HealthSherpa posted a lengthy criticism of our WSJ editorial some time back. Here is our response.
Our editorial said that if you are healthy, have average income and have to buy your own insurance, your options in America have never been better – all thanks to Obamacare. But if you have serious medical problems and require expensive medical care, your options have never been worse.
[OK, we probably should have said, for most people, they have never been worse.]
In response, HealthSherpa says you can pay a modest premium and get an HMO plan with a family deductible of $5,000. However, there is coinsurance after you reach the deductible (in some cases as much as 50%). So what counts is not the deductible, it’s the total out-of-pocket exposure. For a typical HMO plan like this, the exposure is $13,000 – on top of the premium.
Here is the bottom line: if you are healthy and need only preventive care, health care and health insurance are essentially free for average income families. But you’re going to get hammered if you need expensive care.
HealthSherpa does make an interesting point, however. If you are going to max out on spending, you can actually save some money (a few thousand dollars) if you choose a plan that requires a modest premium payment over plans that have no premium. That being true, you would think that CMS would try to guide people with expensive-to-treat medical conditions to these plans.
Instead, TV advertisements boast that 4 in 5 enrollees will pay $10 a month or less – literally encouraging buyers to choose a plan with the lowest premium. Perhaps for that reason,
The average annual out-of-pocket exposure for a family in 2024 is $18,900 in the federal marketplace exchanges.
And we hasten to add that after paying that outrageous sum (year-after-year if your condition is chronic), you are denied care at centers of excellence in Dallas, Houston and other parts of the country.
What makes this especially strange is that Obamacare was sold as a remedy for “junk” insurance that mistreats the sick, not as a giveaway to the healthy.
Virtually all the gold and silver plans quoted in Health Sherpa are much cheaper than what the same family would pay in cash for the average employer’s insurance package. Very few people are as industrious as Mr Gaba in studying ACA plans. If people studied these plans, they would demand that the firewall” between ACA and employer plans be torn down.
Incidentally, the Goodman editorial did make a mistake when it quoted only a bronze ACA plan.