Last week, it accomplished both—but not the way I expected.

Many people call the Affordable Care Act a great success that only needs minor adjustments. So when I picked the title of last week’ issue, How to Survive the Obamacare Collapse, I thought some people would be upset that I questioned its viability.

Oddly, that didn’t happen. I got more than 60 responses, and no one even tried to defend Obamacare.

Apparently, we all agree it’s not working. What we mainly disagree on are the reasons—and the best strategies to fix it.

The fact is, if Obamacare isn’t available in 2018, or is so expensive no one can afford it, millions of Americans will have no health insurance.

I asked for ways to reduce and control this risk, and readers responded. Today, I’ll share some of their ideas.

Insurance Hacks

I suggested looking for short-term medical coverage if Obamacare becomes unavailable in your area. Reader Mike E., a Colorado insurance broker, added some details.

Temporary insurance will probably continue to be available since it's not under the ACA restrictions. But there are several caveats:

Not only will it not cover preexisting conditions, many of the temp insurance carriers will deny any coverage if you show preexisting conditions on your application form, even common things like moderate hypertension. Leaving such details off the application is a risky prospect, because the carrier can deny all claims if they find you've falsified information. And if they're receiving major claims, they'll probably look for a reason to deny them.

The biggest downside is the total benefit limit. As far as I know, there are no plans available with a limit above $2 million. Nonetheless, temp insurance is a good option if you can qualify.

Some readers may be in a position to change their permanent residence (e.g., to a second home). Traditionally, the choice of which to use has been based on state tax rates, but now access (and cost) of health insurance may be a bigger factor.

We have been selling quite a few “microgroup” plans, partly because group insurance is the only way to get a PPO plan in Colorado for 2017. Generally, the carriers require at least two participants, one of whom has no ownership stake. (Some carriers apply other rules, including whether 1099 employees are eligible and count.) Apparently, the working population is overall considerably healthier than the non-working population, and thus the group health insurance market hasn't seen the turmoil that the individual market has.

On small-group insurance, Ray H. said to consider using a PEO, Professional Employer Organization—what was once called employee leasing. I’ve been such an employee before (of John Mauldin, actually, many years ago) and we had big-company-style benefits. It’s worth investigating if you are self-employed.

Another idea: Go (or go back) to school. Some community colleges have student group health plans open to part-time students of any age. The rates are low because the group is mostly young—but you have to be a legitimate, enrolled student and pay tuition. That might outweigh the lower premiums.

Healthcare Cost-Sharing

From Richard J.:

Many thanks, Patrick for your letter this morning; it's right on. And thank you for finally mentioning the religious healthcare alternative, which is getting little to no mention at all. I am relatively healthy and have been with an alternative care for 2 years now.

The savings are huge, bigger than all my investing profits during the same time, and if you’re healthy and following the suggestions in your letter, it is smart, it feels good to help others, and it's good to know some program that really works is behind you. Keep on doing the good work.

Richard refers to the handful of religious cost-sharing cooperatives that received a special exemption in the Affordable Care Act. Participating in one satisfies the Obamacare individual mandate even though they are not “insurance” per se.

So what are they? Here’s a succinct description from US News:

Begun more than 20 years ago as an alternative approach to managing growing health care costs in the U.S., members “share” in medical bills instead of paying for insurance. In some ministries, participants receive a letter about another member’s medical bills each month and send a check for a set amount directly to that member. Sometimes they include notes of encouragement, Bible verses, or even gifts.

The ministries are big cooperative agreements in which people help each other with medical bills. There’s no guarantee you will get help when you need it. Nonetheless, several readers reported good experiences, so check it out. You can learn more in the article linked above and also at the Alliance for Health Care Sharing Ministries site.

Doctor’s Orders

From Bill B., a retired physician:

If you have insurance now:

1. Be sure your blood pressure is under control. Strokes and heart attacks are horrifically expensive to treat.

2. Get your skin examined by a dermatologist; skin cancers are exceedingly common, especially in sun-exposed areas. Treatments can be expensive.

The skin exam is something people forget. My wife Grace is a longtime hair stylist. Many times, she’s seen an unusual spot on someone’s head and urged them to get it checked. Usually the spots were nothing—but some turned out to be malignant and could have been fatal, had the person not sought treatment.

If you have insurance, it likely includes a free annual wellness visit with a primary care physician. Use that benefit now… while you still have it.

Get Off the Carbs

Here’s some good input from Michael S., via Facebook:

Let's be honest about the #1 cause of our “high health care cost—poor results” situation. It is the terrible eating habits of our population, greatly influenced by the government’s suggestion to reduce fats in our diets. The reduced fats were replaced with poor-quality carbohydrates and sugar, and that has led to increasing rates of obesity in the population and declining health.

We can do things to try to improve our quality of healthcare and reduce its cost, but until we acknowledge this #1 problem, we are pushing the rock up the hill.

I don’t know if it’s the #1 cause, but clearly our sedentary lives and poor diets are major problems.

But can changing them reduce your financial risk? I think so.

Several readers pointed out that the American diet is much worse than those in other countries where medical costs are lower. There’s a reason for that.

Food and eating habits spring from geography. For instance, tropical island cultures eat lots of fish and fruit because that’s what is handy. Subarctic cultures eat a lot of fat from whale blubber and walrus.

Here in the US, our native foods are carb-heavy grains. We eat lots of corn and wheat because our Great Plains are the ideal environment for growing them, and we have a river system to ship them.

Alas, the refined grains we eat are turned into sugars by the human body. Add to that a car-based culture where people don’t walk as much, and we’re set to gain weight.

Worse, you can be obese and malnourished at the same time: according to a 2015 Guardian article, 85% of Americans don’t consume enough of the most important vitamins and minerals necessary for proper physical and mental development.

So we develop diabetes, joint problems, high blood pressure, heart disease, and more. And in the last decade, the costs of treating these conditions have exploded.

Quick personal anecdote: About eight years ago, I was 40 pounds overweight. What helped me was a doctor-supervised low-carb diet called Ideal Protein. Over time, it changed my eating habits, so I lost those pounds and kept them off.

Yoga helped too. Your head needs to be in the right place, or nothing will work.

If you’re struggling with weight loss, stick with it. Losing even a few pounds will help reduce your health risks.

Look Abroad

From Kenneth S.:

One alternative would be to look at other countries. Particularly if you have relatives you can stay with or want to vacation in an area. Friends have had prostate and carpal tunnel surgery in Colombia at a cost less than the co-pay on their insurance. Their experience has been as good as any friends’ with similar surgery in the US.

I’ve heard of this. Some hospitals in Thailand, for example, reportedly deliver US-quality treatment at a fraction of the price. The savings are enough to pay travel expenses, too. This will no doubt become more popular if Obamacare falls apart.

Breaking the Logjam

I hope these ideas help. As I said, there’s a time to debate better systems, but right now I am more concerned about 2018. It may take a major crisis to break the political logjam.

Thanks again to everyone who sent in ideas and comments. I may not have shared yours, but I read them all.

See you at the top,

Patrick Watson
@PatrickW

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