ACA: So Much for Keeping Your Doctor


It’s new enrollment season for ACA (Affordable Care Act). It’s time to buy new insurance or switch your insurance or make any type of changes to your insurance. It’s also the time when people hope, with baited breath, nothing changes from the previous year.

I’ve just purchased health insurance off the Exchange for my two children at the rate of $360 per month for both of them. It’s a decent PPO plan with a reasonable deductible, with pretty comprehensive coverage. I could have qualified for federal subsidies, but I chose to forego that and claim my deductions at the end of this year rather than upfront so that I don’t run into problems of certain doctors or providers not accepting my children’s on Exchange insurance. My son at the moment is under the care of several specialists on top his usual pediatrician, I need him to be as well covered as I can afford.

The first shock to my system this year is my pediatrician announced that she is no longer taking individual plans on or off Exchange. She’s only accepting group policies as her in-network. So, this makes my carefully curated and selected insurance policy useless. I am now out-of-network despite my PPO plan. For a simple check up and a vaccination for my two children cost me $757 out of pocket, the billing department from my doctor’s office will submit it to my insurance for out-of-network reimbursement and anything they receive they will refund to me or keep as as ‘credit’ at their office for us to use next time. However, unless a miracle happens, I have to meet my deductible before I get any coverage and/or reimbursement, and I haven’t met my deductible yet. Which then begs the question, what the hell did I get for $360 a month PPO plan that is NOT on the Exchange.

One of the hallmarks or the selling points of Obamacare is 1) It will cost less 2) We can keep our doctor or choose any doctor we like 3) Easy and simple to access. None of those are true. It doesn’t cost less and it won’t cost less in the long run as long as privately held insurance companies are allowed to opt out of the Market Exchange. The Obamacare price model was predicated on insurance companies large and small pooling their resources to form one huge group to offer discounted insurance rates and better comprehensive coverage to patients. This model would work in theory, provided if insurance companies can’t willy nilly opt out when the profits don’t go their way. So far in California, a supposed ‘success’ story of Obamacare; UnitedHealthCare, Aetna and Humana all have opted out of the Market Exchange due to ‘infeasibility’ or translation: not making enough money off of sick people. These also happen to be the three best companies in terms of coverage. And they do not offer individual plans to consumers, they only offer big group plans to employers. Another woman with two small children at the doctor’s office the same time I was covered under the NHL Player’s plan offered by Aetna. Her plan was accepted without a problem. So we are back at where we started, people who are lucky enough to be employed with companies that offer health insurance benefits and are covered under a big group policy get the best access to health care. Everyone else sort of languish between not being able to choose or afford the best care they can get or worse, going on state funded insurance, which can be yanked away by President Elect Donald Trump after January 20th, 2017.

We ‘can’ keep our doctor, provided we pay out of pocket for them. My son who has some immediate health issues he needs to address, all the extras will just have to come out of our pockets. I can’t imagine the stress and anguish of parents with children who have special needs, to have to navigate this income and class driven health care must be disheartening. The whole health care industry is a massive collusion between health insurance companies, big Pharma and state governments who serves as a conduit to allocate those services and resources. State agencies and corporate boards get to decide how medications and health services are allocated, not the actual health care providers. This is a deliberately created scarcity so that health insurance companies and big Pharma with the help and collusion of the government can reap big profits at the expense of sick patients. This is why Universal Healthcare needs to happen and it can’t happen soon enough. The ACA was again, typical of Obama, the slimy fence sitter who wants look like the good guy fulfilling the promise he made to his voters but then not wanting to piss off his corporate donors at the same time. He dangled the Single Payer plan for ten minutes to make it look like this was his original goal but due to ‘factors beyond his control’, he’s unable to implement that. It’s nonsense. We do have a single payer system, for people over 65, it’s called Medicare and guess what, its satisfaction rate from both users and providers consistently rate at 90%, so it works. But the only reason why Medicare lasted this long is because its users are the older white demographic, folks who actually bother to drag themselves to the voting booth for every election, local or national. Politicians know this so they can’t aggressively gut the program yet. But with this new administration along with the shifting demographics from a white majority to a more diverse one in forty years or less, soulless conservatives such as Paul Ryan is looking to turn Medicare into a ‘voucher program’, aka, privatization, aka gutting it, which means the poorest, most vulnerable elderly people will die of diseases which can be easily treated or managed, and worse, die in deplorable undignified conditions. And in light of this, the media is focused on Trump and his alleged prostitutes. Maybe its their goal, so we are so distracted we don’t realize what’s happening to our most prized social services.

8 thoughts on “ACA: So Much for Keeping Your Doctor

    1. LOL – to be fair, our doctor was excellent, it was a 2 hour visit. It was a full comprehensive check up for kids (much more than turn around a cough). She saw my son’s throat to be very red, immediately did a throat culture (which of course I paid for) to make sure it wasn’t strep throat (his health is not the best right now, he can’t get sick…his heart issues, blood count etc etc). And I emphasize, it’s not the doctor’s fault this has happened, in fact, they warned this might happen. Some doctors go along to get along, i.e. do shoddy care, mine won’t; even if I have to pay for it. I won’t write a check for that amount if I wasn’t confident in her care… 🙂


    2. And by ‘simple’ I mean, it’s a routine wellness exam that kids need, not a sick visit. To clarify. To bring your kid with cold/flu to doctor is whole other thing…


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