I for one am desperate for an alternative to the high cost and poor coverage issues realized under the Affordable Care Act. We are a self-employed family of 4. We purchased our first individual family health insurance policy in 2010 when we opened our business, crafting a plan with our local BC/BS affiliate that covered all care in our primary provider's office without regard to deductible and minimal co-pay. Other care was subject to a $5K family deductible, which seemed high at the time, but quaint now. We had no maternity care, which we did not want or need, but did have vision coverage and behavioral health coverage. We were on our own for dental. Our premiums were approximately $500/month.
Fast forward 7 years. We now pay $1500/month for a plan with a $15K family deductible, so those numbers have tripled. That means we pay $18K/year and then the first $15K out of pocket, totaling $33K for anything other than the mandatory preventive services, many of which we have no use for. If we paid full price out of pocket for the preventive services we use, it would probably amount to about $500 per family member. So for our $18K premium, we can expect to receive about $2K per year in actual services. I understand that's how insurance works, spreading costs out over pools of participants. But keep in mind that $18K isn't the starting point for our actual insurance coverage. $33K is. That is unsustainable. We pay a larger % of our income for healthcare than anything else. It out-paces the cost of our home, cars, utilities, food, and even college education for 2 children. We earn a relatively high income and can barely afford this. I can't imagine how families with more modest incomes do it.
Besides cost, the other issue that impacts us is that so many insurers have pulled out of the individual market in our state. When we purchased our first policy in 2010, there were a number of companies from which to choose, and several different plans offered by each company. We had a wide range of choices for cost and benefits. We are now down to 2 companies offering individual plans here, and none include out of area care, other than life-threatening emergencies. Both our children are in college. One attends about 2-1/2 hours from the city where we live, and must travel home for any healthcare service to be covered. Her college is very small, does not have a student health center, so if she has a minor illness such as strep, she either has to drive 150 miles home to have her visit counted toward our deductible, or pay fully out of pocket to go to a local urgent care or doctor in her college town. Our younger child attends college 1/2 way across the country, so we had no choice but to purchase a separate college-based policy for her, with additional premiums of about $200/month. But at least she doesn't have to fly home to get her strep throat checked.
I firmly believe that unless/until the primary responsibility for payment rests with the individual consumer, costs will never be reigned in. A plan to reduce costs must include personal responsibility for payment, coupled with the ability to purchase insurance across state lines, the ability to purchase coverage that meets ones needs and budget, not a pre-determined set of benefits, transparent pricing and reporting of outcomes, negotiation between consumer and provider, and the establishment of pre-tax/tax free personal healthcare savings accounts.
I understand that low-income individuals will require subsidies, and welcome that approach, but EVERYONE must pay his/her own bills from his/her own (potentially subsidized) account, removing the perception that healthcare doesn't cost much because other people are paying for it.