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.
aimai
Can I just say that I, too, had a child with Asthma (two hospital stays beforewe got it right) and an employer sponsored health insurance plan with a 6000 dollar deductible. The costs were very, very, high. You can’t take any chances with a kid that young (I think she was five when it started) and we even ended up being put in an ambulance to go from one hospital to another the first time. Its crazy that all that isn’t covered entirely. We could afford it but even a percentage of what this all cost would be prohibitive to a lower SES family.
Yatsuno
Now your goal is to get 218 votes in the House and 60 in the Senate for it. And show your work. I’ll wait.
Richard Mayhew
@Yatsuno: For 2016, it is is not to get 218+60, it is to draw a clear contrast with a popular policy that benefits a demographic that used to have signiifcant Democratic loyalty but has flipped hard GOP while also laying the argument that we need to up AV for insurance policies instead of decreasing it. Actual implementation would be either 2018 or 2021 target dates.
What Have the Romans Ever Done for Us?
@Yatsuno: You need the votes to make it happen, but you don’t need the votes to campaign on it. His point is that, first, Democrats should campaign on it, and, assuming they win, try to make it happen.
Danack
At the risk of giving someone I don’t know medical advice – if your guy isn’t already taking an anti-histamine it might be worth trying one.
I have a history of Asthma, but it’s mostly faded away as I’ve gotten older, with the exception of this part of the year when there is a whole load of tree pollen floating around. When this happens I get an incredibly irritated airway which looks and feels like asthma. Taking one-a-day allergy tablet (cetirizine hydrochloride is the most effective for me) stops the irritation.
I also find that drinking caffeine in the form of coffee or PepsiMax also has a nice anti-inflammatory effect.
WereBear
They are discovering more and more than asthma can be triggered by allergies, and wheat is an incredibly common trigger.
Or maybe it’s just everywhere… I spoke online with someone who figured it out when they kept not being able to breathe in donut shops.
Tommy
So sorry to hear this. I hope things work out and your son feels better. Soon! I have a few health care nightmares in my family, but nothing chronic, something you have to deal with daily.
I was dating the women that lives behind me. One of her two daughters has Cystic Fibrosis. We got along well, but we stopped dating because as a single, working mother, she didn’t have time for me.
Her daughter, who thankfully got a lung transplant last year, needed a lot of attention. Her reasoning that she needed to focus on her daughter and not me, well that made complete sense to me.
cahuenga
Being outside of the subsidies the ACA really hasn’t changed one thing for me. Premiums are more stable but higher out of pocket costs make it feel like the total price is still growing at an unsustainable rate.
I think I had unrealistic hopes for the bill and need to come to grips with the fact that the ACA was created for the marginalized. And I guess I’m okay with that.
varmintito
I am on a (non-ACA) high deductible employer plan since the beginning of the year. Quite a rude awakening. Until we hit the out of pocket maximum, I will pay full retail for all medications and lots of other costs, with the blow softened only by my ability to use pre-tax funds courtesy of my HSA (also a new thing for me).
I need to look at alternatives, if only to satisfy myself that they do not exist.
Germy Shoemangler
WASHINGTON — Many people in the United States doubt that the Supreme Court can rule fairly in the latest litigation jeopardizing President Barack Obama’s health care law.
The Associated Press-GfK poll finds only 1 person in 10 is highly confident that the justices will rely on objective interpretations of the law rather than their personal opinions. Nearly half, 48 percent, are not confident of the court’s impartiality.
“That lawsuit should have never made it this far,” said Hal Lewis, a retiree from Scranton, Pennsylvania.
kathy a.
@Danack: Boy, dosing a little kid with caffeine doesn’t sound like a great idea.
But you should see the doc anyway about preventive meds. We landed in the ER several times when our kid was little and a teen, and it is not fun. Albuterol is a “rescue” med; it pulls up heart rate and can cause agitation and irritability. You need preventives, so you do not need to use the rescue meds so much. I have some lung afflictions myself, and am using meds like the ones my kid got for allergy season — one is an inhaled steroid, to keep down inflammation; the other is Singulair, which reduces bronchostriction.
kathy a.
On health insurance, I’m also a fan of Kaiser — which I did not expect to be, hated leaving our longtime PCP practice. But the cost is lower than the previous health plan, and basically everything is on site — other specialties, blood draws, diagnostics, pharmacy, even mental health care. And covered, with low co-pays — they even covered most of the cost of an oral surgeon for something they could not provide (spots on my lips and mouth that needed to be biopsied). They invest heavily in preventive care. It is easy to talk with providers via a secure email system. They mail meds to my house. Not one bad experience there with a provider. A young adult relative with a low income was able to get back into Kaiser easily, qualifying for medicaid in our state — and they even helped with the paperwork. At least where we live, this is a great alternative.
Older
@kathy a.: It depends on the kid, and on the kid’s particular medication needs. Sometimes it’s exactly the right thing. My daughter made sure her asthmatic son had a glass of Coke every day before he went off to his elementary school. It prevented a lot of otherwise possible problems during the day. Back then, for instance, your kid could be without adequate breathing for quite a while as the school tried to find the person responsible for keeping him safe from his inhaler.
Danack
@kathy a.: “Boy, dosing a little kid with caffeine doesn’t sound like a great idea.”
If the choice is between a kid (or myself) being a little bit hyper vs feeling like having to lay down to concentrate on breathing for the rest of the day, the choice isn’t that difficult for me.
kathy a.
@Older: and Danack: Point taken! Caffeine does notch an asthma problem down.
But coke/coffee and rescue meds are not necessarily great long-term strategies, on their own. The preventive meds go a long way toward keeping the crisis from happening, or from being a bad crisis.
Our problem when our kid was younger was that we’d get through the crisis, and we’d forget to look for triggers. So the pollen, the colds, the exposure to whatever got a chance to take hold — and there we were again, relying on the rescue meds and occasionally going to the ER. (Also, singulair was not a thing we knew about in the beginning; and then our insurance denied coverage because they thought claratin was good enough, which it wasn’t; and blah blah.)
When my kid with asthma was in middle school, he wrote an essay about his scariest asthma attack, the one that landed him in the hospital for a few days. He talked about not being able to breathe; being all shot up with drugs; seeing parents and doctors swarming around like ants. Became an immediate and longlasting fan of preventives.
Doug Wieboldt
@Yatsuno: I take it that you have no interest in helping?