My friend Maxine tells a great story about health care “back
in the day.” Her older brothers had been ill with sore throats, so the doctor
made a house visit to remove the offending tonsils, right on the dining room
table. After he finished, he looked around and saw 5 year old Maxine watching
with wide eyes and said, “Come on, Maxine. Hop on up here. We might as well take
your tonsils out too.” That’s one way to save on medical costs.
That’s what health care looked like in the early decades of
the twentieth century, and people paid for doctor’s visits, usually in cash,
but sometimes with chickens or produce. Progress came with sickness insurance,
an early form of disability insurance, then Blue Cross and Blue Shield, and finally
health coverage as a benefit of employment.
There have been many efforts to provide universal coverage
over the years, but none succeeded. Perhaps the most bizarre episode in health
care reform occurred in the Nixon era, involving Wilbur Mills, whose House Ways
and Means committee seemed to be making progress towards that goal. However,
Mills was pulled over by the police at 2 a.m., and his passenger, a stripper
known as Fanne Foxe, jumped into the Tidal Basin –wrecking Mills’ career and ultimately
knocking healthcare reform off the table.
Now, almost 40 years later, we have the Affordable Care Act,
aka Obamacare. Like most Americans, I am confused and concerned. How will this
legislation affect the bottom line of the national budget and impact those who
struggle to access health care?. But, like most Americans, I also want to know the
impact on the bottom line of our household budget and access to medical care
for my family.
My husband and I currently have health coverage through his
employer, and Obamacare has mandated the coverage be extended to our son who is
under 26. So far, so good. If we need to pick up health coverage between now
and Medicare eligibility, as a self-employed person I should qualify for insurance
through one of the exchanges starting in 2014. That’s good news for us, because
in our current income bracket, we’ll only pay less than 10% of our income for
health insurance (through tax credits).
What about our 30 year old uninsured son who works full-time
for a local restaurant that doesn’t offer health benefits? If they have less
than 100 employees, then the exchange program will be available to them. if they have 100+ employees, they will
have to make health coverage available, or pay fines.
But what exactly does that mean? Is there anything to stop the employer from
assessing a large percentage of the insurance premium to their low wage
employees?
That’s what’s happening to son number 1. Because his
workplace offers medical coverage to its employees, he won’t qualify for insurance
under the exchanges. The way he sees it, he and his wife are stuck, because according
to former CBO director Doug Holz Eaken, “Under the Affordable Care Act, if a low income
household is offered qualified coverage by their employer, they are
automatically ineligible for additional federal premium assistance (this is the
so-called “firewall” rule aimed at creating a barrier against mass migration
out of employer-sponsored insurance).”
Aye, there’s the rub, as
Shakespeare was known to say. If I understand the Affordable Care Act (not an
easy thing to do), if you work for Company A, and they offer healthcare
insurance, you have to take that – you can’t opt out, look for a better deal,
or go without unless you want to pay a penalty. So, because his company offers
it, my son must continue to pay more than 50% of his bi-weekly wages for
healthcare while those who qualify to use the exchanges will pay a much smaller percentage – and those who
qualify for Medicaid will pay nothing.
My friend Maxine and I are both
glad that medical care in America has progressed past tonsillectomies on the dining
room table. But the Affordable Care Act
hasn’t convinced me that it will truly make medical care affordable to all
Americans. I hope I’m proven wrong on this one.
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