A Pro-Single Payer Doctor’s Concerns About Obamacare

By Adam Gaffney for Salon

As a single-payer advocate who is also a doctor, I was concerned after the Affordable Care Act was passed that it didn’t do enough to combat rising underinsurance. A recent study by the Commonwealth Fund, which used new data to demonstrate that in 2012 some 31.7 million Americans were underinsured (i.e. insured, but still with heavy additional out-of-pocket health care expenses), argued that the burden of underinsurance will likely lessen as the ACA fully unfolds. But is there really reason for such optimism?

This is a complicated issue with many moving parts, so one way to tackle it (before immersing ourselves in the exhilarating policy literature) is to pose a simpler question: if your family is insured, and someone gets seriously sick, can you not worry about going broke?

The short answer: it depends on how much you have in the bank, and on the “out-of-pocket maximum” established by the ACA for your particular plan. The out-of-pocket maximum is the most that you would have to pay (after premiums) on things like co-pays for medications or deductibles for hospitalizations, and it can go as high as $12,700 annually for exchange plans under the ACA. But doesn’t the law provide protection for lower-income individuals, for instance, in the form of reduced out-of-pocket limits? The answer is yes – but to a lesser extent than we initially thought, even though, somehow, no one informed us that things had changed.

Continue reading…


  1. mike russo on April 23, 2014 at 3:57 pm

    All I know is that all people need and have a birthright to complete and comprehensive lifetime all purpose health care, period! Health care for all regardless of income or lack of it, that should be a common place thing, is way past due. the fact that we have to still be talking about it is beyond believe, disgraceful, obscene and an abomination of the worst kind. While we talk about and discuss it people are dyeing, suffering and going broke. Enough is enough, get the word out to the whole country and let people know what is at stake and unforgiveable. let’s wake up and smell the roses for the sake of sanity!!