THIS TIME ON CODE WACK!
Healthcare premiums aren’t the only costs going up. Your pocketbook is also getting hit with higher out-of-pocket costs – like deductibles, co-pays, and coinsurance – often under the radar. How is this hidden cost crisis affecting families – and what can be done about it?
We spoke with New York Times bestselling author and leading healthcare reform advocate Wendell Potter. A former health insurance executive turned industry whistleblower, Wendell is now board president of the Center for Health and Democracy and editor-in-chief of HEALTHCARE Un-covered, which investigates healthcare corporations and insurance conglomerates. This is part one of a two-part series.
Check out the Transcript and Show Notes for more!
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SHOW NOTES
WE DISCUSS
You recently wrote a post entitled ‘The Other Healthcare Cliff Americans are About to Fall Off.‘ Tell us about the financial crisis most people aren’t talking about.
Potter: Most of us just look at premiums, and that includes policy makers and politicians broadly, as if that is the only thing that is important for us to look at. But increasingly, [insurance companies] are also pushing more out-of-pocket obligations to us.
… under the Affordable Care Act, there is a cap on how much we have to pay out of pocket, but it’s extraordinarily high – around $21,000 for a family. There aren’t many families in this country who can afford to shell out $21,000 and … that’s why we have more than a hundred million of us who are carrying medical debt.
… We find out when it’s too late that we have to pay a lot of money out of our own pockets before our insurance company will pay a dime.
That’s a great point. A lot of times we don’t think about the possibility of getting sick or getting hospitalized. And we don’t really even know how much things are gonna cost until we get the bill.
Potter: That’s right. That’s what makes health care and healthcare costs so different from anything else. And it depends on the kind of health insurance you have – if you have health insurance.
Most of us go through the year, year in and year out, relatively healthy. We don’t need to test the limits of our health insurance policies, and we think that the coverage is gonna be there for us when we need it.
But unfortunately, millions of us every year do have to test the limits of our health insurance and find out when it’s too late that our health insurance is just completely inadequate.
That is a crisis and it’s why a couple years ago I founded this organization called Lower Out of Pockets Now, and it is focused exclusively on that … to try to raise the awareness of this burden that few people talk about.
… we have over a hundred organizations that are part of this coalition, and we meet with members of Congress … to educate [them] on this. You see what happened when the Affordable Care Act was passed: it did a lot of good things, including setting a limit on out-of-pocket costs. Before that, there were no limits. Insurance companies could charge pretty much, or obligate you to pay enormous amounts of money …
I came across [insurance] policies before the ACA was passed in which families had to pay $50,000 out of pocket before their coverage would kick in. People don’t understand that insurance companies don’t want to pay our claims. And by settling us with more and more out-of-pocket costs, that enables them to avoid paying for a lot of the health care that we need.
In your article, you point out that many people are switching from Affordable Care Act Silver to Bronze plans to keep monthly premiums down, even though it’s a financial gamble. Are consumers really being given a choice here or are they being forced into riskier coverage?
Potter: They’re being kind of seduced into riskier coverage … When you sign up or shop … for coverage on the ACA marketplaces … that’s where you have to pay attention to, whether [the plan you’re contemplating is] Gold, Silver, or Bronze.
And you’ll see that the premiums for a Bronze plan [are] less than they are for a Silver plan. So people think, ‘well, I’ll just go for the Bronze here because the premiums are less’ without realizing, or even if they do realize that their out of pockets are greater, they’ll just take this gamble that, ‘okay, I’ll go another year in good health and I won’t be hit by high out of pocket costs.’
But the sad thing is that when people leave a Silver plan and go to a Bronze plan … they’re leaving money on the table in many cases because the government still does subsidize premiums for most people who enroll in a Silver plan.
What is being debated and what’s making the news are so-called enhanced subsidies that were put in place during the pandemic and during the Biden administration to make the subsidies available to more people.
I think the ACA did good, but it was built on shaky foundations and the faulty premise that we need to have health insurance companies in the mix.
Why don’t we just make the Medicare program available to more people? … Having Medicare for All, in my view, would save us a lot of money. We’re not there yet, but I’m hopeful that we can begin to get there …
Helpful Links
Center for Health and Democracy
HEALTHCARE Un-covered, Wendell Potter
Understanding the ACA Subsidy Discussion, Committee for a Responsible Federal Budget
ACA metal levels: How to compare Bronze, Silver, Gold & Platinum, HealthMarkets.com
Silver Loading, Paragon Health Institute
Federal cuts and reversals upend California health care in 2025, CalMattersw
Episode Transcript
Read the full episode transcript.
Guest Biography: Wendell Potter
Wendell Potter, Editor-in-Chief, HEALTH CARE uncovered, is a leading advocate for health care system reform in both the political arena and the marketplace.
Working dual roles, Wendell is board president of the Center for Health and Democracy, and he regularly engages across the political spectrum to discuss health insurance issues with members of Congress, state legislatures and their staffs. He is also the editor-in-chief of HEALTH CARE un-covered, which investigates and reports on health care corporations and insurance conglomerates in particular. He frequently posts on X.
A New York Times bestselling author, Wendell returned to his first career of journalism after serving for two decades as head of communications for two of the country’s largest insurers, Cigna and Humana. He became an industry whistleblower when Congress was debating what became the Affordable Care Act. Wendell testified before several Senate and House committees, pulling the curtains back on prevalent industry business practices that resulted in higher health care costs and a growing number of uninsured and underinsured Americans.
His first book, Deadly Spin, won numerous awards and is still used in journalism and health policy classes at universities across the country. He has contributed to The New York Times, The Washington Post, USA Today and many other publications, and has appeared frequently on CNN, NPR, MSNBC, Fox Business and other media outlets.
Host Biography: Brenda Gazzar
Brenda Gazzar, the host and co-producer of Code WACK!, has produced over 300 weekly podcast episodes, topping 400,000 downloads. A skilled interviewer and storyteller, Brenda brings nuance, curiosity, and clarity to every conversation.
Brenda has worked as a multilingual and award-winning reporter with more than two decades of experience in California and the Middle East.
Her work has been published by Reuters, Ms. Magazine, USA Today, Los Angeles Daily News, the Orange County Register, The Wrap, The Jerusalem Post, Cairo Times and numerous other publications. She speaks Spanish, Hebrew, and moderate Arabic and is the recipient of national, state and regional awards.
Brenda also enjoys being a life coach, helping people align with their purpose so they feel fulfilled while achieving their boldest dreams.
Brenda’s work is grounded in a belief that systemic change and personal growth go hand in hand — and she’s here for both.
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