I’m doing a little personal research on health insurance options, and my God do the plans suck. Mia has a simple fracture and it’s $2,800 out of pocket on an New York Excellus “Bronze” plan:
If Mia makes $50K/year and has a 28 year-old child, she’s paying $385/month for that Bronze policy for the privilege of “50% coinsurance after deductible”. Her out of pocket is limited to a staggering $8550 per person, or $17,100K total. I realize that $50K might be high for a job without insurance, but say Mia works two jobs part-time and has some skills. She better not break a leg, or get any medical care that isn’t preventative. Her savings will be wiped out or her credit card will be maxed out. (If Mia was single, she’d pay $239/mo for her plan. If she had a “silver” plan, her fracture would cost $2,600. Gold is $1,690. Platinum is $570 with a $629 monthly premium for single Mia.)
I don’t mean to step on David Anderson’s turf here, and I certainly don’t think that the Obamacare fight wasn’t worth it, or that Democrats shouldn’t be proud of our accomplishments getting somewhat affordable healthcare to people whose alternative pre-Obamacare would be much worse. Still, if we’re going to be political realists, we need to be real about the health insurance situation for the otherwise uninsured middle class in the US. “It’s better than it was” isn’t a winning message. These kinds of numbers breed resentment and cynicism, not gratitude. What would your response be if Mia said to you, “Why is it called the Affordable Care Act? I sure can’t afford it.”
Also, don’t even get me started on Peg having a baby on her Bronze plan. Let’s just say it is nowhere like a dream come true:
Major Major Major Major
…Mia’s fracture isn’t covered? That can’t be right.
Oh, and yeah we should have universal Medicaid with private add-ons (quite possibly doable with reconciliation)
Butch
There’s no competition where we live, so the plans are expensive to begin with. The insurance company (Blue Cross) has so thoroughly gamed the system that a Bronze plan is very close to not having insurance at all, but it’s the only one we can afford.
chopper
@Major Major Major Major:
why would an in-network ER visit be not covered at all?
Four Seasons Total Landscaping mistermix
@Major Major Major Major:
It is covered, in an in-network ER. That’s what “coverage” looks like with a Bronze plan. Silver isn’t much better. God knows what it would look like in an out-of-network ER.
Luckily, we can all pick an ER to visit when we’re injured. /s
VeniceRiley
@Major Major Major Major:
Yes, this! We could get people to vote for this.
I mean, it’s nice having an out of pocket cap and all, but people tune out, and the issues are too complex for the average person and are anxiety producing.
Benw
Bake sale, baby! Bake sale!
Betsy
This is why I deliberately keep my income below ~ 20,000/ year.
Working more puts me into a higher category of insurance payments and it’s simply not worth it.
I know there are a lot of people who are under employed intentionally to keep from falling off the health insurance cliff.
This is no way to run an economy.
It’s not particularly good for me, either, but it’s a lot less stress than making $35,000 a year and getting hit like Mia with massive risks that take a third of my total income.
This country has to decide whether it wants a working middle class or not.
Kay
That’s why I don’t really understand the Democrats push to add more benefits to Medicare. It would be great to do that if everyone else was affordably covered but they’re not.
It’s the 35k to 50k working crowd who need the help right now. They’re in bad shape. They don’t qualify for Medicaid or Medicare. At some point they’re going to ask why they don’t get more help, since everyone else is.
Four Seasons Total Landscaping mistermix
@Betsy: I know someone in social services and a lot of her clients work one job that keeps their yearly income low enough for benefits, and then work under the table for the rest.
Kay
The dumbest situation is young people who come from low income families so had Medicaid coming up and then they age out and get a job and we throw them off.
It’s ridiculous. They’re young! It won’t even cost that much! Is there a country that is more mean-spirited and ungenerous to people just starting out? Why do we hate them?
Betsy
@Four Seasons Total Landscaping mistermix: Absolutely. All my income is legit, but I wouldn’t fault anyone for guarding their income by working under the table.
Poor and middle-income workers paying income taxes and social security tax on every dime, while heirs and heiresses and high rolling investors pay *nothing*?
And high-income earners are exempt from social security tax above 100,000-whatever it is?
Fuck that shit!!
Betsy
@Kay: Gotta make sure the Boomers get everything.
Kay
@Betsy:
I guess! Poor Mia and her newborn. Under the bus again. This is EXACTLY what JD Vance means when he says you people hate children :)
Damien
Same reason we can’t do a cap and trade CO2 system: entrenched wealthy assholes who would rather everyone suffer and burn than give up their yachts.
We can’t have nice things because of a tiny, rich, sociopathic minority controlling a larger, poor, stupid minority with fears of even poorer minorities coming to take what little they have to distract from the rich robbing them blind.
Four Seasons Total Landscaping mistermix
Also, if you want to know why we have a mental heath care problem in this country, the Bronze plan offers 20% coinsurance for mental health services. No wonder a lot of providers in the area have gone to cash only, no insurance. Insurance isn’t worth the bother — they just lower their rates to something (some) middle-class and upper-middle-class people can afford. Those providers, by the way, are full up. The long-term lack of insurance and other funding for mental health care means that the infrastructure is pitiful.
Kay
Off topic but Tim Ryan has a really competent campaign. I don’t believe I’ve ever seen this much effort so early and it’s not just digital. They call people and go places. It’s encouraging.
Betsy
@Kay: Ha! Yeah. Funny thing, I never could afford to have kids so I didn’t altough I dearly wanted them, and now that I’m too old I get no tax credits or deductions but pay full freight in the income I do make. My kinder-rich relations are buying me dinner and guiltily tipping the grocery store essential workers with $20 bills because they’re rolling in Biden child credits. More power to them, I’m all for a robust family safety net — but still waiting for my Maiden Aunt credits.
I think we single women pull more than our share of the work of the world; many of us do more for society than actual moms and dads but we’re the ones who really get screwed on benefits because we’re not skating on some breadwinner dude and never will have a widow’s social security income (typically much higher due to survivorship and to husband’s vastly higher earnings)
lowtechcyclist
I had been under the impression that the Dems were going to limit out-of-pocket on the Exchanges to 8% of income. I guess that isn’t happening, huh?
WereBear
@chopper: They make their own rules.
I got tested for a rare genetic disorder. My hunch was correct: I have it.
But they wouldn’t pay. Because “nothing can be done.” While they are wrong about that, they don’t care: it’s rare and there’s no public outcry, so they wouldn’t even pay for the positive diagnosis.
Kay
@Betsy:
If they lower Medicare eligibility without too much of a lookback maybe you’ll make out there. That makes more sense to me just because older people are more expensive to insure, so taking them out of the private market earlier should help both groups. I’d put the money there rather than upping benefits for people who are already covered. Maybe it’s pure political calculation- more of them vote, but I think 60 to 65 year olds would be thrilled to be newly eligible. Some of them probabluy want to retire but can’t.
sab
@Betsy: Boomers weren’t getting much either. Before I aged out into medicare I was paying $ 1700 a month for a silver plan. The good thing about ACA insurance is it is actually insurance, even with the co-pays and deductible. Before that I paid for individual market insurance for ten years, and at my first claim, ten years in, they said oops. You didn’t tell us about that unrelated item that we have decided is related so your pre-existing condition that you didn’t even know about means you aren’t covered but we get to keep all the premiums you paid for the insurance you only thought you had.
Four Seasons Total Landscaping mistermix
@lowtechcyclist: They limit premiums to 8.5% of income, presumably for a bronze or silver plan because Mia’s Platinum premium is way more that 8.5% of $50K. That’s a big “so what” for Mia if anything serious happens, since her out of pocket is a whopping 22% of pre-tax income before insurance pays anything.
Kay
@Betsy:
I thought it might have to do with the debt limit- go offense on Medicare since Republicans are salivating to cut it and they’ll use the debt limit to try it, and then make it an issue in the midterms but that might be too elaborately strategic. It would be “expansion of Medicare v cutting Medicare”. Maybe it’s a preemptive move to take it off the table.
Major Major Major Major
@Four Seasons Total Landscaping mistermix: a little turned around by “this condition is not covered” in the image… I’ll blame whoever made it.
Major Major Major Major
@Damien: cap and trade doesn’t really work, so it’s no great loss.
@Four Seasons Total Landscaping mistermix: and shit, that’s still a big improvement from where we were!
Mom Says I*m Handsome
@Four Seasons Total Landscaping mistermix:
Ted Leo sees what you did there.
ETA: I supported my music-teacher friend by playing bass for his student concert. One of his students, a 14-year-old girl, chose this song (“Me and Mia”) — kinda alarming. Great song, though. (Same kid also chose “Portions for Foxes” by Rilo Kiley; man, the kids sure do grow up fast these days.)
taumaturgo
Poor working and middle-class folks are enriching the pockets of the honchos of a malignant and completely broken healthcare system. Not are Americans paying more and getting shitty results for their money, the deaths due to deferring care for lack of access continue to climb. Even if one is insured, avoid getting sick or having an accident and if you do, avoid calling an ambulance and avoid the ER, chances are that if you survive your finances would die.
Betty Cracker
This image from a hospital hallway is a great summary of our fucked-up healthcare situation:
prostratedragon
@Four Seasons Total Landscaping mistermix: And if there’s one thing we clearly need in this country it’s more and readily available mental health care
Enhanced Voting Techniques
In England the anti-vaccers tried storming BBC head quarters, stormed the wrong building
https://www.theguardian.com/world/2021/aug/09/confused-anti-vaccine-protesters-storm-bbc-hq-years-after-moved-out?CMP=twt_gu&utm_source=Twitter&utm_medium#Echobox=1628530133
Deranged stuff like this makes wonder if 1/6 was less a coup attempt and more a critical mass of pale skinned drug addicts lashing out at the voices in their head. I mean look their leaders, both Trump and Lindell are amphetamine abusers for example and Boris Johnson sure got that vibe. Six months ago they were set to lynch congress, now they can barely notice the Infrastructure bill but they are ready to murder doctors and nurses over a vaccine.
chopper
@Major Major Major Major:
yeah, “this condition is not covered, patient pays 100%” appears to make it seem like it isn’t covered.
different-church-lady
Wait, you expect insurance to pay for something?
lowtechcyclist
@Four Seasons Total Landscaping mistermix:
Yeah, but my understanding was the Dems were aware of this, and it was a Dem priority to fix it so that the out-of-pocket would be limited to 8%.
Earl
Also, too — if this is anything more complicated than a simple fracture, and perhaps requires multiple surgeries, you’d best make sure you get injured in the first half of the year. If treatment for a single injury spans 1 January… tada! a new deductible year
This happened to me and I just couldn’t believe it was real.
Leumas
The stimulus bill passed in March limits premiums, not sure if it is all premiums or just those from
the exchange, to 8.5% of adjusted gross income. Just got a notice yesterday from BCBS that my
premiums will decrease starting 9-1-21 due to this. Not perfect, but this is progress.
Betty
@Kay: I agree. Those extra benefits are generally not what put people in debt. I am on Medicare and would rather have them expand A and B coverages rather than require purchase of supplemental coverage. They could also lower the age eligibility to help early retirees.
Betty
@WereBear: What a broken system. It requires a massive overhaul which can’t happen because of all the money involved. So sorry for your situation.
burnspbesq
@VeniceRiley:
No you can’t—at least not the only people whose votes matter, Republican U.S. Senators.