Louisville Medicine Volume 65, Issue 8 - Page 30

OPINION DOCTORS Lounge (continued from page 27) 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. STAY Connected 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 McKenna.Byerley@glms.org for more information @LouMedSociety linkedin.com/groups/Greater-Louisville-Medical-Society 28 LOUISVILLE MEDICINE