This article was first published on LinkedIn on January 27, 2020.
I’m in my second year of violating Obamacare’s “individual mandate,” which is the part of the law that requires us to buy an ACA-compliant health insurance plan. When the 2017 Tax Cuts and Jobs Act was passed, the financial penalty for not having health insurance was removed. The first year I could – 2019 – I skipped buying a plan on the Marketplace and bought a short-term catastrophic plan instead. It costs me about $150 a month.
You may consider my choice to be selfish. Insurance pools are supposed to use the contributions of healthier members to fund the care for sicker members. By not participating, you could argue that I am not doing my part to pay for the health care for other, more needy Americans.
Well, paying insurance premiums is just one way that health care gets funded in America.
I pay taxes. Taxes fund premium subsidies for individuals who buy insurance on the Marketplace, but can’t afford to pay for it. In 2018, almost 70% of individuals who bought ACA-compliant plans were beneficiaries of a subsidy. Both Medicaid and Medicare rely on taxes. A third of the U.S. population is enrolled in one of these programs. Most disturbingly, I, like many of you, will spend the rest of my life dealing with the impact that the ballooning federal debt is having on the budget. What’s a major reason why the national debt keeps growing? Skyrocketing spending in the Medicare program.
Because I don’t have traditional health insurance, all of my health care expenses are paid out of pocket. That’s good for everyone for two reasons. First, I am consumerizing the health care market. Second, I actively manage my health, tripling down on prevention to minimize costs. I’m not sure which of these byproducts is more important, but they both lead to a better health care system in our country.
When it comes to consumerization, I am always looking for the best price that provides me with the value I want. For example, I have to pay out of pocket for a mammography. (If I had an ACA-compliant plan, my test would be covered.) I go to the provider who has the most advanced equipment, because my family has a history of breast cancer. That means I’m not shopping on price, because newer technology is generally more expensive to access than older tech. However, I ask for market prices, or cash prices. I’ve been quoted a lower rate for an exam when I pay in cash on the day of service than I would pay if the provider had to file an insurance claim.
The fact that providers can even articulate a cash price is a relatively new phenomenon. It is a response to not only people like me, who don’t have insurance, but also to individuals with high deductible health plans. As noted, mammographies are covered under ACA-compliant health insurance plans. But plenty of things aren’t. Providers, be they doctors, surgery centers, rehabilitation facilities, what-have-you, are realizing that patients are going to shop around. More of them are making it easier and cheaper to access care, especially in the outpatient environment. That’s great for everyone.
Not having health insurance also impacts if, when and how I access health care services. Obviously, I am incented to use as little health care as possible because I have to pay for it. The healthier I am, the less likely I’ll need to pay for care. That drives me to focus on prevention. I emphasize the behaviors that have the biggest bang for the buck: exercising regularly, eating right and sleeping well. These behaviors don’t guarantee that I won’t get sick. But when I do, I will bounce back faster than I would if I weren’t as healthy as I am.
Critically, my behavior influences the people around me – and vice versa. I take the time to cook healthy meals, which benefits me as well as my children. Their friends see what they eat, which generates positive conversations in the Gen Z community. On the flip side, one of my friends encouraged me to start an exercise class with her. We’re on our third year of doing the class together, and both of us have encouraged other people to join too.
My hope is that more of us will focus on wellness so we can lower health care costs and lead more robust, fulfilling lives. Our interactions with the health care system should be minimal. And hopefully, as pricing becomes more transparent, our experiences will become less painful.