How Obamacare Affects Baby Boomers
NEW YORK ( MainStreet) While much has been made about the consequences of the Affordable Care Act for the poor, the underinsured, working class and the young, not much has been mentioned about the Baby Boomers.
According to the Kaiser Foundation this group relies disproportionately on non-group coverage since only a small fraction have employee-sponsored retirement and health benefits. There are some marked differences for insurance choices in this group.
For example, people in their early 60s can pay as much as four to six times what people in their early 20s would pay for the same type of insurance, according to Kaiser. Another way is by using a modified community rating. ACA policies are not individually underwritten or experience rated. They will also be guaranteed issue. Premiums are limited so that people in their early 60s will be limited to three times the amount of those in their early twenties.
But even though these are wonderful modifications for Boomers, they are not accomplished by waving a magic wand nor are they accomplished by eliminating the evil "profit motive" as so many politicians want citizens to believe.
These benefits are offset in very tangible ways.
"One issue is what the ACA has done to Medicare reimbursement - to some extent the reimbursement cuts might be unattractive to Baby Boomers," said Scott Harrington, a professor of healthcare management and the director Risk and Insurance Program at Wharton.
Contrary to the claims of the ACA's ardent advocates - no one is assured of keeping his doctors, current insurance plan and current price point for medical expenses.. This is as true for Boomers as for everyone else.
"The ACA is driving narrow networks for Medicare Advantage products," said Dennis Olmstead, a medical economist with the Pennsylvania Medical Society. "You may have seen press reports about Medicare Advantage (MA) plans deselecting numerous physicians from their networks. UnitedHealthcare has received much of the press coverage, but in Pennsylvania we have also seen other MA plans reducing the size of their networks. This appears to be related to ACA prescribed reimbursement methodologies tied to the Medicare Advantage star rating system and the treatment of chronic conditions of MA members by the network providers."
Another feature of Obamacare, also very controversial for Boomers, was revealed during President Barack Obama's June 24, 2009 ABC television appearance. He responded to an audience question by providing a glimpse of what containment strategies might include.
"We can let doctors know," Obama said. "Maybe this isn't going to help. Maybe [the patient is] better off not having the surgery, but taking the painkiller."
Unsaid was who would be the "we" who was going to "let doctors know." What Obama did say, albeit inadvertently, was that the ACA would probably use "evidence based medicine" which used to be called in the early and mid 1990s - medical management using "clinical practice guidelines."