53 Things American Health Care Doesn’t Cover and How to Use Natural Medicine Instead
You can be on the left side of the fence or the right; you may even still be on the fence. But the one thing that we can all agree on is the desire to have health care coverage for you and your family. For better or worse, health care coverage (or lack thereof) is something that affects everyone, and it’s a highly relevant topic right now. Back in late March 2017, the U.S. House pulled the Republicans’ bill that would have repealed and replaced the Affordable Care Act (ACA, also known as ‘ObamaCare’) and ushered in the era of the American Health Care Act (AHCA or ‘Trumpcare’).
But as of May 4, 2017, the Trump administration’s second iteration of the AHCA bill passed and is now in the Senate’s hands. While some last-minute patchwork was done to get other Republicans on board (many of whom didn’t even read the bill before voting on it), the AHCA bill will likely go through further amendments in a seemingly endless effort to satisfy both parties. When you objectively consider that the bill barely passed, the likelihood of it getting through the senate is dim. So, for now, ObamaCare remains the system in place.
But in all of the noise surrounding this emotional bill, many Americans’ main concerns remain: What does the AHCA mean for your pre-existing conditions and coverage? As many of you have experienced, the world of health care can be terribly intimidating and hard to understand. So let’s delve into the basics of both ObamaCare and Trumpcare to see what is or isn’t covered. We’ll also provide some resources for you to learn how to treat particular health problems with natural medicine or approaches.
(We’ll try and keep it as simple, clear, and concise as possible!)
How ObamaCare Works
An important fact to consider is that ObamaCare did not create health insurance. In March 2010, Obama signed it in as a reform law which he intended to regulate and expand the availability of quality, affordable health insurance.
By 2014, ObamaCare required Americans to keep their then-current health insurance plan or get a new one. Over 85 percent of Americans already have health coverage from through Medicare, Medicaid, or private insurers, and 50 percent of people receive coverage through their employer. This shows that a lot of people actually have some form of insurance that complies with Obama’s reform law.
However, the approximately 13 percent of Americans without coverage still need to obtain health insurance. Their only other options are to qualify for and get an exemption (i.e., regular or hardship exemptions), or pay a monthly fee on their tax returns for each one they remain uninsured. To avoid the fee, you will need to get Minimum Essential Coverage (MEC) which is simply explained in the short video below:
What Does ObamaCare Cover?
This is a challenging question to address because an accurate answer requires personal details about your family’s income, medical history, and where you live. Generally, ObamaCare helps reduce health care costs and ensures that you have access to the most important services (i.e., essential health benefits) you and your family need.
10 Essential Health Benefits According to ObamaCare
Under ObamaCare, every plan in the marketplace across all states must cover this minimum set of health services:[4,5]
Ambulatory patient services (i.e., outpatient care you get without being admitted to a hospital)
Hospitalization (e.g., surgery or overnight stays)
Pre- and post-pregnancy, maternity, and newborn care
Mental health and substance use disorder services (e.g., behavioral health treatment, counseling, and psychotherapy)
Rehabilitative and habilitative services and devices (e.g., treatments that can help you recover from a stroke or help a child with autism spectrum disorder learn to speak)
Preventative and wellness services and chronic disease management
Pediatric services (i.e., dental and vision care)
What Would Trumpcare Look Like?
To start, there’s still a lot we don’t know about the new health care bill and with that comes speculation and rumor. However, under the AHCA, there are 6 important things we do know:
Individual states would have greater power apart from federal government
Pre-existing conditions would be still be covered
Financial assistance would change
ACA’s 10 essential health benefits could be modified
Medicaid would be radically altered
Individual mandates would be gone
To keep this section brief and address the source of most people’s worries, we’ll focus mainly on pre-existing conditions and pre-existing coverage.
Trumpcare’s Effect On Pre-Existing Coverage
Many people are afraid that under Trumpcare, their coverage will cease to exist should it get voted in. You have every right to worry, but not for at least the rest of 2017, so long as you continue to pay your existing premiums.
Should the Trump administration’s repeal of ObamaCare follow through, things including taxes, regulations, subsidies, Medicare savings, and Medicaid expansion would also be changed or stopped. As a result, 22 million people who got insurance under ObamaCare would be left without it. On the contrary, Trump’s plan to allow companies to sell insurance state to state and change taxes on health care policies suggests that it would only help a projected 1 million people. These are the kind of numbers that result in people chanting “Healthcare Not Wealthcare” in the streets.
What About Pre-Existing Conditions?
Like ObamaCare, Trumpcare would require all health insurers to cover people who apply regardless of their medical history or pre-existing conditions. But as we dive into what ‘pre-existing condition’ means, the waters become muddy. Under ObamaCare, you could be denied health insurance if you had a history of anything from asthma, high blood pressure, or chronic back problems to diabetes, pregnancy, or cancer.
These concerns will still stand should the AHCA become law and so the real issues lies in how Trumpcare will offer coverage for pre-existing medical problems. And these are two of the most talked about options that the AHCA could put into place:
Establish high-risk pools that save insurers money: States could apply for a waiver (as per the McArthur Amendment) from the requirement to offer health insurance without medical underwriting
If a person with a pre-existing condition allows their health insurance policy to lapse, then they could be charged 30% more by the insurance company when they sign up for another plan later
Here’s a look at the excessive list of pre-existing conditions from the Kaiser Family Foundation:
(Click the highlighted conditions for effective, inexpensive, natural remedies should you not get coverage)
AIDS, HIV, lupus, alcohol and drug abuse with recent treatment, severe mental disorders such as bipolar disorder or an eating disorder, Alzheimer’s disease or dementia, multiple sclerosis, rheumatoid arthritis, fibromyalgia, and other inflammatory joint disease, muscular dystrophy, cancer, severe obesity, cerebral palsy, organ transplant, congestive heart failure, paraplegia, coronary artery or heart disease, bypass surgery, paralysis, Crohn’s disease, ulcerative colitis, Parkinson’s disease, chronic obstructive pulmonary disease or emphysema, pending surgery or hospitalization, diabetes mellitus, pneumocystic pneumonia, epilepsy, pregnancy or expectant parent, hemophilia, sleep apnea, hepatitis C, stroke, kidney disease, renal failure, and transsexualism.
To make purchasing a health insurance plan even harder, ‘pre-existing conditions’ can also include:
Acne, allergies, anxiety, asthma, basal cell skin cancer (a type of skin cancer that doesn’t tend to spread), depression, ear infections, fractures, high cholesterol, hypertension, incontinence, joint injuries, kidney stones, menstrual irregularities, migraine headaches, obesity, restless leg syndrome, tonsillitis, urinary tract infections, varicose veins, and vertigo.
On the surface of American health care, the basic benefits many people seem to need are available. However, be sure to research the nuances because these services are covered to varying degrees depending on where you live. It’s unfortunate that we have to worry about nitty gritty details such as these, but that’s the world of insurance. Since ObamaCare is the current health care system in place, we go into more detail about natural alternatives for what it doesn’t cover below.
9 Health Services that ObamaCare Doesn’t Cover (and Natural Medicine Alternatives)
Under each one, we list resources to natural medicine and approaches that you can use to treat yourself. Oftentimes, we don’t need drugs or a trip to the emergency room to treat our issues. Instead, alternative therapies, natural medicine, or a simple glass of water will usually make a world of difference without any of the nasty side effects. You’ll see as we delve into the following list.[6,7,8,9]
1. Long-Term Care
When it comes to illnesses or accidents, those with health insurance should have no issue getting coverage. But, ironically, ObamaCare does not cover the long-term care that comes as a result of said illness or accident. This refers to the assistance you may need with dressing, eating, and bathing.
Because of this, many families must resort to extra long-term care or life insurance policies which means spending more money. Let’s say you want or need to stay at a nursing home in a semi-private room. You’ll be looking at an average cost of $6,844 per month (and more if it’s private)! If you’re still somewhat independent but require in-home care, the monthly cost is still quite steep at $3,861.
MEDCottages (or ‘Granny Pods’) are a perfect and potentially more cost-effective route for someone requiring long-term care. It gives families an opportunity to remain close to the member who’s in need while allowing them to maintain some of their independence and dignity. You can learn more about Granny Pods here!
2. Dental Care
Oral health is an essential health benefit, but one that stops once you turn eighteen. After that, adults get their dental coverage elsewhere. Some marketplace health insurance plans do take care of your teeth and gums, but you must buy it at the same time you buy your health insurance.
Natural Medicine Alternatives
3. Vision Care
The same age bracket applies to vision care as dental. Unlike dental care, however, anyone seeking vision coverage may need to look outside of the marketplace. Instead, they’ll buy a plan directly from an insurance company or through an insurance agent or broker.
Natural Medicine Alternatives
4. Weight-Loss Surgery
One study estimates that the obesity epidemic accounts for about 18 percent of deaths in America, so it may be surprising that ObamaCare wouldn’t cover this kind of surgery.
While weight-loss surgery is a controversial topic for some, for the morbidly obese, bariatric surgery can be a life-saving procedure. However, if you are considering a weight-loss surgery, it costs $16,000 to $42,000 on average. That’s a figure which many people could not or would not spend. But there have been incredible body transformations made possible by hard work, eating right, and commitment to self.
Natural Medicine Alternatives
5. Alternative Medicine
There are many types of alternative medicines and therapies that ObamaCare won’t cover. The funny thing is that these apparent age-old “unconventional” approaches to medical care are often ones that Naturopathic Doctors and other health care practitioners use – successfully, too!
Some states – California, New Mexico, Washington, and Maryland – have made acupuncture an essential health benefit that marketplace health insurance plans cover. While this is definitely a small step forward, there is still a long way to go before the rest of the world sees natural medicine as a trusted, reliable, and arguably necessary alternative.
From acupuncture to aromatherapy, chiropractic care to massage therapy, and sound therapy to herbal remedies, you have other cheaper, healthier alternatives.
Natural Medicine Alternatives
6. Certain Medications
While ObamaCare lists prescription drugs as an essential benefit, this doesn’t guarantee that you will get the exact drug(s) you need. Insurance providers don’t necessarily cover every single prescription medication.
In fact, the nation’s two largest pharmacy benefit managers – Express Scripts and CVS Health – recently removed a total of 239 prescriptions from their formularies. Some of these drugs include ones for cancer, hepatitis, asthma, and arthritis. Instead, they’ll probably prescribe you generics that are cheaper (which will ideally help you spend less).
Natural Medicine Alternatives
7. Cosmetic Surgery
If you want to change your physical appearance solely based on aesthetics, you’re out of luck with ObamaCare. So you may want to start saving for that nose, breast, or buttock job you’ve been thinking of (But don’t – you’re beautiful the way you are). You’ll be looking at an average cost of $4,332 for a breast lift or $4,633 for a buttock lift.
In cases where someone has severe burns, his or her health care plan may consider covering the necessary procedures. But for now, let’s focus on the inexpensive alternatives that can help you look and feeling younger.
Natural Medicine Alternatives
8. Infertility Treatments
These have been historically excluded from health insurance plans. To date, only a couple of states offer marketplace plans that include infertility treatment coverage. According to The National Infertility Association, however, six states consider these treatments to be an essential health benefit. They include Massachusetts, Illinois, New Jersey, Rhode Island, Connecticut, and Hawaii.
Getting a diagnosis test usually costs a few hundred dollars. In addition, fertility drugs can cost hundreds to thousands of dollars while in-vitro fertilization (IVF) will cost an average of $10,000.
Another controversial topic, there are currently twenty-five states whose marketplace health insurance plans do not cover abortion. Those that do tend to restrict exceptions to cases of rape, incest, or endangerment of a woman’s life. There are also six states that offer no abortion coverage at all.
The states of Hawaii and Vermont offer some plans that will cover a pregnancy termination. Though the cost of it can start from $400 and go up to $1,650. (Prices vary depending on the state, the facility, and how long the woman has been pregnant for.)
Disclaimer: This information is not intended to be a substitute for professional medical advice, diagnosis or treatment and is for information only. Always seek the advice of your physician or another qualified health provider with any questions about your medical condition and/or current medication. Do not disregard professional medical advice or delay seeking advice or treatment because of something you have read here.