My knowledge base is comprised of 13 years in Mid-Senior level healthcare reimbursement, in all area's from outpatient practices to a level 1 Trauma hospital that served a targeted population (the poor). I also have had to use Medicaid so this touches me personally.
On the Right they talk about skyrocketing premiums, exchanges closing, OBamaCare dying.
This is only partly true. As a liberal democrat let me be the millionth to say O'BamaCare needs serious fixing. Let's also be honest though. Once the mandate was denied enforcement and the federal government stopped paying subsidies in some areas the exchanges could not function- so a large part of this failure is lack of actin on pieces of the ACA that had to happen for its survival. It also comes down to how much the insurance companies and pharmaceuticals deem the minimum profit margin must be. Let's never underestimate the impact of that. The other thing that is misstated is that states with only "one" plan left have several levels to choose from. Even KS has 4 types in their "one" plan and within each there are several to choose from...similar to when you enroll in a job plan and have several options of out of pocket vs monthly cost- KS website says:
The costs above are for a silver plan in your area. Silver plans are one of four levels of coverage that you can buy with financial help. These levels – bronze, silver, gold, and platinum – tell you about how much financial protection the plan will offer you if you get sick. Bronze plans have the lowest monthly costs, but when you need medical care, you will pay more for your care. Gold and platinum plans offer more financial protection if you get sick, but these plans have higher monthly costs. You can receive financial help to purchase any of these levels of coverage.
So, again....take what you hear with a grain of salt and be aware that a chunk of what you hear is incomplete.
As far as the left goes there are also misrepresentations. People will not "die on the streets" they will die in the hospital and someone is going to pay for it, I'll give 3 guesses as to whom.
Before we can make truly educated comments on what repealing parts of the ACA mean I think we need to review where healthcare was Pre-ACA
My entire work life, 1996-2013 my insurance premiums for my family of 4 ranged from $450/month to $700/month with a varying level of deductibles/copays. At one point I was paying $630/month and was making $49K a year. 20% of my "pre" tax income without counting ded/copays
So I headed to the website that calculates cost. I entered $49K as my base pay and 4 in the family. I used to SILVER (more expensive than bronze) to see what I would pay now.
Estimated financial help:
$1,074 per month ($12,883 per year)
as a premium tax credit. This covers 80% of the monthly costs.
Your cost for a silver plan:
$264 per month ($3,171 per year)
in premiums (which equals 6.47% of your household income).
If you continue increasing salary the subsidies are given until you exceed 400% of the poverty level or roughly $100,000. The premium, without any subsidies (IE +$100,000 income) is $1334/month.
Please note those dollar amounts I use are from the premier SILVER plan
Check it out yourself. I am going to switch to what State Run Medicaid looks like.
When I was working in healthcare I had a few jobs that would help people fill out and submit an application for Medical Assistance. Often referred to as Medicaid. Cash assistance and food stamps have their own set of guidelines and the three may share similar income requirements but each has different eligibility requirements. Cash assistance in KS is about $500/month...so no one's getting rich.
Before the ACA, the federal government helped subsidize Medicaid through block grants. The idea was each state could run it better themselves. At that time, to qualify for medical coverage, you could make up to 150% of the poverty level or roughly $32K a year. This allowed WORKING families to be insured without being devastated financially. Most to all elective medicine was not covered.
So when the ACA became law Kansas decided not to accept the expansion program...which in all reality was covered by block grant funding, just at the federal level. This meant KS' grant income decreased but they also could adjust their own guidelines. So the did. Please view this chart with the thought that pre ACA a family of 4 could make about $2500/month. Here are today's guidelines for an adult to be covered- in all fairness the kids would be covered to that 150% poverty line (About $36K in today's dollars)
INCOME STANDARDS The monthly countable income will be compared to the income standards below. If the family income exceeds the maximum income limit for this program, the children can then be considered for coverage under the children’s medical program (See Medical Coverage for Children fact sheet for additional information.)
# of PPL Max Monthly Income
Those are not misprints. A family of 4, to maintain adults being covered, cannot exceed an income above $768/month.
This affects me personally. This entire blog has been dedicated to talking about Mental Health and my own sobering diagnosis 3 1/2 years ago of Borderline Personality with sever depression and anxiety with insomnia. I went through a very shaming and difficult process applying for disability which I was denied. I was told that although I had a disability I did not qualify for SS disability and that I was gaming the system. The same system I paid into for 35 years basically gave me the middle finger. In order to get disability your income cannot exceed about $1000/month.
Our only saving grace has also been disastrous. Both programs allow for loans without counting that as income. We are now so deep in debt that we can never fully recover I am sure. In addition to the personality disorder I have 4 discs that have gone bad in my back and an impinged nerve, I also have a few other meds I take.
How do I get started? I'm 50 years old, aging in the workforce, out of work 3-4 years with no real explanation- do I say I was applying for disability? I can't be on my feet (That was partial disability) and driving long distances or continuously is hard. I'm not proud, I would wait tables if I could.
The problem is I can't lose my health insurance and with the limitations I have that job paying a minimum and I mean bare minimum ($45K with benefits) just isn't out there, I have been looking since my denial in February as I have no choice. No one wants a 50 year old that is 4 years post professional employment in an entry level position and no one has shown any interest in even bringing me in for an interview.
So the Republicans think taking away my health insurance is the answer? This is the "Welfare to work" program that bombed in Wisconsin.
I've maintained all along that I want to participate in my recovery. I want to be that guy the republicans love....the one that grabs himself by the boot straps and works his way back up....but without health insurance it just won't happen.
That's my reality. Medicaid is not a hand out- its a hand up.