Since the Patient Protection and Affordable Care Act (aka, Obamacare) launched six years ago, California has shown how a competitive free market can work for consumers.
The state’s marketplace has helped millions gain coverage and the state’s uninsured rate is now at a historic low of 7.1 percent – less than half of what it was in 2013.
While the law created a new era of health care, we know that more can be done. We also know the law is not perfect and that health care in America is wildly expensive.
The Modesto Bee recently profiled the Pardini family (Modesto Man thanks the ACA for flimsy health plan and sky-high insurance rates,” June 11, Page 1A), who do not benefit from the law’s financial help because their annual household income of $73,000 puts them above the eligibility threshold. Consequently, while the law protects the family from being denied coverage because of pre-existing conditions and bans lifetime caps on their benefits, their health care remains costly.
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The article makes clear that the cost of their premium seems particularly high because the family recently moved from employer-sponsored coverage – with much of the premium paid by Bruce Pardini’s employer – to paying for coverage on their own. The reality of the high cost of health care is hitting their family hard.
The story of this family highlights the real-life issues that need to be considered by policymakers in Washington.
The current bill under consideration in the Senate would not address the Pardini family’s challenges. A recent analysis by the National Academy for State Health Policy looked at the potential impact on premiums depending on an individual’s age, income and where he or she lives. Bringing this home to Modesto, it showed that 60-year-olds making $50,000 a year in Stanislaus County would see their premiums jump from $5,100 a year to $14,500 for the same level of coverage today.
In addition, the Senate bill would establish a new “benchmark plan” that would nearly triple current deductible levels for a Silver plan to more than $14,000 for a family, with nothing likely covered before the deductible is met.
This would be a far cry from Covered California’s patient-centered benefit design, which provides all outpatient care in Silver, Gold and Platinum plans without being subject to the deductible.
As the national discussion moves forward, the story of the Pardini family does well to remind us the solutions that matter over the long term are bringing down the underlying costs of health care.
At Covered California, we are doing that today through policies that are making sure all of our enrollees have a primary care physician they can turn to, and projects to stop rewarding doctors and hospitals for doing more – instead, we should be rewarding those who make sure patients get the right care at the right time.
While the debate in Washington continues, we will seek to bring our experience to bear while we focus on making sure those we cover get the best care possible.
Peter V. Lee is executive director of Covered California; he wrote this for The Modesto Bee.