The Affordable Care Act requires insurance policies to provide ten essential benefits:
- Outpatient care—the kind you get without being admitted to a hospital
- Trips to the emergency room
- Treatment in the hospital for inpatient care
- Care before and after your baby is born
- Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy
- Your prescription drugs
- Services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.
- Your lab tests
- Preventive services including counseling, screenings, and vaccines to keep you healthy and care for managing a chronic disease.
- Pediatric services: This includes dental care and vision care for kids
People on the individual market for insurance purchase insurance products regulated by HIPAA as well as by the ACA. According to HIPAA, you are supposed to be able to renew your insurance policy annually. If not, HIPAA requires that the insurer
Provides notice in writing to each individual provided coverage of that type of health insurance at least 90 days before the date the coverage will be discontinued.
So what’s happening? Lots of people in the 17% of the market that buy individual insurance probably have pretty crappy insurance:
There are lots of insurance policies, especially on the individual market, that are really bare bones. Some argue they shouldn’t even be called insurance coverage, because their coverage is too sparse to insure against financial ruin. One report from the Obama administration, issued in 2011, found that 62 percent of individual market plans don’t offer maternity care. Eighteen percent do not cover mental health benefits and 9 percent do not pay for prescription drugs.
Remember that the leading cause of bankruptcy in this country is medical bills, and lots of people go bankrupt who thought they had adequate insurance. The market for insurance has been remarkably opaque, and one of the effects of the Affordable Care Act is define what really constitutes insurance and what is simply crap with insurance in the title. The ACA is throwing out deficient policies and HIPAA therefore is requiring insurers to tell subscribers that such policies will not be offered next year.
The cost of insurance does not consist of premiums alone. One of the conservative talking points regarded really cheap insurance. Ezra Klein looked at one such policy that cost $109 per month with a $4500 deductible, a $2500 deductible for brand-name medication, and huge co-pays. You go to the company’s website and it appears with a “bestseller” icon next to it. What happens when you try to buy it?
Click to buy the plan and eventually you’ll have to answer pages and pages of questions about your health history. Ever had cancer? How about an ulcer? How about a headache? Do you feel sad when it rains? When it doesn’t rain? Is there a history of cardiovascular disease in your family? Have you ever known anyone who had the flu? The actual cost of the plan will depend on how you answer those questions.
According to HealthCare.gov, 14 percent of people who try to buy that plan are turned away outright. Another 12 percent are told they’ll have to pay more than $109. So a quarter of the people who try to buy this insurance product for $109 a month are told they can’t. Those are the people who need insurance most — they are sick, or were sick, or are likely to get sick. So, again, is $109 really the price of this plan?
So maybe even you, oh vibrantly healthy reader, would not even have been able to buy that plan.