Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The skinny on skinny health insurance

Mark Kelley, MD
Policy
May 24, 2018
108 Shares
Share
Tweet
Share

The Affordable Care Act (ACA), widely known as “Obamacare,” has survived several repeal attempts by Congress. Storm clouds, however, are still on the horizon.

The ACA’s individual mandate obligates every American to be covered by comprehensive health insurance. This requirement has been the most unpopular feature of the law. That’s because healthy people, especially those who are self-employed or between jobs, have found the ACA premiums too expensive.

They are not alone. Health insurance premiums continue to rise at a rate of five percent per year. Meanwhile, the average American makes about $55,000 per year and has seen little increase in wages.

The ACA suffered a blow last December when Congress passed the recent tax bill, which eliminates the penalty for the individual mandate in 2019. Some health experts think this will encourage as many as 13 million individuals to forgo health insurance. Without healthy people paying into the insurance pool, insured patients will end up paying higher premiums to cover the loss. Fearing this, some states may impose their own penalties for non-enrollees.

The individual mandate makes economic sense to policy-makers, but not to the average voter. The fines for refusing to buy ACA health insurance have been much lower than the cost of premiums. Over 8 million Americans chose to pay the fine rather than buy insurance in 2016. The federal government had planned to implement higher penalties, but the new law closes that option.

Many healthy Americans still want health insurance — but only on their own terms. That may happen through an emerging option called “skinny” health insurance.

With this type of insurance, the premium price is based on likelihood and size of the loss. If you have an expensive house or fancy car, you will pay more for insurance. If you want to lower the premium, you can take more risk and pay a greater portion of any losses. The lender for a car or home will also make you buy enough insurance to cover a car loan or a mortgage. These are all factors that go into the decision about purchasing insurance.

Skinny health plans work the same way. Unlike ACA insurance, which offers only full coverage, you can use skinny plans to buy what you think you need. The benefits can vary and may depend on how individual states regulate the plans. Major insurance companies are beginning to offer these plans, which suggests that they see a market opportunity. Here are some features of these policies:

  • They are often marketed as supplemental coverage for consumers who already have traditional, comprehensive health insurance.
  • Skinny plans may help patients cover the costs of deductibles, or co-insurance.
  • Most skinny plans have strict caps on total expenditures per year.
  • Some plans provide little or no coverage for patients with previous conditions.
  • The coverage may be limited to doctors services hospitalizations.
  • Because of these coverage limitations, premiums may cost as much as 60% lower than ACA insurance.
  • Skinny plans can be purchased at any time of the year and for shorter durations, such as three- or six-month contracts.

The demise of the individual mandate is not likely to affect the future of the ACA. Most Americans had health insurance coverage before the ACA. This was provided either by their employers or by programs such as Medicare and Medicaid.

Caught in the middle were the working poor and lower middle class who could not afford health insurances premiums. The majority of newly insured patients are in this group. ACA subsidies allowed them to buy health insurance. Politically it is unlikely this support will be withdrawn.

The ACA enabled about 17 million uninsured Americans to receive health insurance. However, several years after the ACA was implemented, the effort appears stalled.

Since 2014, 27 million Americans (11 percent of the population) remain uninsured. Almost half of the uninsured say the costs of insurance are too high, followed by a third who cite job loss or lack of employer-sponsored insurance. Many of the uninsured are trapped in states that refused federal subsidies for their citizens.

This stalemate is all about the price of insurance. If you have a good income and an employer-based health plan, you have the financial ability to cover most costs. With low to mid-range income, you may not be able to afford any health insurance, especially if you must buy it yourself. The ACA subsidies can help, but only if they are allowed in your state and your income is low enough to qualify. Many Americans are caught in this vulnerable position, especially the self-employed, contract workers and employees of small companies.

Skinny plans may be useful in providing a stopgap for healthy folks who are between jobs. But there is a potential risk. These plans offer limited coverage, similar to dental insurance. For a taste of that experience, ask anyone who had dental insurance but still paid a tidy sum for a root canal. A hospital stay is even more expensive and, without adequate insurance coverage, can lead to enormous debt.

“Make America Great Again” has been the rallying cry for opponents of universal health coverage. Yet it’s hard to see “greatness” in a nation whose productive citizens cannot afford health insurance. As with public safety, defense, and education, only the federal government can ensure health care for all its citizens. We have come closer with the ACA — but many have still been left behind.

Great countries don’t let that happen.

Mark Kelley is a pulmonologist and founder, HealthWeb Navigator, where this article originally appeared.

Image credit: Shutterstock.com

Prev

A physician's personal crisis with pain

May 24, 2018 Kevin 2
…
Next

What to do if you want to be a cruise ship doctor

May 25, 2018 Kevin 0
…

Tagged as: Public Health & Policy, Washington Watch

Post navigation

< Previous Post
A physician's personal crisis with pain
Next Post >
What to do if you want to be a cruise ship doctor

More by Mark Kelley, MD

  • Why this physician teaches first-year medical students 

    Mark Kelley, MD
  • A pulmonary physician’s take on vaping

    Mark Kelley, MD
  • America leads the world in high tech care and health care costs

    Mark Kelley, MD

Related Posts

  • Here’s why health insurance is different from other insurance

    Joseph Crisp
  • Why is health insurance so unaffordable?

    Emily O'Rourke, MD
  • Think you have health insurance? Think again.

    Asser Shahin, MD
  • High deductible health insurance is bankrupting Americans

    Ben Aiken, MD
  • COVID-19 shows why we need health insurance

    Jingyi Liu, MD
  • A case for national health insurance

    Jonathan Michels

More in Policy

  • How healthy eating can protect us from extreme weather

    R. Jason Newsom, MD, MPH
  • Georgia’s new law promoting truth and transparency in health care credentials

    Carmen Kavali, MD
  • Unveiling the global pandemic threat: insights into risk factors and urgent measures for prevention

    Ton La, Jr., MD, JD
  • Why the WHO’s pandemic accord is critical for global health care

    Elizabeth Métraux
  • The revolutionary Kaiser-Geisinger deal: How health care giants are reshaping the industry and empowering patients

    Robert Pearl, MD
  • Unveiling the intricate link between housing costs and health care

    Harvey Castro, MD, MBA
  • Most Popular

  • Past Week

    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • Georgia’s new law promoting truth and transparency in health care credentials

      Carmen Kavali, MD | Policy
    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician
    • From Moscow Mule to the opioid crisis: Unveiling the tragic legacy and urgent solutions

      Osmund Agbo, MD | Meds
    • Unmasking the truth: the shocking reality of the opioid epidemic and who’s really to blame

      Jay K. Joshi, MD | Physician
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Proactive risk management: a game-changer in preventing physician burnout

      Howard Smith, MD | Physician
    • Unmasking wage disparity in health care: the truth behind the Elmhurst Hospital physician strike

      Kevin Pho, MD | KevinMD
  • Recent Posts

    • Breaking free from limiting habits: Unveiling the path to your full potential [PODCAST]

      The Podcast by KevinMD | Podcast
    • Emotional journey: An inspiring tale from the operating room in Nicaragua

      David Alfery, MD | Conditions
    • Physician excellence: Transitioning from the comfort zone to the growth zone for exceptional patient care

      Harvey Castro, MD, MBA | Physician
    • Pursuing undergrad research without misrepresenting your career path

      Paris H. Grey and David G. Oppenheimer, PhD | Education
    • How healthy eating can protect us from extreme weather

      R. Jason Newsom, MD, MPH | Policy
    • Unfilled residency spots and the future of emergency medicine [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Outgoing AMA President Calls for Unity in the Relay That Is Medicine
  • Was Kratom Linked With Lethal Arrhythmias?
  • Ultrasound for Distal Forearm Fractures in Kids; Ketamine vs ECT for Depression
  • Are Engineering and Medicine Good Bedfellows?
  • Poor Nutrition Status Linked With Survival After MitraClip

Meeting Coverage

  • Outgoing AMA President Calls for Unity in the Relay That Is Medicine
  • Poor Nutrition Status Linked With Survival After MitraClip
  • Transapical Transcatheter Mitral Valve Replacement Trial Raises Questions
  • MitraClip Shines in Real-World, Core-Lab Data
  • Risankizumab Safe in Older Crohn's Disease Patients
  • Most Popular

  • Past Week

    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • Georgia’s new law promoting truth and transparency in health care credentials

      Carmen Kavali, MD | Policy
    • Decoding name displays in health care: Privacy, identification, and compliance unveiled

      Deepak Gupta, MD | Physician
    • From Moscow Mule to the opioid crisis: Unveiling the tragic legacy and urgent solutions

      Osmund Agbo, MD | Meds
    • Unmasking the truth: the shocking reality of the opioid epidemic and who’s really to blame

      Jay K. Joshi, MD | Physician
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Proactive risk management: a game-changer in preventing physician burnout

      Howard Smith, MD | Physician
    • Unmasking wage disparity in health care: the truth behind the Elmhurst Hospital physician strike

      Kevin Pho, MD | KevinMD
  • Recent Posts

    • Breaking free from limiting habits: Unveiling the path to your full potential [PODCAST]

      The Podcast by KevinMD | Podcast
    • Emotional journey: An inspiring tale from the operating room in Nicaragua

      David Alfery, MD | Conditions
    • Physician excellence: Transitioning from the comfort zone to the growth zone for exceptional patient care

      Harvey Castro, MD, MBA | Physician
    • Pursuing undergrad research without misrepresenting your career path

      Paris H. Grey and David G. Oppenheimer, PhD | Education
    • How healthy eating can protect us from extreme weather

      R. Jason Newsom, MD, MPH | Policy
    • Unfilled residency spots and the future of emergency medicine [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...