Tuesday, October 8, 2013

Why the ACA Isn't As Unpopular As Some Would Like

In February, I purchased a high-deductible, individual policy for myself and my two dependent children, since the family coverage provided by my husband’s company would literally cost us his entire paycheck. Our high-deductible plan cost $447.73 monthly, and I was glad to get it.

Last week, I used the insurance for the first time. Thomas, my youngest son, was due (okay a tiny bit overdue) for his annual physical, and I was concerned that he’d failed a recent hearing exam at school. Another concern is that he’s been blinking more frequently, as though his eyes are dry or irritated.

The entire office visit took approximately 90 minutes, which wasn’t terrible but wasn’t great either, seeing as most of our time was spent with the medical assistant, a medical student, and Thomas and I staring at each other waiting for the doctor. We’ve been coming to this hospital for more than 20 years, since my oldest son was an infant, so we know these folks and consider ourselves satisfied customers.

The doctor examined my son, and afterwards I told the doctor my concerns. Thankfully, my son’s hearing test was fine, but since the inside of his ear looked a little “dull,” the doctor prescribed an antibiotic and for his eyes, eye drops.

So, I go to the Target pharmacy near the hospital and drop off the prescriptions. When I go to pick them up, I remember that my HD plan will require me to pay for the prescriptions in full, and I wonder what the medicines are going to cost. I’m not terribly worried, because the last time I had to purchase an antibiotic for someone’s ear troubles it was all of $10, and how much could eye drops cost?

My bill was $154.20.

The way this is supposed to work, plan holders pay a discounted rate (the rate negotiated by the insurance provider and the prescription provider) so that even if I’m paying out of pocket, I’m paying less than would someone with no insurance at all. And indeed, my receipt lists the “retail” value of these prescriptions as $227.98.


Cue to the part where I ask the clerk, “Excuse me? Could you repeat that? Could I see those receipts?”

But, because the medicines were for my son, and because I had no idea whether Target’s price was above market, at market, or below market, and because I had funds in a health savings account (HSA) I paid what I was told to pay.

(When Thomas heard the price he said, “What?! How big is the bottle?” It’s 2.5 mL, that’s how big.)

As for the antibiotic, it turns out not to be the pink, thick liquid I’m used to, but a powder that needs to be mixed with water to activate. (Seriously?? $25.75 and I have to mix this myself?)

Here’s my point, and I’m making it because I truly believe that those who oppose Obamacare just don’t understand.

Something in our healthcare system has to change, and ordinary working people know this very well.

And in my rational mind, I know that the ACA is, at the moment, creating as many problems as it is resolving.

But in my emotional mind, I’m simply tired of all the out-of-control costs associated with healthcare. (And don’t think I’m not aware for a second that my situation could be a lot worse. A lot worse.)

Ridiculously high premiums, doctors with too many patients, ineffective means to comparison shop goods and services, and expensive prescriptions that may or may not be effective (did I mix it correctly? Let’s hope so) are just the tip of the iceberg.

Something has to give. Someone has to do something.

So while the ACA is far from perfect, at least it’s a start. And we need a start.


  1. Crystal...I couldn't agree more! I've said this before...the ACA isn't perfect, but for a lot of Americans like myself it helps, a reader challenged me to "go get a quote on the healthinsurance.gov website. Let me know if it's something you can afford monthly, can you afford the deductible?" - I wrote: thanks for your comment, I went ahead and took your challenge and here's the breakdown: - my monthly savings on the premium was close to $150 for just my wife and I, and closer to $300 if I added my children. - The coinsurance was roughly the same with only a 3% variation if I used an in network provider, but the silver plan covered more than 27% more when compared to my employer coverage for out of network providers. - The out-of-pocket maximum for the silver plan was $1500 less than what my current out-of-pocket maximum is.
    This was information that I was able to compare with a quick overview. So currently, I think for many Americans like myself, I have another option that may help me save money for mine and my family's health coverage. --- Like you said Crystal, it's not the perfect start, but it's a start.


    1. Ernie, wow, thanks for all the good info! (By the way folks, if you want to know anything about how the ACA works, visit Ernie's blog http://ernieshrproject.com/, he's broken it down like nobody's business)!

    2. Haha...thanks for the shout out Crystal!

  2. You say that's a high price for the prescriptions, but do you have any knowledge of what the costs actually are? "They're just eye drops" is the pretty much the same as saying an iPhone is just a plastic and metal box, with a tiny bit of glass, and it's hundreds of dollars! I understand that it sounds wonderful to have free or cheap healthcare, but hospitals and pharmaceutical companies have to make a profit (on top of their already enormous costs), or why would they even exist? To lose money for people?

    1. Hey Anon. I get your point, and I'm aware that a lot of R&D as well as other overhead goes into the cost of prescriptions (although one study http://www.huffingtonpost.com/2012/08/09/pharmaceutical-companies-marketing_n_1760380.html claims the industry spends far more on advertising than anything else).

      In any case, come on. Are you telling me that if you went to your family doctor complaining of dry eyes, and the doctor, without doing any type of thorough examination or making a diagnosis, said, "OK, I'll prescribe some eye drops" you'd expect to pay $130 at the drug counter?? I don't believe it.

      Now, perhaps I should have said, "Hey doc, if you haven't seen anything fishy maybe we should start with Visine?" But I didn't. My mistake.

  3. Unfortunately, all the ACA has managed to accomplish is to raise insurance premiums! Our company has had to make changes to our plans because of what additional mandates and taxes do to premiums - they INCREASE them! A process had begun to correct the outrageous costs - it's called CONSUMERISM, but it was just beginning. Until people actually realize just what medical care costs and then MAKE RESPONSIBLE CHOICES to help reduce their need for services, we are only going to see costs continue to rise!

    1. Hi Lydia.

      I've led the consumerism movement at my places of employment and am generally a fan. However, it's not that simple, because comparative information is not easy to find and consumers aren't easily made into informed advocates. Choosing a surgical center is not like choosing a refrigerator--where you can Google prices and have the freedom to buy from just about anywhere. I think better information, better technological tools, and assistance from expert advocates is the way to go, but pharmaceutical and medical device companies will continue to push their products, doctors and hospitals will continue to charge all kinds of money, and insurance companies will continue to want to make huge profits even as they waste resources. (If you've dealt with insurance companies, as I assume you have, you know that I mean.)

  4. Like in many situations, the issue here is communication. Why not ask the pharmacist BEFORE buying what the cost is and ask for a generic version or have them call the doctor for an alternative rx. You could also look at goodrx.com to compare prices of drugs.

    1. Hi Anon. I agree that as consumers we have to become better informed, but I don't think that's the entire issue. I'm no doctor, and I don't want to be one. When the doctor says here's the prescription, I'm thinking it's the best thing for me. What you're suggesting (and I don't necessarily disagree) is that more of a discussion about finances, of all things, must be had at this time. That's a big cultural shift that'll take time to effect.