KonceptWould those that you're mentioning as "uninsured" be those that are opting out of the program in favor of their own plans that benefit them more? Because I feel like if that's the demographic that can afford their own programs without many financial issues, then is there much of a reason to worry about them, since they are investing in a program that theoretically (or actually idk which tbh) would offer them more?
There is no "program" to opt out of.
The vast majority of Americans get health insurance through one of three places: A job or institution which provides such benefits, a family plan, or Medicare (seniors only) and Medicaid (below the poverty line only).
So if you have a chronic condition, your best bet is to be employed full time for a large firm or the government, be poor enough or old enough to qualify for Medicare or Medicaid, or be young enough to be on your parents' health plan which only exists if they are insured through work.
The demographic who can afford treatment for serious chronic illnesses without insurance is vanishingly small. Many people without these options go without insurance, which is ok for younger people, and not very ok for older people who have occasional health mishaps. That's also why people show up at the E.R. with unmanaged chronic conditions -- there is no money for insurance to treat chronic conditions, but the E.R. must take people who are sick, so people who don't have insurance end up letting minor things they can't afford turn into major things that require ambulances and surgery.
Also medical bankruptcy is the most common form of bankruptcy in the US.
I understand that through reading the article that you linked that there's a little more than meets the eye when it comes to this kind of business across state lines, but is there a real reason why there are contracts between the doctors and the hospitals that were mentioned? I'm asking because I'm genuinely curious to see if there could be a possible solution that's not happening just because of a few things
Insurance companies generally require you see specific doctors (a network), take specific medications (among those available for your condition), and physically visit specific clinics. The insurance company does some negotiating with those parties to lower costs for the insurance company -- you pay sticker price for anything outside of the "network". When I switched insurance, for example, I changed insulins from Novolog (Novo Nordisk) to Humalog (Eli Lilly). I also changed doctors and clinics. Not for any health reason, mind, but so that my insurance company could get a cheaper rate on my care. I personally had issues with dosing when I switched doctors and medications -- didn't wake up one morning and had to take a $5000 ambulance ride. We negotiated the collectors on my ambulance debt down to around $1500 and paid out of pocket.
These reasons among others are why there are so many young people uninsured. Because it's an expensive nightmare. Might as well go bankrupt if you're in a bad car accident or have a freakish heart attack. Also, it's one reason for rising insurance costs -- fewer healthy policy holders to subsidize the sick and chronically ill.
When the ACA was passed, it did a number of things:
- Allowed young people to stay insured through their family's policy for longer
- Fined people and businesses without insurance (adding healthy, otherwise un-insured people to the pool -- lowering costs ultimately for everyone)
- Prohibited insurance companies from dropping chronically ill polcyholders
- Offered subsidies for people struggling to pay high insurance premiums
It was specifically designed to allow those people who fall through the cracks to get insured and have access to healthcare. But unfortunately, there was no public option -- i.e. no expansion of medicare to people younger than 65. The penalties for staying uninsured were too low -- the healthiest in the pool who are supposed to subsidize care for everyone else simply pay the fine and stay uninsured. Republicans vigorously fought both when the bill was on the floor. Actually, no, Republicans fought vigorously on every provision of the ACA.
So, when HRC had specific policy proposals to expand medicaid, expand the ACA, and potentially offer a public option... There was some hope there.
Instead, we need to burn the whole thing and leave it up to the magic of business (tm) to lower our rates. We'll see, I guess, won't we?