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| Self-portrait, 2013. Photograph by Franetta McMillian copyright 2013. |
By Franetta McMillian
(Franetta McMillian describes herself as “a full-time writer, sometime artist and part-time retail drone
living between Newark, Deleware and Avondale, Pennsylvania.” Most
recently her stories and poems have appeared in Broadside Review
and Possum Garage Press. This report, significant for its
personalization of the real-world impact of what has come to be known
as Obamacare, shows she's also a talented journalist. It is her first formal contribution to Outside
Agitator's Notebook.)
IT WAS MY employer's annual benefits
enrollment period that put the Affordable Care Act of 2010 back on my
mental radar again, not that it had ever really left.
Many large companies (though most are
not as graceless about it as Wal-Mart, Applebee's and Papa John's)
are looking for creative ways to "control costs" and
"empower" their employees to "take charge" of
their health. What this usually means is saddling employees with
higher premiums and co-pays or slashing labor hours so these
companies are no longer obligated to provide health coverage at all.
They will do the bare minimum to follow the letter of the law —
which in this case is all they can follow because the Affordable Care
Act has no spirit.
Though the law was trumpeted as a way
to expand coverage to many who do not have it, as it is currently
written it will not even come close to accomplishing that lofty goal.
Obama's intentions may have been noble, but the law serves too many
and the wrong masters, resulting in "reform" so diluted,
it's barely reform at all. Like I said: no spirit.
If you really want an idea of how big a
nightmare the Affordable Care Act will be in the real world, read
Obmamacare:
A Deception. It's not exactly a quick read; it's technical and often tedious, but
then again, the Affordable Care Act itself is some 2000 pages long. I
doubt even members of Congress read the whole thing.
The Affordable Care Act requires every
American who can afford it to buy health insurance. If you can't
afford insurance, the government will provide you with a tax credit
to help you do so. The poor and the near-poor (those whose income
falls within 138% of the federal poverty level) will be part of the
new expanded Medicaid. Sounds reasonable, doesn't it?
But take a closer look. The amount
you are required to pay for insurance is determined by your modified
adjusted gross income, which is a different beastie than the more
familiar adjusted gross income you use to determine your federal and
state tax obligations. For many the modified adjusted gross income is
higher, which means you may not be as poor as you think.
My modified adjusted gross income
fluctuates from 200% to 300% of FPL, which means the government says
I can afford to spend 4% to 9.5% of that income on health insurance.
That's approximately the amount of a car payment. Good thing I don't
have a car payment now, but that's not saying I won't have one in the
future. Oh well. If I do, I can live on beans and rice; I've done it
before.
Okay, let's go buy insurance!
The new health care exchanges will
offer four levels of coverage. The platinum and gold levels are way
out of my league and our government will do little to help me with
the cost of those even though they provide the most comprehensive
coverage. So I'm stuck at the silver and bronze levels. Silver only
offers 70/30 coverage with a $2050 deductible. Bronze is worse with
60/40 coverage and a deductible nearly twice as high. All plans cover
up to $250 for preventative care — the annual physical with basic
labs — and my pre-existing hypertension won't lock me out of
purchasing a plan. However, since there is no cap on what the
insurance companies can charge for a policy, there's no telling how
costly that plan will be. Oh yeah, and I'm in my early 50's, the age
when things slowly begin to unravel even for the healthiest of us.
That's going to add some cost, too.
The government's help, the so-called
advance tax credit, is based on the cost of a silver level plan in my
state and my modified adjusted gross income. Since there is no way I
can precisely know what my income for 2014 will be, that credit will
be based on my income for this year (2013). If, by chance, 2014
brings me loads of freelance work and a couple of especially
lucrative short story sales, thereby increasing my income
significantly, I will have to pay back all or part of that credit
when I file taxes in 2015. And on and on. It could get messy. Uncle
Sam may giveth, but if he thinks he's giveth too much, he will
certainly taketh away.
Let's say 2014 brings me worse
fortune than the current year, enough to get me bounced into
Medicaid. Well, that's not exactly unconditional love either. I may
get some semblance of care, but should I die of whatever ails me, the
state will be allowed to recover the costs of my medical treatment
from my heirs, who aren't exactly rolling in dough either.
I don't want to sound like a total
hater here. The law does bring some significant improvements.
Everyone with insurance is covered for a yearly physical. Insurance
companies must spend at least 80% of premiums on actual healthcare.
Children can stay on their parents' plan until age 26. People with
preexisting conditions can no longer be turned down and there is no
longer a lifetime cap on benefits.
However, there are no established legal
limits on how much those now mandatory insurance plans can cost and
no price controls on the actual cost of treatment itself. (For an
especially frightening — and utterly exasperating — examination
of healthcare pricing check out Steven Brill's piece, Why
Medical Bills are Killing
Us.)
There isn't even a guarantee a doctor or hospital will accept your
insurance for non-emergency care once you've mortgaged your arms and
legs to buy it. This especially holds true for bronze level plans and
Medicaid.
Even if your bronze level plan is
accepted, the bills can pile up very quickly. A few years ago I was
unlucky enough to have an illness that required several surgeries.
Fortunately, I had decent insurance for most of the course of my
treatment, but even then, I racked up thousands of dollars in
incidental costs due to deductibles and co-pays, not to mention
several thick manila folders of paperwork. (Which, incidentally, I
still keep just in case I get a surprise bill. No kidding. I once got
a bill for injections nearly two years after the fact.) If I'd had a
bronze level health plan, those nickel and dime charges could have
easily ballooned to the high tens of thousands, and I would still be
paying those bills today and for several years to come.
As it stands, the Affordable Care
Act barely lives up to its name. It is an expensive and needlessly
clumsy piece of legislation that will give private insurers lots of
bang with your bucks. Hopefully it won't be so expensive and clumsy
that it will sour Americans on the ideal of universal healthcare or
erode our dwindling faith in government past the point of no return.
Thing is: it didn't have to be this
way. Obama could have just said, "Medicare for everyone!",
and I bet the majority of Americans would have understood. Yes, that
would have been expensive too, but at least we wouldn't have been
throwing our money in the street because Medicare works. And if it's
one thing I've learned during my short time on this earth, it's that
it's always cheaper in the long run to do the right thing. And
safeguarding the health of your citizens is the right thing to do. I
believe it dovetails nicely with the "general welfare"
clause of the Constitution.
I suppose you could argue that with the
Affordable Care Act Obama managed to legislate the idea of expanded
coverage and greater access to care where others had failed. Though
the legislation is flawed, this line of thinking goes, we can always
go back and patch the holes later. But I fear an idea so poorly
executed from the start may prove worse than no idea at all.
(Original reporting by Franetta
McMillian copyright 2013, reproduction rights conditional upon
crediting author and linking to Outside Agitator's Notebook.)
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