Obamacare Is a 'Haves and Have Nots' Health System
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The Fiscal Times
March 28, 2014

The rich have always been able to pay for the best doctors and medical care. But until now, that advantage had not been institutionalized by the federal government.

My first boss was a millionaire. I was one of his three secretaries, making a pittance and attending college at night. One night I fell leaving the subway while rushing to class. I didn’t think much of it until my boss noticed I was limping a little. He insisted that I see his orthopedic specialist at the Hospital for Special Surgery in New York — one of the most elite institutions of its kind. 

The doctor fixed my hip, and my corporate insurance covered the cost. Over the years, as I worked for different companies and built my career, I passed on my top docs to people who worked with me. There was never a question about lower-paid employees affording a top doctor for a sick child or an elderly parent — or themselves. 

Related: Hospitals Plot the End of Insurance Companies

Corporate insurance in those days was the great equalizer. I had what the CEO had, as did everyone in the mailroom. That “equalizer” is doomed with Obamacare. So says one of the chief architects of the president’s health care law, Ezekiel Emanuel. He told The New York Times that companies will move away from providing insurance and offer stipends for employees to buy insurance on the health care exchanges. Emanuel said the “Cadillac tax” imposed on high-cost full service plans will push companies to make that choice. “By 2025, few private-sector employers will still be providing health insurance,” Emanuel told The Times.

Even now, as the bulging baby boom moves from private insurance to Medicare, more than 150 million Americans have employer-provided health insurance, not all of which, of course, is as generous as a Cadillac plan. Nevertheless, the unintended consequence of this move away from a “one-size fits all” corporate plan institutionalizes a health care system of “haves and have nots.” Why? If you have insurance through Obamacare, your odds of being accepted by one of the nation’s top hospitals or having access to top doctors is seriously diminished. 

Watchdog.org, a conservative site, investigated how many of the nation’s top hospitals were opting out of Obamacare. They used the U.S. News and World Report list of best hospitals for 2013-14. “Americans who sign up for Obamacare will be getting a big surprise if they expect to access premium health care that may have been previously covered under their personal policies. Most of the top hospitals will accept insurance from just one or two companies operating under Obamacare,” Watchdog reported.

Related: More Companies Dump Employee Insurance for Obamacare

Johns Hopkins in Baltimore and Massachusetts General in Boston are mandated to accept all insurance under state law. But Mayo Clinic in Rochester, Minnesota, only accepts the Blue Cross silver plan. And the Cleveland Clinic only accepts Medical Mutual of Ohio. Like others, they have issues with the reimbursement rates under Obamacare.

“In many cases, consumers are shopping blind when it comes to what doctors and hospitals are including in their Obamacare exchange plans,” Josh Archambault, senior fellow with the think tank Foundation for Government Accountability, told Watchdog.org. “These patients will be in for a rude awakening once they need care, and get stuck with a big bill for going out-of-network without realizing it.”

Imagine you’re a new parent and your baby has a heart condition. You live in Seattle where Seattle Children’s Hospital has sued the state’s Office of Insurance for “failure to ensure adequate network coverage” through Obamacare. If you have insurance through one of the companies that isn’t accepted by Children’s, you’re out — or you have to pay the astonishing costs for access to their neo-natal care center. A hospital news release stated, “Children’s is the only pediatric hospital in King County and the preeminent provider of many pediatric specialty services in the Northwest.”

The result, of course, is that the nation’s high-end teaching hospitals — where the best research facilities and some of the best doctors in the world practice — will be mostly available to rich people. And perhaps just super rich people like Warren Buffett and the Koch Brothers. Clearly a paltry millionaire couldn’t afford more than a week at a NICU and still pay the mortgage on a Tribeca loft.

Related: Top Tier Hospitals Excluded from Obamacare

Still, we all know that corporate and private insurance before Obamacare wasn’t working, either. Premiums and deductibles were increasing at a rate almost as fast as college tuition. The president’s plan does something that corporate insurance was never able to do: make consumers actually shop for health care the way they would for any product or service.

The problem with the president’s plan is that you’re flying blind when you’re shopping. You don’t know if what you’re buying will really meet your needs or whether you will incur additional costs when you “implement” the plan.

More importantly, the administration doesn’t know what it will cost consumers or the economy either. I don’t believe President Obama lied when he repeatedly said you could keep your health insurance and your doctor. He simply didn’t know because he rolled out a plan without test-marketing one of the largest e-commerce plays ever and neither he nor anyone in the administration was prepared for the results. 

One of those results reinforces a societal inequity that Obama wants to rectify — his Affordable Care Act creates a health system that leaves the “have nots” in the dust.

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Editor in Chief Jackie Leo, former EIC of Reader’s Digest, Consumer Reports, and Editorial Director of ABC News’ Good Morning America, is an award-winning journalist and author. The Fiscal Times is her 4th start-up venture.