The Wall Street Journal and the New York Times both ran articles recently about how the end of enhanced ACA subsidies led to millions of Americans dropping health coverage. WSJ wrote about Suzanne and Kip Mercer from South Florida, who dropped their ACA plans and stopped seeking medical care as a result, saying:
Mercer, 59 years old, also hasn’t gotten a follow-up scan that a doctor ordered after a mammogram in December turned up a concerning spot. “It’s awful, you just cross your fingers,” she said. “I just don’t want to know right now, because I can’t do anything about it.”
This is where you are supposed to wring your hands and clutch your pearls, because people should never forgo health coverage. You’ve no doubt read an article like this time and time again. Desperate families decide they cannot afford health coverage, and their gamble ultimately costs them. However, there is no reason for Ms. Mercer to forgo having a concerning spot on her breast checked out just because she does not have Obamacare. RadiologyAssist offers chest CT scans in Miami for about $175. A breast ultrasound is $112. An MRI starts out around $282.
Purportedly, hospitals are noticing an uptick in ER visits and rising bad debts from uninsured patients. The New York Times reported:
More and more uninsured patients are showing up in hospital emergency rooms and clinics, having lost their coverage under the Affordable Care Act.
And many executives said that the hospitals were also reporting more unpaid medical bills and providing more in the way of charity care. Some hospital systems also found that patients were forgoing or postponing lucrative elective surgeries like knee replacements in recent months.
Ronmel Rangel was not among those showing up at hospital ER or running up inflated bad debts. Neither was he one who decided to put off seeking the care he needed. Instead, he shopped around until he found a price he was willing to pay.
Rangel (63) is an immigrant living in Maine. Like millions of Americans, he decided Obamacare cost too much for what it delivered. He decided to forego health coverage and pay for a direct primary care provider rather than pay high premiums for a deductible that would render him functionally uninsured. He later experienced a medical problem that required surgery. However, Rangel did something unexpected. He began shopping around for surgery prices. The following was reported by The Washington Post:
Rangel had what is called an inguinal hernia, which occurs when the contents of the abdomen bulge through a weak spot in the lower abdominal wall. The condition is relatively common, particularly among older adults.
In most cases, surgery is required to fix the muscle wall and can be performed as an outpatient procedure.
Because Rangel did not have insurance, he had no protections from high costs — except time and his ability to shop for an acceptable price for his procedure.
Rangel checked on a nonprofit hospital near his home in Maine and the price was going to be $23,000. Another large health care system wanted $37,000. He checked on having the surgery done abroad and it was going to cost $7,000 in Santiago, Chile. He considered going to the Surgery Center of Oklahoma, where the price appears to be $3,870 (there are a lot of different surgical options making it difficult to know which procedure he would need). Rangel decided Oklahoma City was too far away from Maine. He ultimately found a doctor and an outpatient surgery center in Rockville, Maryland that charged him $2,900. Travel and lodging cost him another $1,800 for a total cost of $4,700. Kaiser Family Foundation Health News provides more details on what other hospitals would charge for the service.
If more people began to act like consumers instead of passive patients, more health care providers would begin to compete for their business. For that matter, if more health care providers made it easier to shop for medical care, perhaps more patients would compare prices. Health insurers could do a lot more to facilitate comparison shopping. The Trump Administration should also put more teeth into the requirement that hospitals disclose prices.
Read more at:
New York Times: After Obamacare Cuts, Hospitals Are Treating More Uninsured Patiets
Wall Street Journal: Health Insurance Coverage Falls for Millions, Straining Healthcare Economy
KFF Health News: Uninsured but Undaunted, a Surgical Patient Searched the Globe for a Deal
Satan is coming