Preface by Hyung Namm HCAO Board member:
Why the lack of universal health care (and high education) keeps people in poverty
[The Official Poverty Threshold Should Be Much Higher]
The original poverty measures were (and still are) based largely on the food costs of the 1950s. But while food costs have doubled since 1978, housing has more than tripled, medical expenses are six times higher, and college tuition is eleven times higher. The Bureau of Labor Statistics and the Census Bureau have calculated that food, housing, health care, child care, transportation, taxes, and other household expenditures consume nearly the entire median household income.
Affordable it isn't, and it isn't "care." The individual mandate buys insurance - NOT "care." With the ACA if you are an average earner there is simply no way to pay for ACTUAL health CARE!
So: because of paying a monthly premium that even with the subsidy is not affordable, and having to buy additional dental coverage, and not having vision care insurance coverage available under any circumstances, many of us average earners find that:
* We CANNOT afford to go to a walk-in pay-up-front urgent care clinic. So if we get a cold or the flu or have an injury - anything short of the ER – there’s no money left over after paying the monthly premium to be able to pay out of pocket for ACTUAL illness or injury health services – and until we meet the high deductibles, often 20 percent or more of average gross income, THE INSURANCE IS WORTHLESS. Most of us will never be able to meet the deductible barring catastrophic health occurrences such as cancer or heart attack or stroke or multiple fractures or kidney failure. IF we experience such a catastrophic health occurrence, we STILL will have to meet that deductible and it is likely that in and of itself will mean a so-called "medical bankruptcy." In fact, the bankruptcy courts are already seeing the unpleasant results of high deductible insurance.
** We CANNOT afford to buy prescriptions. For example, I now have what the doctor called unmanaged asthma. I have about five hits left in my current rescue inhaler which is several years old (expired). A new inhaler would cost the following OUT OF POCKET: physician office visit (between $200 and $300), lab tests (another $200+) and the inhaler itself which currently goes for $348. NONE of this would be ACTUALLY covered under Obamacare because there is such a high deductible. If I was put back on asthma management daily meds I would have $1000+ monthly prescription cost. My take home pay is less than double that. There is no way even if I didn’t have to pay rent that I could cover that for the months it took to gain ground on the high deductible.
**We CANNOT even afford to get a vision exam and buy new glasses because under Obamacare, now required in Oregon, there is no vision insurance available! Even the least expensive exam is approximately $100 and even the cheapest eyeglasses (currently Eyemart Express) is "two for $49.95" and at Eyemart Express you cannot halve that and buy just one. So for someone with an average income around the so-called "living wage" level that is estimated out-of-pocket $150-$200 to try to budget for and the choice will come down to groceries or new glasses, groceries being what gets cut back when everything else in the budget is non-negotiable such as rent, car insurance, and gas to get to work!
A really nasty thing happened when I started calling around to find a doctor both accepting new patients and who would accept insurance issued under the federal exchange. I was told by several office finance managers that I would have to complete a credit application and employment verification so that they knew upfront whether I could pay for actual health CARE until I meet the deductible. Even for a one-time doctor office visit. Comments from providers’ office staff seemed to be more or less this: “under the Affordable Care Act we are finding that once people learn that their deductible has to be met before they have their illness covered, and if we can’t collect in full in cash at the time of service, our bills go unpaid.” That is why some offices demand payment IN FULL IN CASH (or credit card) at the time of service. I also heard the comment that providers are no longer restricted under policies purchased from the federal exchange from going after patients if marketplace policies are slow to pay the provider. Under private health insurance the arrangements between providers and the insurer prohibit the provider collecting from the patient what is supposed to be covered by insurance even if the insurer is slow paying the provider. Under Obamacare, apparently it is “open season” on patients if the provider is unhappy with the slow reimbursement to the provider!
If interested, here is my budget to illustrate.
My take-home pay (after taxes) is $1860. My rent is $835, to go up in June. I have rented from this landlord since 2002 and the rent is actually under market in my geographic area and I am fortunate that it includes sewer, water and garbage (and storage and parking) (could I save up to pay first last and deposit for something else? Not likely, and moving closer to work isn’t an option as the cost of living there is more than where I am right now). My budget-pay plan for electric utility has been $130 per month, I’m advised this will be $140 starting next month. Heat in fall/winter/spring is additional, approximately $60 (pellet stove fuel). My car insurance is $78/month because I drive excess mileage (80 miles per day rt) to the only job I could get at my age, 63; my car is old and gets only 21 miles per gallon so gas is running over $200 each month and if gas goes past $2.50 a gallon I do not know what I am going to do to get to work as there is no public
transportation from my rental to my job in another town. I have no credit cards. (I don’t visit Starbucks either, which seems to be the popular thing for haters to challenge us working poor folks with – e.g. “you could afford *** whatever if you didn’t pay for expensive coffee drinks every day”). My cell phone (no landline) is $55 and it is not a smart phone just basic (no texting, no Internet connection, no entertainment or infotainment features). I am paying off a small tax bill still owing from when I was on unemployment and needed every penny just to survive so did not have tax withheld, that’s about $60 per month. I don’t have cable or satellite just “free” TV (my TV is a 1993 model, btw). Borrowed computer with borrowed Internet connection, borrowed from a friend because the library charges a fee as I live in unincorporated area of the county). I have been paying approx $250 for groceries but have had to cut back because MY
OBAMACARE PREMIUM for the CHEAPEST – all I could actually pay for, and WITH the “subsidy” is $188 per month. AND: It covers NOTHING until I meet the $6,350 deductible. You can do the math and see what is left. What is left is close to zero. Cannot save anything toward retirement. Cannot fix the car (and I need the brakes worked on and electrical problems too and the transmission is going, the car is 23 years old). Cannot pay for dental care, and I currently have infected broken tooth and a mouthful of broken fillings and at least one abscessed tooth.
So – rhetorical question: where would the money come for ACTUAL HEALTH CARE – CARE as opposed to insurance which cannot be accessed until I meet the high deductible? You tell me!