Will Millions of Newly Insured Patients Under Healthcare Reform Actually Be Insured?

healthcare reformMost of the recent discussion is about whether all or part of the Healthcare Act will get through the Supreme Court. But let’s assume for a moment that it does.

What then? Will the newly insured actually get coverage? It would seem that they would: the Patient Protection and Affordable Care Act (PPACA) proposes to spell out in considerable detail exactly what coverage private insurance companies must provide. There won’t be any difference in anybody’s coverage—right? Wrong!
In fact, the majority of those to be newly insured under healthcare reform changes will be insured by Medicaid. But Medicaid is not run by the federal government. It is administrated and regulated at the state level.
This means that the specifics of Medicaid coverage differ from state to state. And due to budget constraints, some states have already started cutting Medicaid benefits to lower and lower levels. For example, states are capping hospital stays:

  • Arizona plans to limit hospital coverage to 25 days a year (and stopped covering certain transplants for many months).
  • Hawaii plans to cut coverage to ten days a year with certain exemptions.
  • Other states have already limited hospital stays under Medicaid: the limit is 45 days in Florida, 30 in Mississippi, 24 in Arkansas, and 16 in Alabama.
  • If you need more hospital care than Medicaid allows, apparently you will have to pay out of your own pocket or else forgo needed care. Basically you are back to being uninsured.

In 2010, state spending on Medicaid jumped 8.8%, and consequently many states have also trimmed “optional” benefits such as vision and dental, and reduced reimbursements for doctors and hospitals. Not surprisingly, even more doctors are choosing to opt out of Medicaid.
The double standard that is built into the PPACA legislation is especially troubling. Private insurers will not be allowed to have any annual or lifetime caps whatsoever on the amount they will spend on an enrollee under the new law. At the same time, Medicaid, as a government program, will not be held to any standard. As John C. Goodman, president and CEO of the National Center for Policy Analysis and widely known as the “father of Health Savings Accounts,” noted last October in an article that brought this problem to our attention:
If a private insurance company denies a breast cancer patient a bone marrow transplant, that’s considered a moral outrage—even if the procedure is experimental and is later shown not to work anyway. If the Arizona Medicaid program denies people organ transplants that do work and save lives, that is considered an unfortunate budget issue.
The point is, individuals will be entering an extremely underfinanced and ineffective program. This will only get worse as more people enter the Medicaid pool, in effect creating a program that is hardly worth the money being paid for it. What is the point of getting more people insured if you are taking away much of what they will get? And as usual, it is the poorest people who will suffer from this political sleight-of-hand.
When the healthcare reform bill was being debated in Congress, ANH-USA suggested to legislators that they should at least incorporate one much needed reform to help poor people: be sure that uninsured patients do not pay more in a hospital than insured patients. As it stands now, uninsured patients get charged in full, which may mean $8 for an aspirin, while insured patients get their bills discounted after review by the insurer. Why not just legislate that hospitals cannot discriminate against the uninsured? This idea seems so basic to us, but got no interest at all from the drafters of the bill.
For more thoughts about the PPACA, please see our Healthcare Reform Overview as well as our earlier articles on the subject.


  1. The double standard by which insured and uninsured are charged is a long standing issue. If the practice was reversed and health cared providers and hospitals charged insured patients more than uninsured patients the insurance companies would be crying foul and having the them investigated.
    Perhaps there should be regulations that prohibit charging the uninsured more that the average of the highest and lowest agreed upon charge for a procedure that a provide accepts from an insurance company.
    This was not a health care reform legislation. It was who is going to pay for everyone’s health care legislation. It was a patchwork approach by the government to fix an issue that they truly do not understand.

  2. It’s better being uninsured and teach yourself how to treat yourself holistically. Insurance will only pay for medical treatments but there are so many other things that can be done without going through the medical doctors.

  3. The answer to this problem is Medicare for all a single payer, government sponsored, health care
    system. Get the insurance companies out of our health care!!!!!!!!

    1. Have you even read these 2 letters? They pointedly show how bureaucratic and wasteful Medicare is. Making yr. answer illogical.

    2. Keep government away from my healthcare.
      “The most terrifying words in the English language are: I’m from the government and I’m here to help.”
      Ronald Reagan.

    3. The cost of everything, including aspirin, at hospitals is priced relative to all the union salaries going on with the nurses, maintenance, etc. Gov’t wants in the health care business to control you.

  4. In the state I reside in, any provider who contracts with Medicare cannot charge any other client a lessor amount then is charged to Medicare for the same service.
    I worked in an office who tried to implement cash payment discounts and more equitable pricing for their uninsured patients. However, trying to get around that particular provision in their contract with Medicaid made it impossible. While it probably is in the best interest of the hospitals’ bottom line to charge the non-insured as much as the insured, it may not really be discrimination in light of the terms of their contracts with various insurance entities.

  5. I just had to add my experience. Almost a year ago, I was admitted through the emergency room of a local hospital for treatment of a suspected MRSA infection. At the time of my admission, I was covered by Medicare and a Medicare Part B Supplemental Insurer. I also had a drug plan supplement through the same private insurer. Some months later when I got my statement for services and materials Medicare paid for, I was dumbfounded to discover that the plain, ordinary 325 mg aspirin tablets I was given (at my insistence because I do not do well with the standard Tylenol which my nurses tried so hard to get me to accept) were monstrously overpriced. The first aspirin tablet was billed at………$25.000! The second aspirin tablet was billed at……..$20.00! And this was with insurance! Talk about “crooks”! I could have easily bought 5 100 tablet bottles of a national brand aspirin at my local Walgreens for the amount Medicare was charged for a single tablet in the hospital!. Why am I fussing about this? Because this outrageous overpricing for simple things like aspirin is why Medicare and Medicaid are losing so much money! What can we do to clean up this price gouging on the part of the hospitals and the medical service providers? We’ve got to do something!
    The bizarre throwing money away hand-over-hand experience continued. Once I was being followed at home by a visiting nurse who cleaned my healing lesions and applied new dressings as needed, my nurse had to order supplies for me. Would it surprise Alliance for Natural Health to learn that two of the three times my nurse ordered simple dressings like Ace wraps and conforming gauze, other nearly useless (but very expensive!!!!!!) products arrived instead? When we tried to send these useless materials back, the distributor refused to accept them because we had opened the shipping carton – even though none of the individual containers had been opened! Medicare paid for these unusuable items without any challenges….. My nurse and I gave up on trying to get the proper dressings through this supplier and purchased the ones I should have had with my credit card – at about a quarter of the cost Medicare paid for the ones that couldn’t be used or returned.

    1. The fact that Medicare gets ripped off is a twofold problem: 1) Insurance companies and hospitals are at fault for overcharging 2) Medicare needs to be more diligent in reviewing bills.
      The reviews and closing the gaps in overcharges and false claims is what Medicare is trying to do. What are the hospitals and insurance companies doing?
      My husband had to have major back surgery – most of his back was either fused or had rods. We are into preventive care and have been for years, but there comes a time when you actually need to use your insurance. Medicare plus the supplement company paid for everything. Otherwise we would have lost our home and gone bankrupt. WHY would I want to get rid of that and go into totally private health care insurance which doesn’t pay for everything and raises premiums exorbitant percentages every year.

  6. I wish NOT to have Health Care…….as “Preventative”…….. I know how to do that myself !!!! I only wish to have Emergency Coverage – which I cannot get. Example: last year bit by Black Widow – didn’t know it……..it was in my Yard Glove……….so let it go for 4 days – while I tried to take care of…………….ended up in Emergency Surgery – almost losing my Thumb – thankfully infection had not gotten INTO the bone………………………5 days later ———3 Antibiotics 24 / 7…………..Hospital bill was OUTRAGEOUS. However, I did get a discount for being Un-insured. Infection was cleared in 2 days- but they kept me 5……..just for more Money – I am sure. I will say the people I know that go into a Hospital and think they are COVERED by INSURANCE ————the BILL GETS HIGHER…………INSURANCE COMPANIES don’t pay all……….PATIENT is STILL RIPPED OFF !!!

    1. I also wish not to have “HEALTHCARE SYSTEM”, BECAUSE IT IS ACTUALLY A “SICKCARE SYSTEM”. I have not carried “SICKCARE INS.”, FOR 15 YRS., I experienced myself what a scam our “SICKO” Ins., were doing to the people in America.
      My choice in 1974 was to totally provide for myself, my family, my pets, and friends with nutrition. The less Medical and Veterinarian that you or your pets visit, the healthier you will be. Once you stop depending so much on doctors and hospitals, you will be amazed at yourself what healing power you have within yourself even in emergencies, but you will have to trust and empower yourself with knowledge and not give your power to the pharmaceuticals, doctors, politicians, etc.

  7. Seems to me the Federal government can’t do anything efficiently and as soon it gets involved, prices soar. Insurance companies see the profit and reliable payments due to the government backing it all up so of course they want a part of this. The answer is to get government out of our health care. Insurance companies won’t be tempted by easy and exorbitant profits any longer. It will be a difficult time but will most certainly lower the cost of health care in the end, The obvious question is what about the people that need services but can’t afford them? Right now we’re all paying for them whether we want to or not. There are NGOs that provide for these people so instead of forced government taxation, we can become charitable givers if we wish. If a charity doesn’t meet its mandate, we decide where our donations go next.

  8. I’m not a big fan of the insurance companies but a couple of points. 1) Some insurance is better than no insurance when you are in an emergency situation. You can not heal yourself in situations of stroke, broken bones, etc. 2) I have a child who is in the “donut hole” for young adults. While I initially didn’t like the Affordable Care Act because of the insurance co provision, I do admit today that I am thankful as my child has a serious pre-existing condition, which is another thing done away with in the Act. I lie awake at night worrying about the Supreme Court overturning the Act and what will happen to our family. 3) Many states are cutting Medicare and Medicaid programs, however, the Act provides money to support the addition of the people expected to move into coverage in 2014. There is a provision to add Insurance Co-Ops in each state based on what is requested by each state or a group within the state. Co-Ops will help to transition from regular insurance to something closer to single payer eventually. 4) The loss ratio provisions within the law are a HUGE plus. When it goes into effect, insurance companies must operate at least at an 80% loss ratio up from 60-65%. This is tremendous. What it means is that an additonal 20-25% is going to be spent on services and healthcare rather than company administration and profit. It is this provision alone that is upsetting to the insurance companies. If the do not operate at an 80% loss ratio, they must then return that amount to their insureds. And 5), yes we can help to make ourselves more healthy but there are situations where we need to seek health treatments. In one example, if we were allowed to eat healthy food without GMO contamination, we would be less overweight leading to less endocrine and diabetes diseases.

    1. Thank you, janeto, for a reply that makes sense. Getting ANY health care act passed was a great feat and, while the results are not perfect, it is a start. If we all work together to get Congress filled with progressives, we may finally be able to move toward single payer where everyone is on the same playing field.
      Instead of complaining about what we don’t like, we need to share what we DO like because people in general have NO IDEA how much this law benefits us. Once there is more support for this, we can work toward the fixes necessary and single payer.
      Do you realize that very high percentages of people like many individual components of the law? I wonder if they even realize those components are in the law they so bitterly complain about.

  9. I have filled out a living will and filed it with Generations Family Health Care, a federally certified group practice serving Medicaid and other low income patients. At my 70th birthday, I plan to try to get a Do NOT Resuscitate order added to it. I figure the best I can do is hope if possible to be like the fabulous one horse shay and go all at once when I go, with second choice to be put out of my misery promptly when I do run into something likely to kill me.

  10. To the article’s points:
    What is the point of getting more people insured if you are taking away much of what they will get?
    While understanding this is a rhetorical question, I can’t help but reply that was exactly the point of this milquetoast, ineffectual, sell-out of legislation to keep that most lucrative support coming from the ‘healthcare industry’ to their favorite elected officials. The insurance companies, who will be employed to administrate this farce, now get to enjoy even larger insured pools (larger pools = less risk) to fill even deeper coffers. And yes, there is nothing stopping them from increasing their premiums while gutting their actual protection and services. So while we the public see the PPACA as ‘better than nothing’, and technically it is because it is WORSE now, we fight to keep it from being thrown on the fire by the angered right and their insurance industry cohorts. And yet…it doesn’t change the fact that we’ve been sold a bill of goods. And then there’s a bridge in Brooklyn with a nice price tag…
    Why not just legislate that hospitals cannot discriminate against the uninsured? This idea seems so basic to us, but got no interest at all from the drafters of the bill.
    Because to you, me, and the thinking public, this is common sense of most people who possess a shred of decency and compassion. Privatized healthcare was not founded on these things. Profits are what it was meant to churn out, and nothing more.
    If the US can finally create a sustainable public system like so many intelligent nations have, wellness programs and lifestyle disease prevention may finally take hold—there’ll be no profit gained by expensive treatment of such ailments anymore!

    1. That’s part of the problem…the hospitals are forced to take the uninsured—-but there is no free lunch and someone always has to pay. That’s why charities and charitable hospitals are the only answer for the uninsured and pay as you go for the rest of the people is the only answer. No one needs the gov’t involved in medical decisions. The government cannot create a “sustainable system” as you propose. Government exists to propagate and extend its power and influence. Government has never existed to protect or to serve anything but itself.

  11. The VA hospitals have gotten to be quite good and have much less waste than many other hospitals in the last few years. We could do much worse than to let uninsured people choose VA instead of a commercial insurer. That would be a good step toward single payer.

  12. There was a much better way of doing this rather then passing the Congress/Senate healthcare scheme. We either needed a one payer system like most countries have or they could have made the insurance industry limited profit companies. That would have made insurance affordable and stopped the flow of money to overpaid CIO’s. NO ONE deserves a million a year.

  13. Reality Check!
    I’d like to point out to everyone that there aren’t enough MD to care for the needs of the people who are already covered, and the situation will only get worse. Here, in Dallas, TX, people who qualify for in-state health care (due to low or no income) have to wait for a year or longer to see a doctor, other than waiting for an appointment (sometimes all day) at a hospital walk in clinic (not emergency room). Having seen a doctor at the clinic, follow ups, even in serious cases can be administratively changed so that the doctor’s orders are not followed, or delayed for weeks or months.
    Then there are the MD’s who will refuse to see many of these new patients… this program will turn out to be another government debuckle!
    In the end, people will still turn to the emergency room, and the cost will continue to skyrocket, and the insurance companies will profit even more… with not much changing at all, except that those who can’t afford to pay the premium will be penalized and as I heard on NPR (fairly reliable), those who can pay the premium will have to invest several thousands before the benefits kick in!

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