OPINION
DOCTORS Lounge
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ACA plans will raise their prices and reduce
their covered benefits. Over time, as the so-
called tax cuts for individuals expire, people
making less than $75,000 a year would stop
buying health insurance entirely, according
to the Congressional Joint Committee on
Taxation. Up to 13 million Americans are
expected to fall into this group.
Even if they keep some plan, the deduct-
ibles are usually set so high that the person’s
out-of-pocket spending reaches thousands
of dollars. The Kaiser Foundation estimates
that even with employer based-insurance,
the average out-of-pocket expenses for an
individual have gone up by more than 50
percent since 2010 (whereas, their pay has
not). Historically, hospital bills, in aggregate,
were paid by the insurer to the tune of 90
percent (less all those carefully negotiated
in-network discounts). The patient owed
the other 10 percent. Nowadays, with high
cash expenses to the patient, some consul-
tants expect a full third of the hospital bill
to be borne by the patient. This translates
far too often as to “bad debt” for hospital
administrators.
We all know what happens when people
need medical care but cannot pay for it. We
do without for as long as possible, then we
go to the ER, the most expensive place to
be, where by federal law we must get seen.
We get a real or theoretical Band-Aid for
complex chronic medical problems, and go
home, only to return, even worse, some time
later. We get admitted to the ICU and have
$200,000 worth of various tests, surgeries
and crises. If we live through it, then fail
to pay, then we file for bankruptcy and the
hospitals lose even more money. Accord-
ing to the Consumer Financial Protection
Bureau, medical debt is the likeliest debt to
set the creditors’ dogs upon you.
Working Americans have had “good”
insurance with low deductibles for so many
years that living with high-deductible plans
(which will soon be the only kind, per the
Kaiser Foundation) has come as a shock.
What makes it unbearable is that hardly any-
one knows what anything will cost, up front.
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Health Savings Accounts (money from each
paycheck set aside for health costs, pre-tax)
can cushion the blow. But many people who
are unemployed or retired have no savings
set aside for health care. They have depend-
ed on the insured patients to pay enough of
the hospitals’ bills that the hospital is still
there to serve everyone.
I cannot say that our current Congres-
sional leaders have shown me that they serve
anyone but themselves. As I write, the final
form of the tax act is unknown. I can say
with certainty however, that with the law’s
changes as noted above, access to medical
care and payment for such care will both
take big hits.
“Reforming” Medicare and Medicaid are
next on the legislative agenda, according
to the White House: what evil lurks in the
hearts of men, only the Shadow knows.
Dr. Barry practices Internal Medicine with
Norton Community Medical Associates-Bar-
ret. She is a clinical associate professor at the
University of Louisville School of Medicine,
Department of Medicine.
facebook.com/Greater-Louisville-Medical-Society
with GLMS between publications
www.glms.org
@LouMedSociety
Contact [email protected] for
more information
@LouMedSociety
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LOUISVILLE MEDICINE