Living in Society Social Commentary

Blogging the ACA

Garden Planning
Garden Planning

When I had my first colonoscopy there was no President Obama, no Patient Protection and Affordable Care Act, I hadn’t begun blogging, and I was on my employer’s health insurance plan.

The company I worked for would have liked nothing better than to present a cash payment to employees in lieu of paying their 65 percent share of health insurance. However, people they asked wouldn’t go for it.

My second procedure is scheduled Friday and I’m curious to see how it will be paid for by the health insurance plan purchased through the ACA marketplace for some $14,400 annually.

The ACA requires health insurance providers to cover recommended preventive services without any patient cost-sharing such as co-pays and deductibles. A colonoscopy is one of these services.

Information is seeping out through administrative cracks in the health care system. It began with a voicemail from the doctor’s office. My insurance company wouldn’t pay for the sodium sulfate, potassium sulfate and magnesium sulfate solution called a “bowel prep kit.” The kit came with two 6-ounce bottles of the solution and a handy plastic measuring cup. I asked our local pharmacist if I could buy it directly as I remembered it was inexpensive. With a $10 off manufacturer’s coupon it would have been $110, making it worth the trip to the clinic in the county seat to pick up a physician’s sample of the brew.

What I am finding in my limited personal health care is the ACA is peeling off add-on procedures that used to be covered by health insurance. No add-ons to physicals, colonoscopies, and other preventive procedures, at least in my experience.

I don’t know, but the change has to have affected gross margin for these businesses and reduced the cost of health care. Whether savings will be passed on in terms of premium reductions remains to be seen, but I doubt it.

While I didn’t receive a bill for my last physical examination, the hospital sent me a bill for lab tests, which I paid. We’ll see if there are any more cracks in the system after my procedure. If there are, I’ll be posting again.

Home Life

No Winter January

My Cookbook
My Cookbook

We had a brief, light snowfall this month, and that’s it. With four days left in January, it seems unlikely winter as we know it will come.

We have had the scenic vistas, frozen lakes and automobile crashes associated with Iowa winter, but the temperatures have been nowhere near cold enough to kill off pests we want dead come spring.

I’m not an entomologist, however, it’s a problem if bugs over-winter.

On the other hand, even with warmer temperatures, most of life at home is indoors. Drawing down the pantry, preparing to file taxes, reading, writing, budgeting and planning take up much of the desk time. It’s okay, but not as much fun as it may seem.

It is time for the Patient Protection and Affordable Care Act to enter the tax filing scene. Businesses utilizing part time workers in their operations are expected to have a reckoning with the Internal Revenue Service. Depending on what time period is audited, businesses with part time employees with more than 780 hours in six months, or 1,560 hours in 12 months, will be required to pay full benefits. My 2014 totals for the job where this is relevant were 694/1,249, so my employer is in the clear.

This has been a complaint about the ACA It is said to limit how much money part time no benefits people can earn and make it more expensive for employers to add employees. IMHO, those are bad arguments against the law. If the government had provided Medicare for all instead of the ACA, the financial burden would have been much less for everyone.

As it is, the cost of health insurance premiums went up post ACA. I’m not sure this was caused by the law, or by insurance companies using it as an excuse to improve margins.

From a cost standpoint, the ACA made health insurance less expensive only in the framework of what certain lower income people pay for health insurance. There were more dollars, just shifted around with government subsidizing many newly insured people.

What matters more about the ACA is how employers manage their business.Employee costs are always a concern and a key part of any business model. Let’s face it. Small and mid-sized businesses would like to get away with all employees being independent contractors without benefits from the company. The problem is the wages paid are comparable to what used to be offered in the form of wages plus benefits, only without the benefits or the amount of money it takes to provide them.

I’ve heard I will have a reckoning with the IRS in the form of a question on my tax return about health insurance. For 2014, the answer is we had it.

As the sun rises it’s time to turn to other work. Working on newspaper articles, planting seeds and cooking will figure prominently as we work through January hoping winter actually comes.