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New health plans may leave some 'underinsured'

Seriously ill patients might have to face expenses that are beyond their means

By Associated Press

LAST UPDATED: 01:57 a.m. HST, Jan 06, 2014

WASHINGTON » For working people making modest wages and struggling with high medical bills from chronic disease, President Barack Obama's health care plan sounds like long-awaited relief. But the promise could go unfulfilled.

It's true that patients with cancer and difficult conditions such as multiple sclerosis or Crohn's disease will be able to get insurance and financial help with monthly premiums.

But their annual out-of-pocket costs could still be so high they'll have trouble staying out of debt.

You couldn't call them uninsured any longer. You might say they're "underinsured."

These gaps "need to be addressed in order to fulfill the intention of the Affordable Care Act," said Brian Rosen, a senior vice president of the Leukemia & Lymphoma Society. "There are certainly challenges for cancer patients."

"Cost may still be an issue for those in need of the most care," said Steven Weiss, spokes­man for the American Cancer Society Cancer Action Network. That "makes it critically important for patients looking at premiums to also consider out-of-pocket costs when choosing a plan."

Out-of-pocket costs include a health plan's annual deductible, which is the amount before insurance starts paying, as well as any co-payments and cost-sharing.

A few numbers tell the story. Take someone under 65 with no access to health insurance on the job and making $24,000 a year — about what many service jobs pay.

Under the health care law, that person's premiums would be capped below 7 percent of his income, about $130 a month — a stretch on a tight budget, yet doable.

But if he gets really sick or has an accident, his out-of-pocket expenses could go as high as $5,200 a year in a worst-case scenario. That's even with additional financial subsidies that the law provides people with modest incomes and high out-of-pocket costs.

The $5,200 would be more than 20 percent of the person's income, well above a common threshold for being underinsured.

"Chronically ill people are likely to be underinsured and face extremely high out-of-pocket costs," said Caro­line Pearson, who tracks the health care overhaul for Avalere Health, a market research and consulting firm. "While the subsidies help, there still may be access problems for some populations."

Under the law, insurance companies competing in new online markets like HealthCare.gov can offer four levels of coverage.

All plans cover the same benefits; the difference is in financial protection. A bronze plan covers 60 percent of expected costs, silver covers 70 percent, gold covers 80 percent and platinum covers 90 percent.

Bronze plans have the lowest premiums but provide less insurance. Gold plans are the closest to employer-provided coverage. Indeed, members of Congress and staffers who will now get their coverage through the health care law have been steered to gold plans.

Silver, however, is the standard for most consumers. The law's tax credits to help with premiums are keyed to a benchmark silver plan in each geographical area. And the law's subsidies to help with out-of-pocket costs are only available to people who get a silver plan.

Avalere found that the average annual deductible for silver plans is $2,567, more than twice what workers in employer plans currently face.

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MalamaKaAina wrote:
"Socialized Medicine is the Keystone to the Arch of the Socialist State." ~Vladimir Lenin
on January 6,2014 | 12:57AM
hanalei395 wrote:
"Socialized medicine" is what Ronald Reagan called Medicare. He changed his mind when he became Pres.
on January 6,2014 | 04:52AM
NanakuliBoss wrote:
Malamakaina is the "Keystone Cop for Socialized Medicine".
on January 6,2014 | 02:50PM
hanalei395 wrote:
America became a "Socialist State" with the birth of Social Security.
on January 6,2014 | 05:39AM
wiliki wrote:
"Socialized Medicine" is a Republican excuse for not providing medical services for all. It's not an acceptable excuse. Go find another one to use.
on January 6,2014 | 08:24AM
what wrote:
"Socialized Medicine" is taking money from those who earned it and giving it to those who didn't.
on January 6,2014 | 09:45AM
hanalei395 wrote:
People without health insurance, and deadbeats who don't want it, go to the ER when they get sick or injured. Of which, the hospitals will then pass on the bills of the uninsured to insurance companies. And that winds-up with higher cost premiums for health insurance, i.e. taking money from people with health insurance to pay for the deadbeats who don't want it.
on January 6,2014 | 10:44AM
wiliki wrote:
Precisely why "what" is clueless....
on January 6,2014 | 03:33PM
what wrote:
You are clueless because you act is if I don't think both laws are bad. You seem to think we have to have one or the other, and can't abolish both. I know it's complicated, but stretch your mind a bit.
on January 6,2014 | 05:32PM
what wrote:
on January 6,2014 | 05:57PM
cojef wrote:
The ones that buy the bronze, still will be going to emergency because the deductible is too high.
on January 6,2014 | 04:05PM
NanakuliBoss wrote:
Cojef,going to ER will stll cost your deductible.
on January 6,2014 | 05:35PM
LanaUlulani wrote:

Socialized medicines is stealing from hardworking local people to give to others who did not earn it. Stealing is not PONO. Nothing to do with Republicans. Everything to do with DOING pono!

on January 6,2014 | 10:45AM
wiliki wrote:
Baloney.... the public is paying now with free ER service. With Obamacare, people will be able to buy good coverage at reasonable rates. Nothing socialized about that.
on January 6,2014 | 03:35PM
NanakuliBoss wrote:
My prediction...Florida 45. Auburn. 13,,,,,at 15430 hrs.
on January 6,2014 | 02:32PM
NanakuliBoss wrote:
Colin Kaepernick over Cam Newton.
on January 6,2014 | 02:37PM
droid wrote:
The Affordable Care Act (ACA) also known as “Obamacare” can be summed up quite simply: Health plan premiums are going to skyrocket for not only the wealthy but also the middle class. This is because the feds and the state need that extra money to pay for the millions of poor and “chronically ill” who will now be insured under ACA.

If that’s not the textbook definition of “redistribution of wealth,” I don’t know what is.
on January 6,2014 | 01:38AM
postmanx wrote:
It's a shame we don't focus on health instead of sick care, which is what it really is.
on January 6,2014 | 07:56AM
hanalei395 wrote:
Obamacare requires that people with health insurance have free physical examinations, i.e. blood tests, pap smears, mammogram screening, prostate examinations, etc., at least once a year.
on January 6,2014 | 12:30PM
mcg68 wrote:
Baloney. Obamacare does require people to have physical examinations, etc. It allows them to have them without copayments if they want them. Please know what you're talking about before you post.
on January 6,2014 | 04:04PM
hanalei395 wrote:
"It allows them to have them without copayments". ...... That's what I said, free physical examinations per Obamacare. In most junk insurance, which are not up to Obamacare standards, free physical exams are also not included
on January 6,2014 | 07:39PM
mcg68 wrote:
I left out the "n't" on "does." It "doesn't" require people to have physical exams. They aren't free. They are included in the cost of insurance.
on January 6,2014 | 08:26PM
hanalei395 wrote:
Obamacare require insurance companies to offer their insurers free physical exams, free in the sense that it is included in the cost of their insurance. Most companies then dropped their junk insurance. In the market place, for people who had their insurance dropped, there are some companies offering physical exams in health plans for about the same cost the people paid for their former junk insurance.
on January 6,2014 | 10:52PM
wiliki wrote:
Baloney.... the public has been already paying for care under ER services. Insurance cuts those services. Hospitals can open out-patient clinics and funnel paying customers to them from ER clinics. As an HMO, they can provide much cheaper service than private physicians.

Also, with the more than 40 million newly insured (who are mostly healthy-- they just don't want to pay for insurace. They'd rather go to ERs and have the rest of us pay for them), there is plenty money available to pay for health care for all. The Democrats have figured out how to provide universal health care. Republicans could never figure it out. It's too hard for their little minds.

on January 6,2014 | 08:21AM
kekelaward wrote:
Luckily for you mental health care is covered under obamacare
on January 6,2014 | 08:37AM
WhyBother wrote:
"The Democrats have figured out how to provide universal health care." Is that by making the healthy, wealthy and responsible pay for the sick, poor and irresponsible?
on January 6,2014 | 11:34AM
wiliki wrote:
As long as Republicans can stop fair tax policies, the wealthy and irresponsible will get away from paying their fair share.
on January 6,2014 | 03:32PM
what wrote:
"Fair share" is bigger for those who create jobs and create wealth in our society, as opposed to those with their hands out.
on January 6,2014 | 05:34PM
Mana07 wrote:
on January 6,2014 | 07:56PM
NanakuliBoss wrote:
Seattle over Saints.
on January 6,2014 | 02:35PM
HonoluluHawaii wrote:
"A few numbers tell the story. Take someone under 65 with no access to health insurance on the job and making $24,000 a year — about what many service jobs pay.

Under the health care law, that person's premiums would be capped below 7 percent of his income, about $130 a month — a stretch on a tight budget, yet doable."

Those are think tank numbers that PhD students throw around in research that has no basis in practical application. Just a pie in the sky theory that is already throwing a thousand monkey wrenches into our nation's Health Care System. One would think that we already learned something from the Housing Crisis led worldwide recession. Looks like if nothing is done, another crisis will occur about five years from now.

on January 6,2014 | 02:54AM
peanutgallery wrote:
Incredible that Americans have tolerated this.
on January 6,2014 | 03:10AM
soundofreason wrote:
Tolerated? Hell, they VOTED for it. Now, let 'em DEAL with it.
on January 6,2014 | 06:49AM
wiliki wrote:
The SA article is biased and not balanced. The reporter knows that Obamacare includes costs control provisions as well as provisions to purchase insurance. I don't see a word on that in his article.

The article also doesn't mention that because of IP differences you can get medication in say Australia for 10 cents that you might pay $20 in the US. I'm thinking Viagra here but I'm sure that it applies to other medication as well. If you can travel to Australia with your US insurance then you might be able to afford the treatment from out of pocket as well.

on January 6,2014 | 08:34AM
what wrote:
Somebody has go to pay for the research and development. Drug may costs pennys to manufacture, but research cost millions. Why does so much drug inventions and innovations occur in the USA? Because we pay for it. The rest of the world benefits. I'm not defending the current model, I feel other countries should pay for the research too. If it costs $20 in the USA and 10 cents in Australia, charge everybody $10 or whatever the fair price is.
on January 6,2014 | 09:52AM
wiliki wrote:
10 cents may be a fair cost in Australia. The drug can easily be manufactured. Of course if we expect them to royalties for our IP then we should be expected to pay royalties for their IP. And we should have the same patent and copy right laws in both countries. OTOH we may want to keep our IP laws which protect patent trolls and can keep copyrights for a hundred years.

Get the picture? If we want them to pay royalties and stop the bootlegging our IP, then we may have to compromise can change our laws match theirs... Also, what they would like to do is to be able to sue the US if it violates international agreements.

on January 6,2014 | 03:24PM
kekelaward wrote:
Biased? They are bending over backward for your messiah, and yet, you want more.
on January 6,2014 | 10:40AM
wiliki wrote:
It would help if the SA had some reporting on the particular issues that Demonstrators along the route were trying to draw attention. The SA just says that there were demonstrators. It doesn't say what they were demonstrating on....
on January 6,2014 | 03:28PM
NanakuliBoss wrote:
45-13 Florida state
on January 6,2014 | 02:34PM
Smiley7 wrote:
My deductible went from $2500 to $9000. The HMSA CEO makes over $1.5 mil and will probably get a raise. Auwe!
on January 6,2014 | 03:48AM
Pacej001 wrote:
You are blaming the wrong person. The apropriate coordinates for you outrage are 38.8977° N, 77.0366° W. I'll give you a clue this location is at the corner of Hope and Change.
on January 6,2014 | 07:18AM
hanalei395 wrote:
I have Kaiser Permanente. What is this "deductible"?
on January 6,2014 | 09:16AM
kekelaward wrote:
It's something that's in HMSA policies, and most other insurance policies.
on January 6,2014 | 10:43AM
Buckykat wrote:
With Kaiser it's more like a co-pay. Which for a "gold" plan for a young male is $300 bucks if he sees an approved specialist, $300 for a CT or MRI, etc. It can add up if there's a chronic condition.
on January 6,2014 | 10:43AM
kailua000 wrote:
and now the middle class that were insured will have to pay higher premiums but cannot afford to go to the doctors because of the high deductibles. I was joking with someone that if a baby is born the parents will have to put the baby on lay away and make payments in full in order to pick it up.
on January 6,2014 | 04:27AM
soundofreason wrote:
Still lovin' your boy?
on January 6,2014 | 06:25AM
soundofreason wrote:
.......Erhorp? You're awfully quiet on this matter today.
on January 6,2014 | 06:27AM
Pacej001 wrote:
Probably just got word of his 2014 health insurance premium/deductivbe.
on January 6,2014 | 07:19AM
kekelaward wrote:
He found out that the connector sent the insurance company totally incorrect info, and that he isn't really covered at all. The good news is that my Nigerian prince friend who sends me email now has all his personal info.
on January 6,2014 | 08:44AM
NanakuliBoss wrote:
Chargers over Broncos
on January 6,2014 | 02:41PM
NanakuliBoss wrote:
Wait,kekela ward is the looney ward at Queens right? Who would even read a loony post?
on January 6,2014 | 02:55PM
NanakuliBoss wrote:
So much misinformation by stupid faceless bloggers.
on January 6,2014 | 02:54PM
Maneki_Neko wrote:
You know how long it takes to get to a $5,000 deductible? One stay at a hospital will do that. Just one short stay. The message for this goat rope of an insurance program is this: make sure you save up enough to cover that deductible and have it ready.
on January 6,2014 | 07:16AM
hanalei395 wrote:
People over 65 and retired, already have Hospital Insurance, Medicare Part A...... For all ages (Kaiser Permanente), patients with the High Option (higher premiums), for room and board, $100 after admission. ... For Standard Option patients, 10% of daily room rate charges. ... After that, for both Option patients .....for all hospital services and supplies, they pay nothing.
on January 6,2014 | 11:24AM
wiliki wrote:
Obamacare not only involves making plans competitive and available to the public with no preconditions, but it is also concerned with controlling costs with best practices. This costs control will also improve services when doctors can focus on a good diagnosis and also have the tools for treatment.
on January 6,2014 | 08:14AM
droid wrote:
Hahaha! Good joke, wiliki. You sound like you’re reading from an Obamacare propaganda brochure. Too bad NONE of what you said turned out to be true in real life.
on January 6,2014 | 08:25AM
wiliki wrote:
Time will tell.... at this point the full program is not rolled out yet.
on January 6,2014 | 03:13PM
kekelaward wrote:
Yes. Many of my male friends are looking forward to seeing the look on our "foot pirates" ( doctors in obamaspeech) faces when we demand the pap smears and mammograms that we are forced to pay for.
on January 6,2014 | 08:48AM
wiliki wrote:
Which will never happen... unless they dress up in drag.
on January 6,2014 | 03:15PM
kekelaward wrote:
Ummm, why did you burying this story in the bowels of the paper? Why not page A3?
on January 6,2014 | 08:39AM
thos wrote:

“For working people making modest wages [the Obama care promise of long-awaited relief now seems likely to go] unfulfilled.”

By forcing millions into Medicaid - - often against their will - - that program is likely to get even more “over-subscribed”.

This lurching expansion of the federal welfare state to capture millions of “new subscribers” who have little or no skin in the game (co-pay) will result in more and more people trying to see fewer and fewer doctors.

Meanwhile the very well off will be able to afford direct pay “concierge” medical care on demand.

In other words the current occupant of the White House - - who has made a career of whining about the division between rich and poor - - will substantially widen that very division with this draconian new welfare program.

What hypocrisy!

on January 6,2014 | 10:03AM
kekelaward wrote:
Well, he is a one percenter.
on January 6,2014 | 10:45AM
NanakuliBoss wrote:
Obama over McCain! Obama over Rmoney.
on January 6,2014 | 02:42PM
hanalei395 wrote:
Dog over Mitt. ... (Mitt going for a 12 hour drive, with Mitt's dog on the car roof).
on January 6,2014 | 04:15PM
RCork wrote:
"Obamacare" is the common name for the ACA endorsed by the President himself. It is not a derisive Republican invention. ER utilization increases with free government care.
on January 6,2014 | 04:50PM
hanalei395 wrote:
It WAS a derisive Republican invention. It WAS SUPPOSE TO BE a derisive term to ridicule Pres. Obama by Republican haters. After Obama said that he likes the term, "because Obama cares", the Repubs no longer said it with a contempt tone of voice. The power to ridicule Obama was pulled out from under them.
on January 6,2014 | 09:14PM
what wrote:
on January 6,2014 | 05:56PM
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