Thursday, February 6, 2014


VON ORMY— There have been many high profile glitches with the launch of the Affordable Care Act (“ACA”), otherwise known as “Obamacare”  Website malfunctions and implementation delays have dominated the media coverage of the rollout. 
    A significant flaw in the ACA is that it mandates health insurance as the sole method for the delivery of health care.  This is short sighed. 
    Non-insurance based programs do not qualify under the ACA., as many residents of Bexar Coutny who are currently enrolled in the University Health System’s Carelink program are finding out.
     Carelink is a pioneering program that allows Bexar County residents to access quality healthcare services through University Health System, which they already fund through property taxation. 
     To qualify for Carelink, residents must earn below 300% of the federal poverty rate.  Many Carelink enrollees are middle class families that earn too much to qualify for Medicaid.  For example, a family of four in 2014 can earn as much as $71,550 in household income and still qualify for Carelink.
     Enrollees of Carelink are allowed to select a primary care provider from the network, plus access to preventative care and specialists within the UT Health Science Center.    
     Carelink was a model of affordable care, with a member responsibility element.  Payment for service depends on family size and income, through co-pays and deductibles.  Monthly fees were very reasonable and range between $40 and $150 depending on income level and annual out of pocket expenses capped at $3,000.
     But starting January 1, the ACA mandates that those over 133% of the federal poverty guideline must buy health insurance.  For a family of four the insurance mandates starts with those earning $23,850 or more of household income.   Any family of four living on less than $2000 per month in income has little room in its monthly budget for an additional  insurance premium.
   While the Carelink program is not going away,  it does not qualify as insurance under the ACA and enrollees must switch to health insurance or face the tax penalties of the law.
     The goal of the ACA should have been universal access to affordable health care, not a health insurance mandate.  The latter was pushed by for-profit insurance companies seeking to get a government mandate of their product.  You cannot blame them for trying, but we certainly can blame Congress for falling for such an obviously flawed law. 
    A fair analogy would be Congress mandating car ownership to promote access to transportation and fining anyone who instead rides a bike, walks or takes a bus to get where they need to go. 
    Programs like Carelink deliver affordable heath care because they are owned by their patients and operate on a non-profit model.  Carelink is also based on a financial responsibility model that requires enrollees to pay co-pays and deductibles based on their income.  It promotes preventative care and shifts patients from emergency rooms and into community clinics, where the cost of care is much reduced.  It does all this at a cost much lower than insurance premiums.  Its main drawback is that patients must use UHS facilities and doctors. But for many that limitation is well worth the cost savings of the program. 
   Those transitioning from Carelink to ACA insurance are finding higher premiums, deductibles and co-pays.      At a recent ACA signup event in Von Ormy, some residents reported to the Star that costs and deductibles were in excess of 100% higher than Carelink.
     While Carelink is not for everyone, Congress should reform the ACA to allow for models of health care delivery other than insurance and reverse the penalties for Bexar County residents who have a more affordable option to access health care for themselves and their families. 


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