Last night was a rough night for my little guy. He played hard all day in some absolutely ugly weather, and then his asthma kicked in. We dosed him with his inhaler right before dinner, and then again right before bedtime. He woke up at midnight for another dosing, and then again at 3:30, and as I was leaving the house this morning, he was finishing up a double dose of Albuteral on his nebulizer. I’m planning to call his pediatrician as soon as they open. I expect the answer will be to bring JayJay in this afternoon if he does not get any better this morning. I anticipate that we’ll be at either the ER or the Urgent Care if he is still bad tonight.
This is a pain in the ass, but one thing that is clear to me, is that I am not trying to ration his needed care because of cost. I’m lucky, the yearly deductible per person for my employer sponsored policy is under 1% of my family income, and the out of pocket maximum is 3% of my family’s annual income. I don’t want to come up with 1% or 2% of my family income, but I can readily access credit, and I can trade my leisure time of watching my kids play for more paid time on the soccer field. I’m lucky.
Andrew Sprung over at Mother Jones looks at the working class hostility to the ACA and makes a couple of very salient structural points:
The Affordable Care Act is a really stark exemplar of this good policy/tough politics conundrum. For almost its entire life its approval ratings have been underwater, pulled down in part by low marks from working class Americans…..
Sliced another way, about half (48 percent) of private plan buyers in the 37 states using healthcare.gov had incomes ranging from 150 to 300 percent FPL, a more or less working class range. But more than half of those were at the lower end, 150 to 200 percent FPL.
The truth is, the ACA private plan market works best for people with incomes under 200 percent FPL.
The ACA is really good for people with kids if they are Medicaid eligible as the cost-sharing is someplace between nothing and $10. It is pretty good for people who make under 150% of FPL as the cost sharing for a family of two would be roughly 4.4% of family income. It’s okay for a family of two making 199% FPL as the cost sharing maximum would be 7.5% of total family income. However, bumping family income for a family of an adult and a kid from $31,500 to $33,000 per year changes the cost sharing maximum to 14% of family income as the cost sharing reduction subsidies rapidly phase down.
That is a steep cliff and a political plus policy opportunity.
As a combination of good policy as we don’t want to punish kids and limit their potential for their choosing non-well-off parents, and as a political strategy to either woo working class voters, or more likely to staunch the bleeding, what if Democrats including Hillary Clinton proposed universal health care subsidies for all kids so that the kids are insured in low deductible, low cost sharing plans.
There are a couple of ways of doing this. The first would be to expand CHIP to make all kids eligible without regard to income limitations and without regard to whether or not the kids have access to other insurance via their parents’ work. This would be straightforward as the feds would pick up the marginal cost of the expansion of CHIP.
The second approach would be expand the cost sharing subsidy structure to all plans for all kids. This would mean private employers would receive pass through federal funds to reduce the cost sharing for kids, it would mean Exchange policies for people making over 200% or 250% of FPL would be enhanced so their kids would get cost sharing subsidies to bring their actuarial value up to to 87% or 90% or 94%.
This would be a tangible policy built on pre-exisiting infrastructure and proven ideas to solve a problem — making sure that kids get the care they need without the barrier of cost sharing making that care too costly for parents who are doing okay but not great financially.