I debated whether or not I was going to write about the health care reform bill and its passage but after realizing that I am probably not the only one who initially was happy about this until I read the fine print. I figured maybe I would share my thoughts on the matter.
It’s safe to say that without a doubt affordable health coverage is a huge issue for most folks, after all not even being gainfully employed means that you will have access to coverage. Hell, I know…the agency I work at is small and barely manages to keep the doors open much less provide me with any health insurance. The Spousal Unit is self-employed and in good years we paid the outrageous costs for self insuring which is not cheap at all until our income went into free fall in late 2007 and we spent a period of time being uninsured. Last year in a fit of desperation I applied for the State Children’s Insurance Plan better known to most as the SCHIP program that provides coverage to kids whose families earn too much for Medicaid but are without insurance.
Well in a fluke move that I don’t understand or as my Dad calls it an act of God, not only was the girl child approved but actually our entire family was approved for state medical coverage. However before you get your panties in a bunch, you will be happy to know that effective April 1 due to increased income we will be rejoining the millions of uninsured though we get a 6 month transition phase so at least I can get my hernia repaired before I go back to being uninsured.
I say all this to say I have been closely watching this discussion because with the Spousal Unit self-employed and me working at a job that does not offer benefits, I was anxious to find out what this all would mean to me. Now I will admit that at over 1000 pages I have had to look at the cliff notes version and I have found several that distilled this down to an understandable and practical level.
For starters single folks earning less than $14,400 and a family of 4 earning less than $29,000 it seems these folks would most likely be routed into the expanded Medicaid pool, I have to say after having spent a year with Medicaid, frankly while it’s not too bad for kids. In many states it sucks for adults, lets see no dental coverage, no vision and the number of providers that actually take Medicaid is shrinking. I can only hope and I admit maybe my understanding is off so please feel free to chime in, but I see more folks on Medicaid as a real bad thing. Case in point when we were informed that we were eligible for Medicaid, almost 75% of the providers they listed in the booklet that we could sign up with were not taking anymore Medicaid patients. Need to get a referral on Medicaid? Good luck with that! In the end the physician that girl child and Spousal Unit had been seeing allowed both of them to stay on as patients since we had been with him for years. I ended up sticking with the sliding scale clinic I had been going to when I didn’t have insurance and let me tell you wait times to actually see my provider are quite high. Again the powers to be are going to have to tweak this big time to handle the rush of new patients in the Medicaid system, of course they have 4 years to figure it out.
Which brings me to another point that an online buddy with Medicaid experiences brought up, generally in order to get Medicaid there are asset limits, so again will the government be tweaking this? Otherwise all those newly signed up folks with shiny Medicaid cards could be in for a rude awakening.
Well now that I have covered the free coverage lets move on to folks who are either self-employed or working at gigs with no coverage, well depending on your income and for a family of 4 we are talking an income of up to $88,000 you are eligible for the subsidies and can buy your coverage in the brand spanky new exchanges that will be put together. Right now if I am reading correctly, you won’t have to pay more than it seems 9.5% of your income for coverage. So if you are Joe and Jane Doe and you earn about $60,000 as a self-employed family you can expect to pay almost $6000 a year for coverage. Excellent!
Well to be honest in a decent year our family income is in that general ballpark and today’s world with the cost of living paying almost 10% of my income for health insurance is not always doable. Hell, it’s the reason we went without for over a year. I can only hope these plans will offer real and comprehensive coverage which might…and I mean might make them worth the money.
Look, I admit there are some positives to this bill, folks can no longer be cut off because they actually get sick and use the plan nor will folks with preexisting conditions be turned away and yes its good to know that young adults can stay on Mom and Dad’s plan. Hell, Medicaid dollars will now pay for free-standing birthing centers…these are the cool things.
But I have to say that when I saw online friends proclaiming joyously that everyone will have coverage I wonder did they understand that everyone will be pretty much forced to buy some coverage. See, everyone being told to buy coverage thus making us all insured is very different from we all are getting insurance for free. I admit initially I didn’t notice the difference until I saw some buddies of mine who I know are deep into social justice issues, some like myself are front line workers who seemed to not be rejoicing that made me wonder what this really was all about.
Mind you if you decide to opt out of this, you will get fined, oh initially it will be a small slap on the wrist penalty of $95 a year but it will go up with each passing year that one chooses not to become insured eventually to 2.5% of income or $695 a year, which ever is greater.
Now I am not even going to get into how this will affect employers since that would be its own post but I will say I wonder if this will cause a negative impact on future hiring or more employers using independent contractors to skirt the law.
Look, I like Obama,I voted for the man, I think we need healthcare reform but this bill now law seems deeply flawed, I can only hope though as the Spousal Unit said last night that over the years maybe it will be tweaked enough to provide some real coverage. Because right now as it stands we basically just got told we all need to buy some health insurance and frankly the idea of anyone telling me how to spend what few coins I have does not sit well…friend or not.
I welcome your comments, after all with a bill this large it’s entirely possible I missed the boat and if that is the case please let me know. Only thing I ask is that we keep it civil.