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No Remedy Yet

“Obamacare” has left the insurance companies in charge of health care.


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Six years ago, here in Montana, I visited a small medical clinic when one side of my face quit working. I thought I might have had a stroke, and the doctor thought I actually did have a stroke. I was taken to the hospital and proceeded to run up quite the medical bill as thousands of dollars' worth of tests were performed.

While whether or not I had suffered a stroke was being determined, I followed doctors' orders and went along with recommendations for an MRI and spinal tap, among other costly procedures. After being released with a minor case of Ramsay Hunt Syndrome (similar to Bell's Palsy except faster healing), I returned to work and to life.

Within a few months, the final bill came, and the insurance company I had been paying for more than a decade let me know they would not be covering the incident and the trip to the emergency room, because it was not "an emergency."  No matter that the entire process started when the doctors were convinced I was in an emergency situation. As anyone who has battled an insurance company without access to expensive legal assistance knows, further resistance was futile.

Some $7,000 in medical debt later, with a new and hopefully more compassionate insurance provider, I still have little trust in the health insurance system, reformed or not.   

Providing health insurance for employees has never been cheap, but for the past five years, the Livingston Current newspaper I publish has offered such insurance to employees after their first 90 days. For a business with fewer than five employees, the premium rates are steep, but employees are healthier and have access to preventative care. They may also avoid crippling debt if they face major medical expenses.

Our company followed the "Obamacare" health-reform debate of the past year and hoped to see benefits for many of the low-income workers our business and others in the community employ, but alas, those benefits now come with higher costs for health-insurance premiums. Our insurance provider has raised our company's rates, effective in June, some 13 percent. 

Not everything provided by Obamacare is bad. The reforms implemented across the country in March 2010 included a new focus on preventative care — generally requiring all new health-care plans to cover services such as mammograms or colonoscopies without charging a deductible or co-pay. The reforms also extend the age limit for coverage for young adults who are on their parents' insurance, remove some restrictions for preexisting conditions, and establish an externally reviewed claims and appeals process.

New tax credits, enacted March 23rd for an estimated four million small firms across the country, are promised. Many of these businesses, which are barely breaking even or in the red, will be unaffected by this benefit; many others may see progress over several years. But in the meantime, employers like me will be required to find an extra 13 percent for premiums. Payable immediately. This is reform?

Running a small business anywhere in America right now is a financial challenge, regardless of the rising costs of basic health coverage for employees. Add a basic health-insurance premium to the costs of employment and the total amount paid to employ a worker begins to rival an actual salary.

New reforms promise tax credits and decreased employer financial responsibility for health premiums. Employers will only be required to cover 50 percent of premiums, whereas previously the responsibility was 60 percent. But passing the cost on to the employee seems less than fair considering the take-home pay employees receive is already taxed and levied heavily.

No reform can be considered permanent, and the insurance industry will certainly continue to bob and weave as far as absorbing any real cost or allowing the enacting of any true reform. All we citizens can do — employees and business owners alike — is continue to let state and federal representatives know this is not reform; it is business as usual. 

Within the fine print of the health-care reform law lie the same loopholes which allow the insurance industry to determine the rules and definitions of individual health-care coverage. If the loopholes cannot be exploited, premium costs will simply rise. What can we do? Not much, except pay the increased premiums and play by industry rules and hope real health-care reform will come in the future. Above all else, we can hope we don't get sick.

A native Memphian, Reilly Neill is editor/publisher of the Livingston Current, a Montana newspaper she founded in 2005.


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