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You are here: Home / Anderson On Health Insurance / Meet the Brady Family

Meet the Brady Family

by David Anderson|  November 15, 20131:04 pm| 96 Comments

This post is in: Anderson On Health Insurance, Politics, World's Best Healthcare (If You Can Afford It), All we want is life beyond the thunderdome, Nobody could have predicted

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I’ve been in correspondance with a commenter for the past few weeks about a situation where someone under Obamacare may be made worse off or at least no better off and I want to highlight the story as it is intriguing, real and verifiable facts.  I’m changing some names and fudging some details to protect her family’s identity but I have high confidence in the validity of the situation.
 
The Brady family has a working mother in who if Sen. Lieberman did not engage in needless hippy punching would be eligible for expanded Medicare buy-in, Carol, and four lovely girls including the commenter in question.  The commenter is out of the house and on her own and has been for a while.  In 2013, Carol has been providing health insurance coverage to the three youngest who range in age from 20 to 25.  Carol’s method is a bit unusual.  It has worked well enough for her.
 
Carol works at a barbecue restaurant chain for roughly twenty five hours per week.  At this chain, she is offered and has been using a “mini-med” plan which has cost her $50 per week ($2,600 per year) and has an annual family limit of $3,000 in benefits.  This type of plan is being phased out as the coverage does not come within 500 miles of meeting minimal acceptable coverage requirements.  Carol also works at the local school district for rougly twenty five hours a week.  The school district has been offering a family plan with no premiums but a $3,000 deductible and some co-pays and but no co-insurance.  Carol has also been using this plan.
 
In 2013 and in previous years, Carol has patched together rather comprehensive health coverage that functionally looks like a Medicare plus Medicare supplemental package where her base insurance is the school district major medical policy but the BBQ chain mini-med fills in the deductible so she effectively had a no-deductible and minimal co-pay plan for roughly $2,600 a year.  Carol is a smart and thrifty woman.
 
This system will not work in 2014.  As I mentioned before the mini-med plan offered by the restaurant is being phased out for 12/31/13.  The BBQ restaurant is offering a Bronze compliant plan that will cover a family but cost roughly $500 a month ($6,000 per year) (verified by looking at comparable Bronze plans on the relevant Exchange) and have very significant deductibles.  The school district is offering a family Silver analogue with a $3,000 deductible and 20% co-insurance with an out of pocket max of $5,000 for $40 per month ($480/year).  Given past medical history, Carol is lookling at spending $4,000 between premiums, deductibles and co-insurance if 2014 is exactly like 2013.
 
Going forward to 2014, Daughters # 2 and 3 (Marcia and Jan) are moving out of the house and off Carol’s insurance.  Marcia will be covered under an employer policy and Jan has already signed up for expanded Medicaid.  Cindy is still at the house as a 21 year old non-student. Obamacare under first blush will cost Carol an extra thousand dollars or more to cover her and Cindy for equivelent services due to the deductible.
 
Carol can not collect subsidies on the Exchange as she is already being offered an affordable coverage option that meets PPACA requirements through her employer (the school district.)  The BBQ restaurant is offering compliant coverage but it is not deemed affordable.  If the school district was not offering affordable coverage, Carol’s income would qualify her for a very substantial subsidy plus significant cost-sharing assistance.  She would have been breaking even or significantly better off.
 
I went back and forth with the commenter several times on alternatives. The first option is to speak with a navigator or an insurance broker.   A promising alternative is to move Cindy to Medicaid if she is eligible (minimal income but lives at home, so she may count as a dependent but she does not have any disability besides a proclivity to use irony as the default conversational setting).  This move would reduce Carol’s premiums to zero as the school district still offers individual coverage without premium and it would reduce her deductible slightly.  Even in this case, assuming all of the moving parts works, Carol would most likely be breaking even on just covering herself compared to covering 4 people in 2013 for the same budget.
 

This is an unusual situation but it is not a scenario where people who need help getting affordable health insurance will be getting significant help.  This is a very low probability case but it is a legitimate problem.  And as far as policy fixes, allowing Carol to go to collect subsidies on Exchanges would be facially attractive, but systemically, this is a massive swipe at the employer sponsored health care model instead of the mild tilt against employer sponsored healthcare model that the rest of PPACA so it would not fit with the the other PPACA moving parts and general operating assumptions.

Finally, the commenter made a very good point about information and choice overload for people operating from a standpoint of scarcity:

One thing this doesn’t convey is the stress this is having on the
working poor. Not every one has a kid like me who will pester someone they met on the internet until they get an answer…

It’s equally important to understand the disruption this is going to
have on the working poor. These are people who have constructed a patchwork of coverage that, while considered shitty by some, actually provides them with healthcare. Further add that these people don’t tend to have a lot of time to sort things out, may have to make elections by the end of November  — imagine having to make a decision to go with your new employer policy or something from an exchange if you lived one of the states that have essentially no access to healthcare.gov. Even with access these changes are still very confusing for people. For the working poor, this can become very stressful.

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Reader Interactions

96Comments

  1. 1.

    some guy

    November 15, 2013 at 2:00 pm

    3 words: Medicare For All. problem solved, the end.

  2. 2.

    Belafon

    November 15, 2013 at 2:03 pm

    This is indeed a problem. It should be taken to Congress as an example of something that needs to be tweaked. Then the president can sign the fix.

    To be more serious, is she doing the jobs because that’s all she can find, or is she working the two jobs in order to piece this type of health care together?

  3. 3.

    Belafon

    November 15, 2013 at 2:05 pm

    @some guy: Actually, I think the ability to never get injured or sick would be even better.

  4. 4.

    David in NY

    November 15, 2013 at 2:10 pm

    “people who have constructed a patchwork of coverage”

    I doubt that many have been in a position to construct a patchwork of this kind. My only real evidence, however, is the number of times in a community I frequent in upstate New York that I have seen collection bottles on store counters asking for quarters, or dollars, or more from kind neighbors or total strangers to pay for little Jimmy’s medical bills incurred by a hospitalization or the like.

    I do not mean to suggest that Cindy’s problem is unreal. Or even that the change in systems is not unsettling for people having difficulties anyway. But those bottles attest to the fact that lots of people of modest means could not construct a reasonable health care plan out of current offerings.

    I’m for medicare for all, personally — maybe that’s the patch the ACA needs as an option to cover these cases (I am not qualified to assess the feasibility of such a stopgap, however).

  5. 5.

    some guy

    November 15, 2013 at 2:13 pm

    the first step would be to introduce a bill to lower Medicare eligibility to 55 in the Senate. get everyone with a D after their name on board. Next year re-introduce the bill, lowering the Medicare eligibility to 50. When the insurance companies and Big Pharma and AHIP see this threat to their business model isn’t going away you’ll be amazed at how quickly the confusion and issues with ACA get cleared up, lickety split.

  6. 6.

    Richard Mayhew

    November 15, 2013 at 2:13 pm

    @some guy: Really — Medicare for All (assuming no significant plan designs changes for premiums) would make this family worse off (Part B Premium of $104/month/person, Part A premium up to $426/month/person)

    Sure, bring in a younger and cheaper risk pool, those numbers come down a little but I’m assuming some age banding as we don’t want the 22 year paying full freight so call it $400/month per person with a $1,350 per person deductible and significant co-insurance costs. Throw in $35 per month for Part D per person and Donut Hole exposure of $1,800 plus $350 Part D deductible, Medicare Care for All looks like the following for 1 person without significant subsidies for Part A/B premiums.

    $5,200/year in premiums
    Combined $1,600 deductible
    20% co-insurance
    $1,800 co-insurance max for drugs
    No co-insurance max for Part A/B

  7. 7.

    guachi

    November 15, 2013 at 2:14 pm

    So am I reading this correctly that her insurance costs on 2013 are $2,600. They will increase to a minimum of $480 but will almost certainly be higher as she might, you know, actually use that insurance. Her estimate is that her costs, if 2014 is identical to 2013, will be $4,000 under a new plan.

    Her costs, therefore, are $1400 higher per year. If this is typical then an average year her insurance will be worse than before (same benefits, higher costs).

    Are there any circumstances where the new insurance will be better than her old insurance? Perhaps a catastrophic illness?

    I’m very glad I’m in the military and so is my wife. Dealing with all the possible permutations to get the best insurance sounds like a real headache.

  8. 8.

    piratedan

    November 15, 2013 at 2:14 pm

    seems to me that since she’s not a “full time” employee that there should be some subsidy value in play here

  9. 9.

    Lex

    November 15, 2013 at 2:21 pm

    “but she does not have any disability besides a proclivity to use irony as the default conversational setting.”

    Not to make light of the family’s situation at all, but that’s not a disability. That’s a freakin’ gift.

  10. 10.

    kc

    November 15, 2013 at 2:21 pm

    I feel for her. Thanks for highlighting this, Richard.

  11. 11.

    Richard Mayhew

    November 15, 2013 at 2:21 pm

    @piratedan: Carol’s school plan is a qualified plan and her out of paycheck payment for individual coverage is zero dollars. Therefore under PPACA, she is deemed to have affordable qualified coverage and thus is not eligible for either subsidy on the premium or cost-sharing assistance.

    She would be far better off if she was not offered health insurance through the second job as she could have gone on the Exchange with a very big subsidy value and cost-sharing assistance.

  12. 12.

    Belafon

    November 15, 2013 at 2:22 pm

    @some guy: Since these won’t pass a Republican controlled House, what kind of threat would they be?

  13. 13.

    Just Some Fuckhead, Thought Leader

    November 15, 2013 at 2:22 pm

    Can we savage this anonymous person for not giving a shit about the 50 million people who didn’t have health insurance prior to PPACA?

  14. 14.

    Another Holocene Human

    November 15, 2013 at 2:23 pm

    OT: I called Rep Corinne Brown’s office to thank her for having the President’s back. I talked a little bit about what was going on in my county and kind of lost it emotionally and started crying. It really PISSES ME OFF that there are only 2 Navigators for our entire county and they’re stuck in a side office. Plus the local radicals scoffed at going door to door like organizers are doing in South Florida because they’re still stuck on their #ragequit over the public option. THAT WAS FOUR YEARS AGO–FUCKING GROW UP. Anyway, I told her if anything could be done to start a volunteer effort, I volunteer. Though, that was probably pointless since Brown doesn’t “do” legwork what with her having one of the safest of safe districts. She does constituent services and I’m sure that is chugging along, but not everybody thinks to call a district office (especially young people). I’m a big believer in going to where people are.

  15. 15.

    Gene108

    November 15, 2013 at 2:24 pm

    @some guy:

    What Medicare? Part A, B, C or D?

    Part A ain’t all that so we keep adding onto it.

  16. 16.

    Richard Mayhew

    November 15, 2013 at 2:26 pm

    @guachi: She is better off if she only uses no-cost share services in 2014 (unlikely given age and health condition (good for someone her age, but someone her age has conditions). Her break even point is roughly $2,000 in deductible usage

  17. 17.

    piratedan

    November 15, 2013 at 2:26 pm

    @Richard Mayhew: so I assume that there’s not a better plan available thru her employer that is an upgrade to allow more coverage that wouldn’t end up hurting her more financially?

  18. 18.

    Roger Moore

    November 15, 2013 at 2:30 pm

    @some guy:

    3 words: Medicare For All. problem solved, the end.

    I have an even better solution: Medicare and ponies for all. Approximately as likely, and even better.

  19. 19.

    Another Holocene Human

    November 15, 2013 at 2:32 pm

    This is an unusual situation but it is not a scenario where people who need help getting affordable health insurance will be getting significant help. This is a very low probability case but it is a legitimate problem. And as far as policy fixes, allowing Carol to go to collect subsidies on Exchanges would be facially attractive

    Yup yup yup. Effectively, it’s going to mean the end of employer-sponsored family plans except if you have a really niiiiiice job. The upshot is that the cheapo employers have dropped most of the subsidy for those plans anyway, which is why the individual coverage is always affordable and the family coverage isn’t. This is exactly what I worked out.

    The tricky thing is it isn’t always clear that people will keep their doctors by switching plans, a concern for some parents with kids who have existing conditions. However, I don’t know of anyone who had come up with such an ingenious fix as your example.

    I wonder if such a product could still be sold as a supplemental insurance–? Though it seemed more like a health layaway plan. $2600/year to cover up to $3000 in costs? Sounds like the school system ought to implement an FSA or HSA (whichever one is for lower deductibles and takes your money away at the end of the year–NOT a good system but actually exactly like that crap BBQ restaurant insurance in that if you didn’t spend $3k or even $1k it’s not like you got refunded) so she can lay away that $100 from each paycheck and pay the copays with an FSA card. Oh, and it’s a tax deduction so you save a few bucks there too.

    What do you say, Richard?

    Heck, maybe the school system has one of those buggers already.

  20. 20.

    Richard Mayhew

    November 15, 2013 at 2:33 pm

    @piratedan: From my understanding of the situation, the restaurant offered a bare bones Bronze with almost no company share, and the school district offered only a Silver with a very significant employer premium payment.

  21. 21.

    catclub

    November 15, 2013 at 2:34 pm

    She really needs just one plan that all her premiums go into, but because she has two jobs, and each has different insurance providers, that does not / cannot happen. This shows that even the ACA assumes single jobs, not multiple jobs, so is behind the times.

    I think the school – no premium insurance – last year, but then big premium this year is a change that is
    more due to the school than the ACA. Adding in that she is now going to put one of her daughters on that plan makes it even more difficult to compare like with like.

  22. 22.

    Yastreblyansky

    November 15, 2013 at 2:35 pm

    @Richard Mayhew: A case where broader access to the Marketplace would be better than Medicare for All! It strikes me that there must be many such cases. Hopefully more companies will emulate Trader Joe’s and pay the fine specifically to allow their employees into the exchange. http://www.washingtonpost.com/blogs/wonkblog/wp/2013/09/16/trader-joes-cut-health-benefits-last-week-heres-its-side-of-the-story/. Slogan for the next phase of health insurance reform (and it would have been better to make it the first): If you hate your plan you can dump it.

  23. 23.

    FlipYrWhig

    November 15, 2013 at 2:38 pm

    @some guy:

    3 words: Medicare For All. problem solved, the end.

    So by your plan, instead of the 5% of America that has to figure out what to do differently with their insurance, now 84% will: everyone except the people already on Medicare. Well, I’m sure that’s bound to be complaint-free.

  24. 24.

    ruemara

    November 15, 2013 at 2:38 pm

    @Belafon: We are all Wolverine now.

    Everything is stressful for the poor and working poor. Moreso if you live in a red state. Not sure how this can be fixed fairly, then again, it’s kinda the history of the US and it’s social safety net, no?

  25. 25.

    Richard Mayhew

    November 15, 2013 at 2:38 pm

    @Another Holocene Human: Yep, that is one of the probable avenues of approach for Carol — set up an FSA for maybe half her deductible value. The problem is she makes enough money to be taxed but not taxed too heavily, so the tax savings are not substantial.

  26. 26.

    Richard Mayhew

    November 15, 2013 at 2:40 pm

    @catclub: In 2014, the school is offering a Silver plan with $0 premium for single employee coverage or roughly $500/year for employee plus one.

    PPACA does not assume single jobs in its design. It was assuming that not too many part time jobs would offer compliant and affordable coverage (a reasonable assumption, but this is an edge case)

  27. 27.

    ? Martin

    November 15, 2013 at 2:46 pm

    @ruemara:

    Not sure how this can be fixed fairly, then again, it’s kinda the history of the US and it’s social safety net, no?

    You fix it fairly by raising wages. All of the above problems vanish if you do that.

    And most Americans support that solution.

  28. 28.

    Fair Economist

    November 15, 2013 at 2:46 pm

    Basically $400 of her increased costs come from losing the medical layaway plan and $1000 from the school charging her more. The $400 is probably an overstatement because if there’s *any* way she can fall short of her deductible some years then she doesn’t get the full benefit. The first you can blame on Obamacare, and there should be an option for supplementary insurance. The second is her school employer’s choice, and the question there is: how much is due to Obamacare and how much is due to the school using an insurance change to squeeze its employees?

  29. 29.

    Another Holocene Human

    November 15, 2013 at 2:56 pm

    @Richard Mayhew: $500/year for employee + one is _really cheap_.

    The problem is that she works PT.

    Is there some food job other than the obviously cheapskate BBQ joint that pays better (idk, more tips or whatever) so she can simply raise more cash?

    Again, I don’t see how the BBQ plan was anything better than a tax-advantaged healthcare layaway plan. She could have done the same damn thing plus or minus a few hundred dollars at the local credit union.

    Also, maybe since her kids are all but grown, can she apply for FT at the school board? I know, hiring freezes everywhere. But she might want to think about that more aggressively since her stable situation has broken up. I’m sure she pursued PT in the first place because she has kids but they’re legal adults now.

    There are also sometimes places that pay extra for working a night shift. Can she get a differential grave before school hours, then do her school board job, then sleep in the afternoon?

    I’m not digging layaway qua layaway because lord knows it’s hard to hold onto any money when things are that tight, but this sounds like an income problem and her circumstances have changed.

    Can she get a peddler’s license and work PT for herself on weekends? Dunno where in the country she is but if she’s done public facing work for years then she knows how to sell shit.

    Just spitballing here but it sounds like she got an effective pay cut from the county while the cheapskate 2nd job’s little arrangement broke up, so why stay loyal to employer #2? They were always shitty and cheapskates.

  30. 30.

    Another Holocene Human

    November 15, 2013 at 2:58 pm

    @Fair Economist:

    how much is due to Obamacare and how much is due to the school using an insurance change to squeeze its employees?

    I’m sure the sequester and assholes in state government play into that, too. And yeah, an insurance restructure is a nice excuse, but it might have been a straight up pay cut instead (like what happened in Florida).

    Heck, the county probably was grandfathered so the plan change was a deliberate choice, we know that.

  31. 31.

    Lee

    November 15, 2013 at 2:59 pm

    Yeah this is a sucky edge case.

    I vote for the moving Cindy to Medicaid (or do without).

    If she has a catastrophic health event, the hospital can immediately sign her up for Medicaid. They might have a better avenue of getting her enrolled since that is how they will get paid.

  32. 32.

    James Hare

    November 15, 2013 at 3:00 pm

    @some guy: What, like CANADIAN Medicare?

  33. 33.

    MomSense

    November 15, 2013 at 3:04 pm

    @Richard Mayhew:

    She would be far better off if she was not offered health insurance through the second job as she could have gone on the Exchange with a very big subsidy value and cost-sharing assistance.

    I think this was the rationale behind Trader Joe’s decision to stop offering coverage to some of their employees. They get a better deal on the exchange.

  34. 34.

    Another Holocene Human

    November 15, 2013 at 3:04 pm

    @Richard Mayhew: Why doesn’t her younger daughter qualify for coverage in the Exchange? If she’s mommy’s dependent are they below poverty line? And if so, why isn’t Medicaid something they’re jumping on instead of $500/yr + copays? Or is the Silver plan really good and she wants to keep it? Can daughter get a PT job? Can daughter earn a few thou annually to put them over 100% poverty line to qualify daughter to buy a similar plan with the same insurer in the exchange?

    I mean, you’re just accepting the framing of ‘this worked last year’. But the real story is that the 1st employer cut back on the family coverage. The ACA kind of encourages this scenario. I don’t get how Mama would qualify to buy coverage for all four of them on the exchange but daughter on her own can’t–? Same household when you apply, right? Same income.

    If there is a problem here please tell me b/c so many of my coworkers–heck, me too–are in this situation. My understanding was that it’s done by IRS household and that if some household members have their own insurance, fine, but there’s no mandate to take unaffordable family coverage from an employer, meaning the household members without affordable care can still get a policy in the exchange.

    That some private employers are in fact urging their employees to do so with spouses and so on.

  35. 35.

    Central Planning

    November 15, 2013 at 3:04 pm

    @Roger Moore:

    I have an even better solution: Medicare and ponies for all. Approximately as likely, and even better.

    Too much shit with that plan.

  36. 36.

    Another Holocene Human

    November 15, 2013 at 3:10 pm

    @Lee: That’s stupid. ACA compliant plans cover preventative care, SOMETHING EVERY WORKING CLASS PERSON NEEDS or they will LOSE THEIR CAPACITY TO BE EMPLOYED since they sell their backs and not, in general, their brains to employers. (The brains are necessary but NOT sufficient–ie, “Your health is your wealth”.)

    Diabetes
    Hypertension
    Stroke
    Herniated disks
    ACL tear
    Worn rotator cuff

    Just a few of the COMMON ailments of working class people that drive them from the 2nd 20% to the bottom 20% because they can no longer fucking work or if they do work are driven to minimum wage instead of the few dollars an hour more that kept them above the poverty line. THIS IS SUPER FUCKING SERIOUS.

    A working class person of her age CANNOT go without preventative care.

    (Having short-term disability insurance, eg AFLAC, is also a BFD for working people.)

  37. 37.

    jon

    November 15, 2013 at 3:11 pm

    The 21-yr-old doesn’t go to school? Does she work? Could she go on the exchange independently and check it out? That might be too easy, but it’s an option.

  38. 38.

    Lee

    November 15, 2013 at 3:15 pm

    @Another Holocene Human:

    Did not say it was the smart option but it is an option. It is not like it is completely unheard of as millions of young adults have gone with that option in the past.

  39. 39.

    NonyNony

    November 15, 2013 at 3:17 pm

    @? Martin:

    You fix it fairly by raising wages. All of the above problems vanish if you do that.

    Many problems disappear if you raise minimum wage to be equal to a living wage.

    Many other problems (notably wage disparity) disappear if you set an high tax rate (90%) on the highest tax bracket (say, income over $500K/year).

    Wouldn’t make every problem disappear, but it sure as hell would make a lot of them go away real quick.

  40. 40.

    Davis X. Machina

    November 15, 2013 at 3:24 pm

    @some guy: 3 words. Run for the Senate.

  41. 41.

    Violet

    November 15, 2013 at 3:31 pm

    As someone above suggested, seems like finding another job instead of the BBQ job is something to look into. Has that been discussed with Mom?

  42. 42.

    kc

    November 15, 2013 at 3:33 pm

    @Another Holocene Human:

    She’s working 50 hours a week and you want her to get a peddlers license and work more hours trying to sell shit? Are you kidding?

  43. 43.

    What Have the Romans Ever Done for Us?

    November 15, 2013 at 3:33 pm

    @NonyNony: I’m all for higher tax brackets but 90 percent on over 500K seems a little high considering 250 is only at 37.5 percent. Maybe 45 percent by 500K, 50 percent by 750K, 55 percent by 1 million, etc. until you get up to 90 percent for the guys who really make the big bucks. I’m not saying half a mill is chump change by any means – it’s real money. But we don’t need just one higher tax bracket. We need multiple graduated tax brackets.

  44. 44.

    Roger Moore

    November 15, 2013 at 3:34 pm

    It seems to me that Carol’s basic problem is that the school district is offering a worse plan this year than they did last year. The plan from the restaurant costs $2600/year and pays out a maximum of $3000/year, so it’s saving her at most $400 compared to what she could do with a HSA. On the other hand, last year the school district had a plan with “no premiums but a $3,000 deductible and some co-pays and but no co-insurance.” This year, they’re offering a plan with “a $3,000 deductible and 20% co-insurance with an out of pocket max of $5,000 for $40 per month ($480/year).” So her deductible is staying the same, but her premium is going up by $40/month and she’s having to pay 20% co-insurance on the first $10,000 in costs. It’s hard for me to see this as anything but another employer trying to cut their insurance costs and blaming the damage on Obamacare.

  45. 45.

    Omnes Omnibus

    November 15, 2013 at 3:37 pm

    @What Have the Romans Ever Done for Us?: I agree with this. Having the maximum bracket at 250K is silly.

    @Roger Moore:

    It’s hard for me to see this as anything but another employer trying to cut their insurance costs and blaming the damage on Obamacare.

    While you are probably correct, it still leaves Carol in a bind.

  46. 46.

    Commenting at Balloon Juice since 1937

    November 15, 2013 at 3:38 pm

    She’s paying 2600 every year just in case she uses 3000 in costs that year? Drop the BBQ plan and put the money in an HSA.

  47. 47.

    Yatsuno

    November 15, 2013 at 3:46 pm

    @some guy:

    3 words: Medicare For All. problem solved, the end

    Sweet! You have a plan to get it through this Congress correct? Show your work and no you cannot just use the Green Lantern trick. GO!

  48. 48.

    Roger Moore

    November 15, 2013 at 3:47 pm

    @Omnes Omnibus:

    While you are probably correct, it still leaves Carol in a bind.

    That’s true, but I think it undermines Mr. Mayhew’s point about her being worse off under Obamacare. She’s worse off because her employer has decided to give her a big cut in benefits. The only way Obamacare is involved is that her employer is using it as an excuse for the benefits cut. An equally accurate way of portraying the situation is to say that Obamacare is doing nothing to prevent employers from screwing over their employees.

  49. 49.

    Yatsuno

    November 15, 2013 at 3:51 pm

    @Davis X. Machina: That was four words.

    /pedant

  50. 50.

    different-church-lady

    November 15, 2013 at 3:51 pm

    Well, I can certainly understand the stress angle, as just a few minutes ago it became evident that because of a combination of my income going up slightly and the elimination of a subsidy tier, it looks like I’m about to fall in the donut hole in MA — can’t make ends meet, but don’t qualify for anything that would keep me from going broke even faster.

    The idea that I’m even on assisted insurance is utterly humiliating to me.

    There are a lot of days when it looks like I’m heading towards homelessness in super-slow motion — after making a pretty decent living for 30 years.

  51. 51.

    ? Martin

    November 15, 2013 at 3:52 pm

    @Commenting at Balloon Juice since 1937: With 3-4 people she’s probably reliably using all $3000 of that. If so, that’s at least a $400 savings. Basically she’s using the plan as an HSA that gives her a 13% discount, which isn’t bad.

  52. 52.

    MikeJ

    November 15, 2013 at 3:53 pm

    @Yatsuno: It’s Davis. ad senatum currunt.

  53. 53.

    Just Some Fuckhead, Thought Leader

    November 15, 2013 at 3:55 pm

    @different-church-lady:

    There are a lot of days when it looks like I’m heading towards homelessness in super-slow motion — after making a pretty decent living for 30 years.

    This is the experience of everyone. It’s why maintaining the status quo just wasn’t good enough with this presidency, particularly after an election campaign that pretended to intend otherwise.

  54. 54.

    Cacti

    November 15, 2013 at 3:59 pm

    @Just Some Fuckhead, Thought Leader:

    Can we savage this anonymous person for not giving a shit about the 50 million people who didn’t have health insurance prior to PPACA?

    This.

  55. 55.

    Baud

    November 15, 2013 at 4:01 pm

    @Just Some Fuckhead, Thought Leader:

    Nothing pretend about it.

  56. 56.

    Cacti

    November 15, 2013 at 4:13 pm

    Since anecdata are all equally valid, here’s mine (names also changed)…

    About 10 years ago, my best friend who I’ll call Lonely was engaged to be married. His fiancee, who I’ll call Deadnow, worked full-time, didn’t have health insurance from her employer but wasn’t poor enough for Medicaid.

    Deadnow ended up getting a pulmonary embolism, but ignored the chest pains when they first came because she didn’t want an enormous emergency room bill. By the time her chest pains became to severe to ignore and she finally did go to the emergency room, it was too late to save her.

    She died at the hospital. She was 27 years old.

    My friend Lonely eventually found love again after several years, but Deadnow became another statistic of the “world’s greatest healthcare system”. Obamacare might have saved her life. But let’s talk about rough things are for poor old Cindy.

  57. 57.

    catclub

    November 15, 2013 at 4:43 pm

    @Violet: How about marrying an aging billionaire? Buying winning lottery tickets?

  58. 58.

    some guy

    November 15, 2013 at 4:43 pm

    @Cacti:

    is Deadnow had run for the Senate she wouldn’t be. clearly, she could have used a good dose of BJ Center-Right medicine, and all would have been well.

  59. 59.

    Gene108

    November 15, 2013 at 4:45 pm

    @Roger Moore:

    Maybe the insurance provider no longer offered that plan to the school?

    One side effect of Obamacsre requiring well visits to be paid 100%, I think infertility treatments have to be covered, increased coverage for mental health services, etc is a lot of plans, in the fully insured market, saw there premiums go up.

    Plans were kept affordable by some degree of ala carte pricing, I.e. the school or business could reduce or not cover infertility treatments or reduce mental health benefits to keep the core benefits – premium paid by employer and employee in line, as well as copays and deductibles – for the users of the insurance.

    There is a price to covering a lot of things that were not covered or were covered in adequately and that is one reason plans have been dropped.

    Without knowing more on the nuts and bolts of Carol’s school plan there is no way to know for certain if it was deliberate cost cutting by the school or if the school was in a situation beyond its control.

  60. 60.

    MikeJ

    November 15, 2013 at 4:47 pm

    @Cacti: Alex Chilton, one of America’s greatest artists, died because he ignored chest pains. Musicians for the most part don’t have great insurance.

  61. 61.

    sparrow

    November 15, 2013 at 4:50 pm

    So can someone explain to me why on earth you would spend $2600/year to get UP TO $3000 in coverage? I assume that most years this was just a giveaway to the “insurance” company. That is not insurance. That is at best a weird coupon to save you $400, if you know you’re going to have a shitton of medical expenses. I’m confused.

  62. 62.

    ruemara

    November 15, 2013 at 4:50 pm

    @some guy: Your “Center Right” spiel is tired. Awareness of reality doesn’t make a goddamn person center right. And trumpeting for Medicare for all doesn’t make you left.

  63. 63.

    askew

    November 15, 2013 at 4:51 pm

    @MikeJ:

    Which is just one reason the CMA skit mocking Obamacare pissed me off so much. A whole bunch of millionaire artists sitting around making a joke about getting coverage through Obamacare when so many struggling musicians don’t have any health care and would be getting it for the first time through Obamacare was really striking.

  64. 64.

    dr. luba

    November 15, 2013 at 5:00 pm

    @Roger Moore:

    I have an even better solution: Medicare and ponies for all. Approximately as likely, and even better.

    I am allergic to ponies, so would be happy with just Medicare.

    Spent a few hours today trying to figure out what to do for insurance next year. I currently have an HMO with few co-pays and almost no deductible/OOP costs. It will go away. The nearest replacement to it is a platinum plan from the same provider, which will cost about the same per month*, but have $500 deductible/$1500 OOP for the year. OTOH, I will get prescription coverage AND a pair of glasses. I think.

    I may need hand surgery in a few months, and don’t want to change doctors midstream, so I’ll probably just go with this for now. I can always change in a year.

    (*compared to 2013. Since my premiums have been going up every year, by 30 dollars or more, there is probably a greater savings there is probably a savings of about 300 bucks a year on the premiums.)

    Overall, a wash for me, and perhaps a bit more expensive in the short run, but dammit, I earn a good living, and have no right to complain. And won’t.

  65. 65.

    Just Some Fuckhead, Thought Leader

    November 15, 2013 at 5:08 pm

    @dr. luba: The important thing is that millions more Americans will have the opportunity to be fucked by America’s Health Cartel and some of them may even get needed care.

  66. 66.

    muricafukyea

    November 15, 2013 at 5:12 pm

    Meet Richard Mayhew, official Ball-Juice Obamacare concern troll.

  67. 67.

    Yatsuno

    November 15, 2013 at 5:15 pm

    @muricafukyea: Herp de Durf. How DARE he sully your blog with his knowledge and stuff!

  68. 68.

    Mike E

    November 15, 2013 at 5:15 pm

    Looks like Team America haz a sad. :-(

  69. 69.

    dr. luba

    November 15, 2013 at 5:50 pm

    Richard: I just got done arguing with my GOP SIL (who voted for Obama in 2008, although that is a secret she keeps from her husband) about insurance. She complains that their insurance through Ford (HMO) is going up 150 dollars a month, and blames it on Obamacare (“paying for insurance for other people”). I told her that I didn’t think so, because a) the employer mandate doesn’t kick in until 2015 and b) this is a large group plan, so the individual marketplace shouldn’t affect their costs.

    Any thoughts?

  70. 70.

    The Raven on the Hill

    November 15, 2013 at 5:58 pm

    “This is a very low probability case but it is a legitimate problem.”

    But there are more than 300 million people in the USA. It doesn’t take a large percentage of “low probability cases” to add up to a large number. I’m estimating that number at around 5 million.

    What are the Democrats going to do come the next election? With the Republicans there to make sure that the worst of these cases are constantly in the public eye? It is true that on the average the PPACA is an improvement, but we do not live on the average and many people, though a small percentage, will be hurt by it.

  71. 71.

    PopeRatzo

    November 15, 2013 at 6:02 pm

    There are a lot more people like Cindy than we’d like to think. And most of us have long thought that “medicare for all” was the best solution.

    So now we have to ask ourselves if the events of the past few months, or the past five years, have made “medicare for all” more likely or less likely. Seems to me the only thing it’s made more likely is Republican government for the next decade.

    This is not just a news cycle problem that’s going to go away. The President saying “I am not a perfect president” yesterday will be a punchline for years, and he deserves to be ridiculed.

  72. 72.

    Roger Moore

    November 15, 2013 at 6:04 pm

    @Gene108:

    One side effect of Obamacsre requiring well visits to be paid 100%, I think infertility treatments have to be covered, increased coverage for mental health services, etc is a lot of plans, in the fully insured market, saw there premiums go up.

    Wellness visits basically pay for themselves by reducing costs for bigger illnesses, so they shouldn’t add much to the cost. Infertility treatment is not required under Obamacare, so that can’t explain increases. OTOH, medical costs have been going up for a very long time, so you can’t necessarily expect plans to stay at the same price.

    Another thing I think is happening here relates to a topic that Krugman is always talking about: downward wage rigidity. It turns out that there’s strong resistance to giving people nominal wage reductions, so most downward movement in wages comes from keeping wages constant and letting them be eroded by inflation, which doesn’t work when inflation is near zero. I think one of the practical consequences of this is that downward wage pressure comes in the form of reduced benefits, which are part of real compensation. Rather than cut people’s nominal wages, they give less generous medical benefits, as employees to cover bigger premiums, etc. I wonder how rigid things look if you include benefits along with nominal wages.

  73. 73.

    Paula

    November 15, 2013 at 7:05 pm

    @PopeRatzo:

    Well, the answer has always been single-payer, but imagine how trying to dismantle an entire industry would have compared to setting up the exchanges in terms of level of disruption and complexity.

    Comment number 1 reveals an inherent dumb-shittiness about lefties who think this episode is somehow revealing how they were right all along about single-payer.

    This whole episode is happening because people don’t know anything about what they’ve been purchasing over the years, even though their lives literally depend on it. If they knew, they would realize that insurance companies would have had the obligation to stop selling them the plans in 2010 and to provide alternatives. If people knew anything about insurance, they would know that the law has provisions to protect them from bad policies. If people knew anything about insurance, we would have single-payer because people would have clearly revolted against the insurance industry.

    So the short answer is that single-payer is about as likely as it was before, because nothing about people’s understanding of health insurance has changed because of this episode.

    There is no panacea for the Brady family, because the problem is not about health insurance, but about her low pay. This bill was crafted to provide insurance for the millions of people who’ve never been able to have it. Unless I’m mistaken, public policy is about trying to create conditions for the greater good, not to fix everyone equally. So the percentage of people on individual plans for one reason or another, despite being a large number, are dwarfed by those who may actually be helped by this law and, in the longer term, if the law actually works as it should, the price for health care may go down enough to make it affordable for people like the Bradys again.

    If you want the law repealed, just say so. This format of anecdote-implicit-condemnation thing employed by bloggers is just chicken-shit. If you want to act like a legislator, you only have 3 options: saying yes, no, or being absent.

  74. 74.

    jenn

    November 15, 2013 at 7:15 pm

    @sparrow: Yeah, that is a little odd, isn’t it.

  75. 75.

    Person of Choler

    November 15, 2013 at 7:45 pm

    @dr. luba:

    ” I currently have an HMO with few co-pays and almost no deductible/OOP costs. It will go away.”

    So you didn’t like that plan, then?

  76. 76.

    different-church-lady

    November 15, 2013 at 7:53 pm

    @The Raven on the Hill:

    What are the Democrats going to do come the next election? With the Republicans there to make sure that the worst of these cases are constantly in the public eye?

    If, on average, the law helps more than it hurts, then the answer is to make sure those it helps are also in the public eye.

    However, given the general tendency of our society to give more weight to the negative, there’s probably some factoring involved — say something like 3 positive stories for every negative.

    But it’s that “average” thing that makes me squinty: there’s no such thing as an “average” person — if you’re one of the people who’s affected negatively, it’s not going to come as much comfort to you when someone points out that 3 other people are better off. That has nothing to do with political optics and much much more to do with the way policy makers look at things on an abstract level. (I keep thinking of General Ripper’s, “I’m not saying we’re not going to get our hair mussed!”)

  77. 77.

    Roger Moore

    November 15, 2013 at 7:56 pm

    @sparrow:

    So can someone explain to me why on earth you would spend $2600/year to get UP TO $3000 in coverage?

    It makes sense if you have a chronic condition that will predictably run up costs that high. There are a lot of medicines for chronic illnesses that could cost that much for a year’s supply.

  78. 78.

    Cervantes

    November 15, 2013 at 8:17 pm

    @Paula: Thanks for your comment. I found it helpful.

  79. 79.

    Matt McIrvin

    November 15, 2013 at 8:29 pm

    It seems to me that a lot of the problems are with people falling into the donut hole between eligibility for subsidies and actually being able to afford insurance, and could be addressed by just expanding the subsidies.

    Of course that brings the system that much closer to generally taxpayer-funded insurance.

  80. 80.

    becca

    November 15, 2013 at 8:33 pm

    This is such a fucked up country. I wish there was a hell, so I could take some solace in knowing Ronald Reagan burns there. Ever since he turned half the nation against their own government, we have been sinking. Why, oh, why did we not impeach that pimp when we had him dead to rights.

    Reading about our INSANE health insurance is like reading some really bizarre satire. I cannot believe that this ridiculous Rube Goldberg-on-Acid Gordian Knot contraption is how we deliver healthcare in these so-called United States. Idiocracy, pure and simple.

    And healthcare is only the tip of the iceberg that is sinking us. We are told daily to be afraid – everybody is watching and collecting data on everybody! Identity theft! Erectile dysfunction! Baby formula! Etc,etc

    We got the mafia going legit in the financial industry, a decrepit infrastructure, no climate policy,income inequality out the ying yang, and one former political party that now serve as geishas for the one percent.

    Are we a beaten people, people? For the sake of my grandchild, I hope not.

  81. 81.

    Matt McIrvin

    November 15, 2013 at 8:39 pm

    47 million people negatively affected by the food-stamp cuts. That’s, what, 15 times as many people as are having their insurance plans cancelled? It doesn’t matter.

    EDIT: Correction, it’s only about 4 times as many.

    Debra: I have hunger but I’ve gotten used to it. It’s something to adjust to. I try to cut it by drinking a lot of water, but water gets boring so I buy Kool-aid for some flavor. I have kidney stones, so my doctor says I need to drink a lot of water anyway. I also have milk and cereal for the mornings. But yeah, I’m hungry. I’m very fortunate because I have a neighbor who gets Meals on Wheels delivered, and she’ll give some of it to me and my daughter.

  82. 82.

    Ripley

    November 15, 2013 at 8:48 pm

    47 million people negatively affected by the food-stamp cuts.

    My god, man, stow your compassion! – don’t you know that some guy is aggrieved by all the center-rightness on display here? Priorities, friend-o, priorities….

  83. 83.

    Ripley

    November 15, 2013 at 8:49 pm

    47 million people negatively affected by the food-stamp cuts.

    My god, man, stow your compassion – don’t you know that some guy is aggrieved by all the center-rightness on display here? Priorities, friend-o, priorities….

  84. 84.

    CONGRATULATIONS!

    November 15, 2013 at 9:10 pm

    Obamacare taking a baseball bat to the working poor. Thankfully, I always know where to come for some blind worship of our Dear Leader. You guys never disappoint.

  85. 85.

    mai naem

    November 15, 2013 at 9:11 pm

    I don’t know if this is a stupid question since I am not following all the numbers but I thought part of O-care was that the employer couldn’t charge the employee more than ten percent of their income.

  86. 86.

    dr. luba

    November 15, 2013 at 9:17 pm

    @Person of Choler:

    So you didn’t like that plan, then?

    Oh, the minimal copay/deductible part of it was nice. As long as I stayed in system, and for what was covered. But there was no prescription coverage, no medical device/hardware coverage, and very limited mental health or drug treatment coverage (not that I need either…..yet). I didn’t use the insurance much because I got much of my medical advice (and some drug samples) from friends and from my PCP via e-mail. And I bought the more expensive meds on my trips to India (hospital volunteer work). And I don’t have any medical issues I can’t manage myself….yet.

    I don’t know how good the coverage would have been had I gotten really sick (?lifetime limit–didn’t even know these existed until the ACA debates). The premiums were pretty high. I got this plan as a conversion from group under COBRA, so never had to fill out forms and jump through hoops.

    It was a pretty good plan for the private market (which generally sucks), but, had I gotten sick, I suspect the premiums would have become even higher than the $700 a month I’m paying now.

  87. 87.

    Just Some Fuckhead, Thought Leader

    November 15, 2013 at 9:22 pm

    @CONGRATULATIONS!: @becca:

    You fuckers should be happy Balloon Juice has our own industry insider helping us navigate the complex system he benefits handsomely from.

  88. 88.

    CONGRATULATIONS!

    November 15, 2013 at 9:42 pm

    We got the mafia going legit in the financial industry, a decrepit infrastructure, no climate policy,income inequality out the ying yang, and one former political party that now serve as geishas for the one percent.

    @becca: You forgot our homegrown version of the Stasi, a surveillance state so perfectly efficient that it would make its East German ancestors kill themselves for shame over how inadequate they were compared to us.

    You fuckers should be happy Balloon Juice has our own industry insider helping us navigate the complex system he benefits handsomely from.

    @Just Some Fuckhead, Thought Leader: Hey, don’t get me wrong. I am slobberingly grateful for any tidbits my betters see fit to throw on the street in front of me. My only wish is that there could be more apologies and excuses for Obama’s failures on this thread. The Juicers are looking rather ungrateful these days,

  89. 89.

    becca

    November 15, 2013 at 10:27 pm

    @Just Some Fuckhead, Thought Leader: you think I don’t know Obama has been dealt the biggest shit sandwich since the invention of shit? The man is trying to do the right thing, but 40 years of the free market theology preached from every pulpit has tied his hands.

    As long as the GOP refuses to govern, but only harass, obstruct, and play the vandals of democracy, we are screwed.

    I think Obama knows that, too.

  90. 90.

    becca

    November 15, 2013 at 10:37 pm

    @CONGRATULATIONS!: data mining is not just for governments, cupcake. How many rewards cards you got in your pocket?

    Kroger knows more about me than Uncle Sam, I bet.

  91. 91.

    Jay

    November 16, 2013 at 3:49 am

    @CONGRATULATIONS!: OK, coming into this VERY late…

    Yeah, sure, the Stasi that could come take you away at any time get a confession out of you, even if you weren’t guilty and send you away for life or death isn’t as bad as America and they wouldn’t even get a critical story on the backpage of a newspaper.

    Let me add to the erudite commentary I’ve come to love at BJ with a hearty: Fuck you, you ignorant, self-important asshole.

    Yes, Obamacare isn’t the best, but overall, its a better thing than what we had for many people. Now we try to build onto it, fix the problems so that the marginal cases aren’t. And yes, I’m glad we have Richard here, yes he benefits from the system he’s explaining…that does not mean the explanations are wrong, or unhelpful.

    And again, CONGRATULATIONS!: Fuck you.

  92. 92.

    Matt McIrvin

    November 16, 2013 at 9:44 am

    @Ripley: on the bright side, the hungry lady evidently does get to go to the doctor.

  93. 93.

    The Raven on the Hill

    November 16, 2013 at 1:57 pm

    @different-church-lady: yeah. Me, writing four years ago: “Because the ‘health’ ‘care’ ‘bill’ is going to harm quite a lot of people, even if it only harms 1% of the population of the USA. Do you want to be the one who defends it to them?

    “The Raven’s first rule of health care policy: Do no harm.”—http://adviceunasked.blogspot.com/2009/12/do-you-want-to-defend-it.html

    Prescient, alas.

  94. 94.

    xian

    November 17, 2013 at 10:48 am

    @Cacti: I don’t see how mocking the working poor advances your progressive beliefs.

  95. 95.

    xian

    November 17, 2013 at 11:14 am

    @The Raven on the Hill: why not flood the airwaves with the 10x or 100x people whose lives were improved immeasurably?

  96. 96.

    The Raven on the Hill

    November 17, 2013 at 3:28 pm

    @xian: Aside from the unlikeliness of the Democrats doing anything so sensible, it won’t wipe out the public perception of the negatives. We’re talking five million people. Everyone will know someone.

    And shouldn’t we be more worried about not harming people, anyway?

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