The coronavirus pandemic has placed the United States in the middle of two major crises: a public health crisis, as millions prepare for a serious illness. And an economic crisis, since the measures necessary to contain the spread of the virus led to a strict brake on all types of economic activity. Before long, we will also face a health insurance crisis, as millions of laid off workers lose their insurance. Those Democrats who have implemented public option plans backed by the promise that "if you love employer-sponsored insurance, you can keep it," are about to find out just how stupid this promise is.
Even in the absence of a global pandemic, this would never be true: there is no health insurance that an employer can provide to anyone. Employers can change insurance plans at any time, leaving those who receive their insurance benefits in this way subject to higher premiums, deductions or copayments. It can also mean losing access to a preferred doctor if you are not in the new provider's network. If employees lose their jobs, they lose their insurance entirely (except for the option to pay their premium in full for temporary coverage under COBRA, which is generally unaffordable)
Typically, these flaws in the employer's health insurance model are a slow-motion problem. The epidemic has changed everything. This is the dramatic reality that millions of Americans now face. Up to 32 percent of American workers can lose their jobs; A percentage of these workers will no longer be insured, but a large percentage of them will lose their insurance when they are laid off. It could be tens of millions of Americans, as well as their partners and dependents.
There are many options for these individuals, none of them offer a smooth and easy transition to coverage, and none of them are universally accessible. Many will apply for Medicaid. Those whose assets or income are deprived of public programs can obtain insurance on the Affordable Care Act exchange. For each of these two groups, your ability to access health insurance will depend on your income. But what if your income varies due to seasonal or weekly differences in hours? What if your income is based on Uber driving, Grubhub deliveries, or Etsy sales, which vary a lot from week to week? What if you were a freelance writer and could reserve a magazine cover story in one month and publish about $ 100 the next?
This is not just a hypothetical problem for CoronaWorld; It is a living reality for the nation's poor, a routine horror that will expand and intensify in the months ahead. States like Texas expel children and their parents from Medicaid because monthly differences in income, even temporary, make them ineligible. Other times, the state makes a mistake, so arbitrary and vague that it is difficult for the average person to believe and correct it.
ProPublica reported last week that in the case of a South Carolina woman with Covid-19 and chronic pain, Medicaid was canceled by the state, "with little explanation other than that she made a mistake" in initially submitting her coverage. You live on less than $ 1,000 a month in Social Security income and food stamps. How is she supposed to buy health insurance herself? Who will pay if I go to the ER without being able to breathe? Who would answer to her death if she delayed going to the emergency room until it was too late, because she knew the bills could lead to financial ruin? Who will respond to the misery imposed on him by the United States and many others? If Medicaid or Medicare is available to everyone, regardless of income.
For those with an income high enough to be required to use Affordable Care Act exchanges, they will be asked to estimate their annual income, which is not an easy task under the best of circumstances, but much less when living in a pandemic with no clear end in sight. If they reduce their income, for example, because they quickly find another job or because their vacations are shorter than expected, they may have to pay the benefits they received for their health care in taxes for the next year. God forbid anyone to get cheap insurance in this country. Again, this is not limited to people who earn a good living: a person making $ 36,000 a year in Erie County, New York, would qualify for approximately $ 215 in tax credits per month if that person earned $ 45,000 a final, decrease. That number drops to $ 131 per month, or a difference of about $ 1,000 for a year. (For people in this income bracket, the amount they will have to pay to the government is set at a maximum of $ 1,300. Another great and generous service from our federal government).
The situation will get worse in some parts of the country. In states that have not expanded Medicaid, millions do not actually qualify for Medicaid based solely on the loss of their income. At the same time, they don't earn enough to qualify for subsidies on the stock market. The technocratic intelligence of the exchange system was to save Medicaid up to 138 percent of the federal poverty level and provide advance tax credits for those who earn more than a penny. This did not anticipate a Supreme Court ruling that would allow states to refuse to expand Medicaid. And so we have an uninsured rate of 17.7 percent in Texas. As people are laid off, without the option to enroll in Medicaid based solely on low income in more than a dozen states, this number could increase. How high do you have to go before you say "No more"?
It is unethical to determine whether a person should receive medical care based on their income. It would be unethical for those income limits to be 10 times what they are, if the millionaires who pursue the rhetoric of Democrats when they warn of global programs are the only ones at risk of losing their healthcare, rather than the mothers who have had so many fighting at Kruger, but it will still be unethical. But even if we put morality issues aside, it is also stupid to pretend that all of this "works."
What this epidemic faces is that it is a bad way to provide health care to anyone and it is not a way to provide health care to everyone. However, the assumption that this system that we have, a patchwork of programs to cover various people who are deemed to need enough government help, is generally a good way of doing things, which underpins the health plan for the possible Democratic presidential candidate. In fact, he assumes the current system is so good that his plan keeps about 10 million Americans uninsured. This is America, after all, Jack, and if America has millions of uninsured people, it should basically be fine.
Those lucky enough to stay healthy and safe in the coming months are still not immune to the effects of this crisis on the healthcare system. Health insurers Cigna and Humana promise to cover their clients' coronavirus costs out of pocket. Others can follow suit. But there is no guarantee that insurance premiums will not increase simply because of increased spending by insurance companies. In fact, Covered California forecasts show that health insurance premiums could rise by as much as 40 percent next year to account for the money it will have to spend to pay for coronavirus treatment claims. Insurers want Congress to create a private reinsurance plan to finance their losses, which begs the question of why we bother insurers in the first place.
As hospitals struggle to meet the increase in the number of patients, it is time to point out that the rates charged by insurance companies, in many cases, are not similar to reality; Hospitals can compensate the prices they want. An uninsured cancer patient who visited the emergency room three times before finally testing positive for Covid-19 received a bill for $ 34,937.43. The Kaiser Family Foundation estimated the cost of Covid-19 treatment to be less than $ 10,000. The patient was insecure because she was about to start a new job, a regular and absurd feature of American life, even in non-epidemiological times. It's amazing that the same hospitals that charge $ 60 for ibuprofen suddenly find their beginnings during this time.
However, many hospitals are also likely to need a rescue plan. The stimulus bill provided $ 100 billion to the Department of Health and Human Services to distribute at its discretion, but Axios reported last week that rural hospitals fear it will be difficult to access the funds quickly. This is to be expected of a system that allocates money to hospitals based on market principles, principles like "Inclusion is very profitable" and "You still make money from us, really", rather than necessity.
Rural hospitals are often created by opponents of health care for a single reason as potential victims of such a system; If reimbursement rates fall below a trigger, they shout, rural hospitals will close overnight. But it is this very system of allowing a hospital to live or die based on its profitability that is killing rural hospitals, which have struggled the most in states that have not expanded Medicaid, because it means that more of their patients cannot pay. your attention. (Some states are already experimenting with global budgets or providing hospitals with a fixed amount to spend, which would replace the fee-for-service model with a single payer.)
This week, Joe Bidding reiterated his argument that this crisis is not a reason to support a motive, saying that a single push "won't solve that at all." Certainly, individual motivation alone does not prevent a pandemic. But Biden, as the sole Democratic nominee, must acknowledge that he has some responsibility for the current situation: Access to health care coverage is a stressful issue, not to mention the care itself, as well as the nightmare millions of Americans are facing about to suffer. His plan, to make adjustments and adjustments to the margins of the current system, is neither serious nor sufficient, and the abstract truth of this is starkly revealed with each passing day. The economic crisis unfolding before our eyes is a compelling case for truly universal healthcare.
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