STEVE INSKEEP, HOST:
Nevermind Obamacare, which mandated buying insurance. This is the story of people who have insurance, whether it is through the Affordable Care Act or through their jobs, the government, something else, and find out it does not cover all of their costs. This is an issue we are covering, whether the candidates are discussing it in detail or not. We're going to talk it through with NPR's Alison Kodjak, who's in our studios. Hi.
ALISON KODJAK, BYLINE: Hi, Steve.
INSKEEP: Hasn't Obamacare raised the number of people who have health insurance?
KODJAK: It sure has. Almost everybody, really, has health insurance. It's up to about 90 percent of the people. But the costs that people are paying out of their own pockets, going way up.
INSKEEP: What kinds of costs are we talking about here?
KODJAK: Well, the premiums are high and rising a little bit every year. But what we're really talking about are deductibles, the amount of money you have to spend before your insurance even covers everything, and then co-pays, you know, what you pay when you go to the doctor. They used to be 15, $20. Now we're finding they're 45. Sometimes it's co-insurance, where you're paying a percentage of the entire appointment or a percentage of the cost of the medication.
INSKEEP: OK. That doesn't sound like so much. But talk me through some examples about how this affects people.
KODJAK: Yeah, so we talked to a woman named Renee Powell. She was out in Bartlesville, Okla. She's married with two kids. And last year, her insurance premium went from $750 to $1,100 a month.
INSKEEP: A month, OK.
KODJAK: And she's got a deductible of $3,000 per person in her family. So they have to pay about $12,000 before they're fully covered in a year.
RENEE POWELL: There was something in me that, it just kind of switched. I was OK with paying 750. But when it became about a hundred dollars more than my housing, it upset me. But, you know, it's kind of the law. So we got the coverage. And you know, we're just going with it.
INSKEEP: I'm just doing some math in my head. She's paying more than $13,000 a year, essentially, what must feel like - her, for nothing. It's just for catastrophic coverage.
KODJAK: That's essentially what she said. You know, she used to have really good insurance. She worked for the state of Oklahoma. She was an epidemiologist. But when her husband graduated dental school, she stopped working. They moved to a smaller town.
And when they went to buy their own insurance, they found that the premiums were really high. And then the insurance company dropped the first plan they had, and the premiums went up. And that's when they started facing these really high deductibles.
POWELL: I felt like I'm just paying money to the insurance company so they can sit on it and put it in stock.
KODJAK: Yeah, so she's pretty frustrated. And she and her husband considered going without insurance. But they think it's a little too risky.
POWELL: It's a lot of money. But you don't dare go without, you know, health care when you've got two small kids.
INSKEEP: And of course, she'd still be paying under Obamacare. You pay a penalty to have no insurance. So are any of the candidates talking about this - not just the premiums but, as you said, the deductibles, the extra costs, the co-pays?
KODJAK: Yeah, they are to some degree. I mean, let's start with the Democrats. Most people have heard Bernie Sanders' proposal. He wants to create this system called Medicare For All, which is essentially single-payer health care. It's not really free because you'd pay it through your taxes. He wants to raise taxes on individuals by about 2 percent, businesses by about 6.5 percent.
And that would guarantee health care for everybody in the country without having to pay anything out-of-pocket. There are a lot of people, including a lot of left-leaning economists, who don't think his numbers add up. But that would take care of the problem of having to pay something every time you go to the doctor and feeling like you're not covered.
INSKEEP: OK, what about Hillary Clinton?
KODJAK: She's got a more technical proposal. She wants to build on what - as she says, Obamacare. She is looking at offering what's called a refundable tax credit. You get money back from the government if you're out-of-pocket costs go up too high. And beyond that, she wants to cap costs for prescriptions. And she wants to protect patients from surprise bills. Like, some people get charged for an out-of-network anesthesiologist when they go into a hospital for surgery, even if the hospital's in-network.
INSKEEP: How do you protect someone from a surprise bill? What's a surprise bill or not a surprise bill?
KODJAK: Well, it's that kind of thing where all of a sudden you're paying this full doctor bill. And they would just require that if you're getting treatment in an in-network hospital that everybody has to take the in-network pay.
INSKEEP: We're going to get to the Republicans also. But you've got another example here, I believe, of how this affects people on a day-to-day basis.
KODJAK: Exactly, we talked to this woman, her name's Melody Simon, she's in Detroit. She was born with a birth defect in which she's had to have seven surgeries on her leg. She has a good doctor in her network who performed her most recent surgery just last December. And, you know, she went back to see him but at a different hospital for a cortisone shot to ease some pain. She's got arthritis in her foot. She'd done this a couple of times before when she lived in Texas, and it cost about $40. But this time, it cost a lot more.
MELODY SIMON: It was like I was going into surgery. They brought me into the operating room and everything. And of course, in my mind, I'm like, what is all this pomp and circumstance for just a, you know, injection? Of course, I should've known that it was going to cost something. And it did, $832.96.
INSKEEP: How did that unexpected $832 affect her?
KODJAK: Well, she's on temporary disability right now. So she's not making very much money. It was a big chunk of her money. She now is almost completely dependent on her partner to cover a lot of her bills because of her lower income. And things have gotten so high at this point that they've decided to get married because her partner's health insurance is much more generous than hers.
SIMON: We can't afford to plan a wedding back home. I mean, it is all financial actually. So we'll probably just elope, you know, get married at a justice's office or something.
INSKEEP: So someone really struggling there with an unexpected cost. We've heard about what Democrats want to do about this. What about Republicans?
KODJAK: Well, Republicans, all three of the major candidates are starting from the baseline that they want to repeal Obamacare and replace it with something else. But none of them have their plans specifically focused on these out-of-pocket high costs. Donald Trump's proposing a lot of tax breaks to help offset the cost of health care for people, deductions for their premiums and health savings accounts. But those tend to help wealthier people who pay a lot of taxes.
INSKEEP: Oh, because when you're paying a lot of taxes, that's when a tax break actually can help you a considerable amount.
KODJAK: Exactly, and if you're not paying a lot of taxes, the tax break doesn't help that much. Ted Cruz doesn't actually have such a detailed plan. But his campaign told me his major proposal is to help insurers sell policies across state lines, the idea being more competition will lower premiums. And that would help everybody.
Donald Trump favors the same thing. There are people who worry a little bit that that will lower the standard of health care across the country. John Kasich, he is looking more in the long term. He isn't focused on today's out-of-pocket costs. He wants to change the way the overall health care system is paid for. He's looking at instead of paying for each service, creating what they call bundled payments. So if you go in the hospital for a heart attack, the insurance company pays one price no matter how many tests they give you.
INSKEEP: Isn't this something being experimented with under Obamacare?
KODJAK: It is. And that's what he's pointing to, his efforts in Ohio that are actually done under Obamacare.
INSKEEP: Alison, thanks very much.
KODJAK: Thanks, Steve.
INSKEEP: NPR's Alison Kodjak, with our latest look at Politics In Real Life. Hey, let us know what issues in your life the candidates should be talking about. Tweet us or find us on Facebook. Just use the hashtag, #PoliticsIRL.
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