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Obamacare Dilemma:
High Deductibles vs. “Huge Fear”

| December 26, 2013

Deductible anxiety. (Jeremy Wilburn)

Deductible anxiety. (Jeremy Wilburn)

With the highest rate of uninsured people in the country, it’s not that hard to find someone like Tammy Boudreaux in Texas.

Boudreaux, 43, lives just outside of Houston and works as a psychiatric social worker on a freelance basis, with no benefits.

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This year Boudreaux estimates she spent about $1,500 on medical care, including a trip to the ER for a cut finger. She also takes a few prescription medications and occasionally sees a psychiatrist and a nutritionist. [Florida, with the second-highest rate of uninsured Americans, is replete with stories similar to Boudreaux’s.]

She can’t get insurance through her partner, because her partner’s employer doesn’t offer benefits to same-sex couples.

And, Boudreaux has been skipping mammograms and other check-ups for a few years. “It’s worrisome,” she says. “It’s like gambling. Gambling with my health, and it is very frustrating.”

Boudreaux was hoping to find a better deal on Boudreaux has logged on, looked at the plans, and so far, remains largely unimpressed.

She likes the monthly premiums that she sees but balks at the annual deductibles.

“Let’s say if I paid the $178 a month, my deductible would be $5,000,” she says. “I would have to pay up to $5,000 before I received any kind of payment from my insurance company.”

As a comparison, the average deductible for single coverage in employer sponsored insurance is about $1,135, according to the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)

Boudreaux could get a lower deductible if she paid a higher premium, but about $200 a month is all she feels she can afford. She doesn’t qualify for subsidies to help pay for a policy, either.

“I don’t smoke, I’m relatively healthy, so I was pretty insulted when I saw this [price],” she says. “I was extremely angry actually. I felt hoodwinked by the insurance companies: ‘Oh here’s this wonderful insurance plan but by the way you need to come up with $6,000 out-of-pocket first before we pay for anything.'”

That reaction is typical, says Caroline Pearson, an analyst and expert on the new health insurance marketplaces for the consulting firm Avalere Health.

“A lot of people aren’t ever going to get out of that deductible,” says Pearson. “Only if you have a catastrophic health event or you’re really chronically ill will you ever hit your out-of-pocket cap. People are left, I think, feeling like ‘I spent a lot of money this year on premium and I didn’t get any meaningful coverage from my insurance.'”

But Pearson says people forget two things if they just focus on the high deductible. One is that the new plans must offer some free preventive services, like mammograms and yearly physicals. The other is that having a plan protects you from medical bankruptcy if you get in an accident or face something like a cancer diagnosis.

That’s because Affordable Care Act requires that health plans have a yearly limit on out-of-pocket expenses.  If something did happen to Boudreaux, she wouldn’t pay more than $6,350 in the year.

Not As Generous As Workplace Coverage

Nevertheless, Pearson points out that the plans sold on the exchange are not as generous as employer-sponsored insurance. The plans have a range of deductibles, depending on which level — bronze, silver, gold or platinum – the consumer picks.

“We think most people are going to be enrolled either in silver or bronze plans, which will cover 60 to 70 percent of a person’s health care costs, and a typical employer plan covers 80,” Peason says. “So when the law was passed, by definition we knew these plans would be less generous than employer coverage. And that has definitely played out.”

Boudreaux has been managing her health needs without insurance for several years. For her depression, her doctor prescribes her double doses of her psychiatric medicines, which she then cuts in half, and because the meds are generic they only cost her about $40 per year.

But Boudreaux has considered the possibility that something catastrophic can happen.

“That is a huge fear. What if …” she says.

If nothing unexpected happens, she thinks she’d pay less just continuing to go along on her own. And she could put the $200 that would go to the monthly premium into a savings account.

In any case, Boudreaux doesn’t feel any urgency to sign up right away. She’s been uninsured for a few years, so what’s a month or two more?

With the holidays coming up, this is one difficult and confusing decision she’d rather just avoid for now.

“Whoa, shut the computer. Find something else to do. There’s something much better I could be doing with my time than trying to figure out this rigmarole of insurance policies and deductibles and what’s covered and what’s preventative and what’s included and blah blah blah,” she says. “It’s not very well explained.”

If Boudreaux does not enroll in a plan by the end of March, her tax penalty would probably be a few hundred dollars – for the first year. The penalty starts out at $95 or 1 percent of income in 2014 and rises in later years.

–Carrie Feibel, KUHF

This story is part of a collaboration that includes KUHFNPR and Kaiser Health News.

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29 Responses for “Obamacare Dilemma:
High Deductibles vs. “Huge Fear””

  1. ohmy says:

    Got as far as the part time Psychiatric social worker who is gay and needs psychiatric treatment herself.

    Our problem is simple: Instead of working on a way to provide health care for the folks that didn’t have it we went and changed everybody’s and most likely will end up with more uninsured.

    That’s what happens when your plans come from a “think tank” like Harvard instead of coming from folks that know what’s going on.

    This is not about healthcare–it’s about redistribution of money–take from the people that work and give it to many who prefer not to!

    • rhwier says:

      “Psychiatric social worker” I was married to one with a Ph D for many years and came to know the profession. Far too many of those mental health professionals are far wackier than those who they claim to be treating.

  2. Anonymous says:

    That being said, high deductibes are nothing new, especially for those with serious pre-existing conditions. At least, people in this situation can GET health insurance now, which many could not before. As for “rolling the dice”, this is exactly what Republicans and the health insurance, pharmaceutical and medical lobbies demanded–and THEN continued to insist was too much, too little, not fair…Let’s face it, NOTHING was going to be “just right’ for THESE bears. And, if we continue to drag our feet where healthcare reform is concerned, it will most certainly be too late! Ms. Bodreaux and others like her, especially younger healthy Americans who decide to take a pass on ACA sponsored plans and incur “lesser” penalties for remaining uninsured, won’t end up being very comfortable with that decision if they happen to end up in a hospital or become the victim of an unforeseen serious accident or health-related event. And THAT will continue to be an irresponsible decision we will ALL end up paying for in the end. We ALL have a responsibility in this fight and sacrifices will certainly be required of many of us. The pay off is that our healthcare system will survive, instead of continuing its ever-accelerating slide into complete ruin.

  3. Geezer says:

    The healthcare system must collapse before someone fixes it.
    Worry not – collapse beckons!

  4. rickg says:

    Great piece… sounds like an excellent argument for a single payer health system. When coupled with the way our Governor and Legislature manages Medicaid why not give single payer a chance?

  5. JL says:

    The Obamacare was not the savior people thought it would be. Most still can’t afford the premiums and/or deductibles. And why make all insurance policies cover maternity? It makes no sense. But to those people who are gambling they will stay healthy til they’re old, think again. I was diagnosed with kidney cancer at the age of 43. I don’t know what I would have done without my insurance. But I paid for my own health insurance long before Obamacare came out.

    • grb says:

      And before Obamacare, your insurance was free to drop you for the sin of getting cancer, AND you would be branded with the dreaded “pre-existing condition” that would assure you would never have health insurance again….yeah, that was a great system.

  6. Nancy N. says:

    I’ve been uninsured for the past two years due to being self-employed and having a pre-existing condition (lupus) that meant I could not buy insurance privately. I’ve been skipping needed maintenance exams and tests, due to the expense. One single blood test that my doctor wants me to have every few months costs $250! Plus the cost of doctor visits and the more than $100/month I pay just for the 6 generic prescriptions I take every day.

    Even if you are healthy, you never know when catastrophe will strike. My 10 year old daughter was struck with arthritis 2.5 years ago. Two months ago I fell hard and am still having problems with my knee as a result. I know it should be looked at but can’t afford a doctor’s visit, an MRI, and heaven only knows what else in treatment once they figure out what is wrong. You just don’t know when today will be your day.

    Thanks to the ACA, I will finally have insurance again on January 1st. What a relief that will be, a major worry off of my mind – and a major benefit to my health. I can finally start taking good care of myself again.

  7. Yellowstone says:

    Wow! We continue with the negativity. Why can’t all of us get together and solve this problem; whereas 15-million plus people have no insurance AND no other choice but to go to the emergency room – then we still pay all their costs.

    This may be one small step – but in the right direction.

    Those of you who have a job, still can pay mortgage payments and were able to keep your home and family – tough up.

    Stop the whining – YOU MAY BE NEXT to fall in the deep abyss.

  8. karma says:

    I keep seeing the single payer option being posted. Please explain how over 313.9 million people will get covered. Do you really think Americans will pay$6.00 or $7.00 for a gallon of gas?The average commute in the U.S is 32 miles a day. Will they pay more taxes on everything while their disposable income decrease? What about the cost of the baby boom generation that’s just starting now?
    Look what it costs in Canada with population of 34 million or England with a population of 53 million in taxes alone. How will the poor pay these high taxes? Is this not the lefts argument made about a flat tax or a fair tax?

  9. Silence DoGood says:

    A look at the cost structure of the ACA, for those who are interested. Good luck.

  10. Ruben says:

    No need to worry, if you don’t have enough to pay your Med bills on a high deductible $5 to $10’a month to the insurance company for life should be acceptable right? I think insurance companies will make collection agencies flourish. I bet if you talk to some who works for a collection agency they will tell you Hospitals and medical facilities are their biggest customers. $5 or 10 should cover your deductible bills for life. Then you will see change. when every poor soul in debt starts paying their med bills this way.

  11. Paul Anderson says:

    You will have to declare bankruptcy to get around the incredibly high obamma deductibles. This is a huge scam or socialist redistribution. It has nothing to do with democrat liars wanting to bring better healthcare to the people.

    This is really the obamadon’tcare scam.

  12. eileen says:

    I think that we really need to look at how much the hospital bills, x ray bills and medical tests cost. A colonoscopy is about $3,000.00 if done in the hospital. How much is a C section? When you have your appendix out? is the insurance company going to pay ALL of it? That is just not reality. i know lots of people that work JUST for benefits. They have not choice

  13. Billybob says:

    I am viewing my policy simply as a catastrophic policy. Because it really doesn’t accomplish anything else. I am healthy and all the things I actually need (quarterly family doctor visits, eye care, dental care, and prescription drug discounts) are not included (before the deductible has been reached). So I’m basically STILL self paying for health care just like I always was. Only now I have a government mandated high deductible policy that I will hopefully never need or use.

    In just 15 minutes of comparing policies you can see that all the policies are geared towards extended stay / expensive care with either high premiums or a high deductible. None of the plans are at all useful to the average person or family unless they are seriously ill or very accident prone.

    As far as calling it “Affordable Health Care”, well that is just absurd.

  14. m&m says:

    Since Obama was elected he had a goal in mind and that was to destroy this country.. This Obamacare is just another step in his process.. The people better wise up AND SOON!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

  15. Sickens me says:

    This is a no brainer..

    Face it folks, Obama is turning this “FREEDOM” country into a DICTATORSHIP country..

    I have a hard time just paying the regular bills that come in let alone the high grocery costs..Now they FORCE you into yet another bill you can’t afford… Sad….

  16. dlf says:

    Nothing in life is free, I don’t care what Obama tells you. Someone will pay, in this case it will be the younger generation who will pay for the older generation, PERIOD.

  17. confidential says:

    My child over 40 years old, after many years of being uninsured and paying of own or with my help when needed medical or annual test, got into ACA aka Obamacare and pays $178/month that includes dental plus and $9 rider insurance extra a month, to cover the deductible of $5,000 when needed. The deductible is only when hospitalization is needed, annual test and doctors visits for colds and minor issues are free.This sure beats the uncertainty of not having for years major medical and annual exams health Insurance, working as an independent contractor.
    There still will be people out there that will think this is too expensive and a waste of money, even will choose to pay the penalty for not getting insurance and as a bargain, given their lack of responsibility. They think their good health being young is not worth to spend their $$ on ACA and save them instead for few packs of beers. When they end up in the ER, then we all pay for them as sooner or later we are all exposed to major medical attention. I am glad that I convinced my child to enroll on ACA and have peace of mind now. Call Jason in Blue Cross and Blue Shield Florida and read the plans before so much wondering. The other states can’t be so much different.

    • barbie says:

      As long as the ACA exists, make sure you use it to its fullest potential. The first thing that means is that you do not–DO NOT–want to go directly to the insurance companies for info. They’ll sell you a plan that might even be named EXACTLY as what the Exchange has listed–but you’ll pay more for it and you will not get any subsidies from ACA. Use the website. It is working now, and working just fine.

  18. rhwier says:

    Our health insurance situation has gone from we could afford it and actually used it and took care of our health to, we no longer go to the doctor because we can’t afford it. I go once a year for my annual checkup and prescription refills. I have let my doctor know, I cannot afford to take care of anything but the annual exam, which they never bill as an annual exam and instead upcode it, and dire, life and death emergencies. I was a life long loyal democrat for 44 years. I am now an independent and will vote for anyone who will end Obamacare and turn back the clock. This man’s presidency has been an unmitigated disaster. I voted for him, twice!

  19. barbie says:

    Oh dear Gawd, all the whining about Obammy. I suppose all of you like things just the way they are now, right? News flash: something had to change. Unfortunately, this was not the way to go.

    And by the way, if this President was a REAL Socialist Dictator, he would have expanded Medicare to all and to heck with the Insurance Companies and what they want. He would have cast them aside altogether and imposed a system similar to the United Kingdom. So if you’re going to point fingers at the man and whine endlessly about his eeeeevildoings, at least get the name of the evils correct. The evil here is the fact that he didn’t use his Amazing Powers to remove the REAL Death Panels–health insurers–from the equation. Idiocy.

    The sad part is that this system has been doomed to failure by misinformation and stupidity. And in the end, NOTHING WILL CHANGE. Death Panel Murder By Spreadsheet Insurance Practices will continue unabated, and Americans will continue to die needlessly. This is disgusting and shameful in the greatest country of the world.

  20. Rob says:

    Before the ACA I could not purchase insurance for me and my wife, and I had a six figure income.
    Doctor’s office even told me sorry we don’t take self pay.
    So we went to either the local walk in pay clinic or the Rick Scott clinics, which were quite good.

    The cost is the cost and the only way to reduce it is to work for a large company. However I work for a so called large company and pay 100% of health care costs and it is not much cheaper than the exchange.

    So those who are complaining about the cost of insurance rising I ask who did they blame when it continued to rise pre ACA?

    Also, everyone here in Florida can thank their state legislatures for not accepting gov funds to assist those who are poor with health care costs.

    Its funny, not really though, how those with health care look for all kinds of rationale to deny others that which they enjoy.

  21. I/M/O says:

    Why doesn’t Boudreaux and her partner move to a state that allows same sex marriage or domestic partners being covered by an employer.

    New York has all that.

    Why stay in Texas?

  22. I/M/O says:

    Look for the democrats to demand changes in the AHCA after the 1st of the year.

    No way the democrats go into the 2014 elections without changing ObamaCare.

    If it looks like Obama will not relent and threatens to veto changes then look to the Court to nullify ObamaCare before the 2014 elections.

    Obama is a simply a “Figurehead”. He is not running the show. He does as he is told. The Banks and Wall Street are running the show. No not Bernanke, Geithner or Yellen. They are simply the “Front Men” for the real major players.

    I don’t see Wall Street Puppeteers allowing the democrats to go down in flames in 2014.

    They want gridlock.

    They need gridlock.

    Obama will trade changes in ObamaCare for partial Amnesty. Then they all look good in 2014 and have something to run on.

  23. Ogrethetop says:

    if you get in trouble in the us ,You have the right to a lawyer, if you cant afford one, one will be retained for you. If you get sick in the US and can’t afford it then your screw\es, we won’t help a bit. why are criminals getting treated better then the sick?

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