ST. LOUIS (KMOX) – KMOX wanted a non-partisan take on whether the Affordable Care Act, or Obamacare, is working or not. We turned to the St. Louis Medical Society’s president Dr. Samer Cabbabe, who says there are good and bad things.
“It did provide an opportunity for people who don’t have employer-sponsored insurance to get an insurance. The other benefit was that for people with pre-existing conditions, that the insurance companies may not pick up, it allowed them an opportunity to get insurance when they may not have otherwise been able to.”
Obamacare is supposed to be affordable – Cabbabe calls that a fine line.
“As we’ve continued to narrow the markets down on these insurances, we’re narrowing the scope of providers available at each one. And it’s not just the Affordable Care Act, it’s also all these ACO plans, like Mercy has a plan, they narrowed the number of providers available.”
Cabbabe tells KMOX that major insurers have dropped out, and that narrows a patient’s options.
Another disadvantage – while premiums are low, Obamacare coverage is more along the lines of catastrophic insurance coverage. This year, deductibles on those plans rose up to 50 percent.
Cabbabe says, “The reason that they’re dropping is because they’re saying they’re having huge losses, and the reason is there’s low premiums, but the problem is that they’re taking care of very sick people, and the premiums are not meeting the expenses. The other major disadvantage is the premiums are low, but this is more along the line of catastrophic insurance.” Cabbabe says that’s because deductibles are sky-high.
He adds, “A number of individuals in high-deductible plans, defined as over $1,500 per person, rose up to 50 percent in 2016. Well, certainly these numbers are much lower in the employer-sponsored plan. So the problem is the same people who cannot afford insurance cannot even afford the deductible.”
Cabbabe, who is a plastic surgeon and specializes in breast reconstructive surgery, sees up to $8,000 deductibles routinely. And since the insurance coverage is billed as catastrophic, very few providers and hospitals are in that network.
“If a patient were to be in an accident and be hospitalized for a prolonged period of time, it’d possible that none of it’s covered,” he says, because the provider and the hospital are not covered.
Cabbabe says this is also true to some degree with employer-sponsored health insurance.
The even worse news – costs will continue to escalate between 10 and 60 percent for the Affordable Care Plans, he says.
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