There are aspects of the affordable care act that I appreciate (mandatory coverage for example). However, with so many different options - insurers have the ability to funnel us high users toward policies that group risk together - so we end up paying higher premiums, deductibles, and co-insurance. HSA type policies remain for individuals who have minimal need for health insurance, so they get bundled into lower premium, high deductible policies - but it doesn't cost them as much since they don't use it.
The thing that has always troubled me is that nobody is willing to address the astronomical increases in cost. Shuffling who bears the brunt of the cost between individuals and insurers is a never ending battle that does nothing to stem the exponential increases in charges.
ICD10 is something in the U.S. that has had a bigger impact on what we pay. As for a first hand experience that illustrates the issues I have been seeing. A specialist is seen annually for a condition that exists. In one year, the specialist bills a fixed amount for the visit, the insurance company reimburses the specialist based on an "agreed" charge, this is less than what was billed by the specialist. Because the patient has said insurance, the patient is only responsible for the agreed copayment (a modest fixed amount). The specialist adjusts revenue accordingly (they will never receive the difference between the "billed" amount and the "allowed" amount).
The next year - same visit, same procedures. This time, the specialist bills separately for five different things done for the appointment. The "visit" (representing only one of the five charges) is much less expensive, but the copay is double due to changes in coverage. Since the "copay" is only applicable to the "visit", the patient is now separately responsible to pay for the four other things done to prep (review two tests two different ways, essentially). So this year, the specialists total bill increased 20% and the "allowed" amount increased 20%. However, the patients share increased over 800% and the amount insurance had to pay decreased over 70%.
Meanwhile, premiums all went up.
The amount of cash we're are shelling out is increasing dramatically, while officially the healthcare "costs" only increased 20%. And, of course, from a gov't perspective, we are "insured" - so YAY!! We comply with the requirements of Obamacare (but isn't the word "Affordable" in the title of the actual act?)
