Tuesday, August 16, 2016

Unaffordable health care

It wouldn't be a plan if I didn't talk about money. In my love of breaking things down into subtopics, and sub-subtopics, I will refrain from talking about that elephant in the room but rather its spawn: HEALTH CARE. It's a pretty big expense in my plan to go solo.

Those of you who know me will probably stop here: "Oh no, a political post." Yes, it's political because it involves policy, laws and regulation. Please keep reading. This is one person's experience with the American health care funding system. Yours might be different, especially if you are working full time, but I suspect that my situation is pretty representative of what people on Obamacare are experiencing.

Let me start with a disclaimer: I am glad we have the ACA, or its nickname, Obamacare. Without it, I would be on COBRA, which is an acronym when laid-off employees pay to continue the health plan they had when they were employed. 16 years ago, COBRA was about $300 a month for one person. That cost has since tripled, and I am supporting two of us.

The ACA provides a subsidy, based on income, to health care insurance premiums. If your income is low enough, you get almost-free health care: Medicaid or, for your child, the state Child Health plan (CHIP), a program which Hillary Clinton was instrumental in developing in the 1990s. ACA also prohibits insurance companies from refusing people based on their medical history, age, etc. It also enables parents to keep their children on their health insurance plans until (I think) age 26.

Now, ACA stands for "Affordable Care Act." What the law did NOT do was make health care affordable to the average person paying for it - the unemployed and the self-employed who support their families.

It is unaffordable in two ways. Firstly, the cutoff salary for Medicaid/CHIP is low. Because I was working for the first half of this year and presumably will get Unemployment insurance for the rest of the year, on paper it looks like I am earning an ok salary even though I am out of work for the near future. I missed the Medicaid and CHIP cutoff by only $3,000 dollars - as a result, I will be paying about twice that in premiums.

Also, because of the way the tax year fell (half a year full-time employment plus half a year unemployment insurance although next year I will have neither), my subsidy will be lower. My government subsidy (based on an income this year of $45,00) for a third-tier, Silver plan (they go by Platinum, Gold, Silver and Bronze) for the two of us is about $260 a month. I am paying the rest, about $420. This does not include dental or eye for which there are no subsidies, and does not cover much in the way of therapy. If I figure in our uncovered expenses, I wind up paying at about $650 a month. If I were on COBRA, it would be twice that, but still!

Next year, my income will be much lower because I won't have any more unemployment insurance and I will just be starting out as a new indexer, but my daughter will only have one year on Medicaid before turning 18, and after that she has to be insured again through private companies.

Also, because of the second problem (below), health insurance rates will be much higher.

The ACA leaves costs in the hands of for-profit companies - the health insurers and the drug companies. Not only does it make it unaffordable to begin with, but those companies have been gradually pulling out of providing ACA plans because their profits aren't high enough. The remaining insurers keep upping their rates - in fact they are now saying that come November, they will raise rates around 25 percent. So, assuming that after a couple of years I am earning enough to go back to an ACA plan, I will still be paying through the nose while earning, if I am lucky, $45K a year.

In Western Europe, Canada, Australia and Israel, there is universal health care and costs are contained by government regulation - their systems aren't identical but basically, they recognize that health care should not be a for-profit endeavor and that all citizens should have it. Insurance companies are so entrenched in the American system, however, that Obama came up with a compromise proposal: What is called the "public option." Here, they would be able to sign up for a government-administered program which would be non-profit.

This isn't revolutionary. Such a program already exists under Medicare and Medicaid, which aren't perfect but my parents' generation depends on it. However, the Republicans in Congress shot the public option proposal down, and Obama went along with it just to get ACA passed.

The excuse for opposing the public option is that it would require raising taxes or closing loopholes on the super-rich. Good. Tax rates for top earners need to go back to what the GOP used to consider normal. But would taxes also go up for ordinary citizens to cover universal, nonprofit health care? Yes, it would, but I don't ever hear Canadians or West Europeans asking to switch their way for our way.

In any case, here we have it: Unaffordable. High rates, low cutoffs for Medicaid, insurers pulling out or raising rates. The Republicans are saying: See, Obamacare is a failure. The Bernie Sanders Democrats are saying See, Obamacare is a failure. They are right, but for entirely different reasons, and with opposing proposals on how to deal with it.

Obviously, I am all for some form of public option. Like my previous post on vacation time, I note that my attitude is shaped by my experiences living and traveling in countries like Holland and Israel (and having Canadian friends) and other West and North European countries. One of my pet peeves is American voters who permanently live outside of the U.S. and aren't affected by its domestic policies and yet vote against public services for people who DO live here.

I was chatting with an old friend from outside the U.S. a few days ago on an unrelated subject. Being that she is also Jewish and in the divorced crowd--where there are a lot of angry, unemployed or underemployed men who think Trump will save them--she had been getting a steady diet of Obummer/Killary/Trump-as-messiah in her social media feed. She seemed to believe what they were saying. So I asked her about health care in her country. She raved about it, how helpful it has been for her - and recalled how horrible the American system was in that so many people didn't have health insurance.

I pointed out what most non-Americans would NOT know: That it was Hillary Clinton who spearheaded the move toward universal health care in the 1990s - and that she failed, except for CHIP, because of Republican opposition. That that opposition was the start of all of the conspiracy theories against her that persist today. That it was the GOP-led Congress has had no solutions to the country's failure to provide affordable health care, and that Trump (in addition to his other, um, problems) isn't any better.

I think a light bulb went off in her head. She hadn't known all that (and it's true, if you don't live here or of are a certain age, you wouldn't necessarily know).

So here I am, on an unaffordable plan, but I wouldn't want it to be dismantled. One of the chief arguments against the ACA was that it would result in people working less. I can say for myself that this is true. I would still be in a career that was killing my health, just to have health insurance, under the old way. Now, I can gradually train to and start my own business knowing that, even if it is expensive, we are insured. Supposedly, about a third of Americans are working freelance and/or own their own businesses. Tying good, affordable health care only to full-time, permanent jobs makes no sense in a world with fewer and few full-time, permanent jobs. American culture worships the entrepreneurial spirit, but you can't succeed in your own small business if you can't afford health care for yourself or your employees.  Even employees at behemoths like Wal-mart wind up getting public assistance. The American entrepreneurial spirit is stymied by the lack of affordable, universal health care.

There are many, many reasons to NOT like Obamacare. It isn't sustainable in its current form - there has to be a public option, loopholes have to be closed and/or it needs to be reshaped into a combination of government regulation and free-market like the Dutch have.

The case of another friend, an American who has been adversely affected by the ACA: She worked part-time for a company which, because of something in ACA, had to offer a plan. So they did. A really bad one which covers almost nothing. But her husband's company then enacted a rule that said if one's spouse has the option of another insurance plan, they have to take said spouse's plan (even, as in this case, it covers almost nothing). So keep her husband's plan for the family, she had to quit her job, thereby lowering their income significantly.

I told my dad, who said it should be the company that is blamed for this policy that hurts its employees. Okay, yes, but a change to ACA could put a stop to this. Either you demand that companies offer plans with decent coverage, or don't demand it at all. Or, if you have the public option in place, then you don't have to go with a company plan at all and still get a good plan.

One reason I'm glad Sanders ran was that he made it acceptable again to talk about the public option; he was not afraid to point out that health care is still not affordable for many. I'm not sure if Clinton would have put it on the platform otherwise, because ACA has put Congress in a state of ongoing hysteria, but she did. I hope she picks her battles, though. Right now there is a lot of talk about various domestic policies - paid leave, college costs, what constitutes a livable wage, civil rights. I realize that a platform should not be about one issue - although Israel ranks high on my list I am not a single-issue voter. But I feel like fixing the ACA and environmental issues are not being prioritized. To me, a healthy public and a healthy planet make for a positive world - and what happens in American affects that world significantly.

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