruptcy – that could have happened will not happen.

Certainly, the Affordable Care Act has flaws. It awkwardly combines a Republican blueprint – the "individual mandate" – with Democratic engineering. So, some of the nuts are screwed onto the wrong bolts. And if we don't continue to service and repair the vehicle conscientiously, the whole thing is going to fly apart with us in it, Democrats and Republicans alike.

Like many people, I've got my own views about what kind of a health reform law I might prefer in the abstract. I would take a page from Sen. John McCain and do away with the tax benefit for employer-sponsored insurance. But I've chosen to put that aside.

We're two months from the opening of the new marketplaces where people can buy health coverage. At work, I've been trying to help set up these new systems so they function well. At home, I'm getting ready to buy our new plan. I think it will benefit our family – and many others.

Micah Weinberg is CEO of Healthy Systems Project, a health policy consulting firm. He wrote this for Zocalo Public Square (www.zocalopublicsquare.org).

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