I had no health insurance for quite some time. Probably from 22 until 26 or so? I was too old for my parents’ plan and I didn’t have a job. And then I had a bunch of part-time/contract jobs which didn’t have insurance.
Then I got a job and it had health insurance! That lasted from about 2009 to 2012. Then the business closed, and the company that bought us out offered COBRA, even though legally they didn’t have to. That was nice, except I was paying around $350 a month for health insurance and I was (just barely) self-employed. I grew my business while building up a lot of credit card debt. I tried to apply for an individual plan during this time, but apparently having (very rare) migraines meant I had a pre-existing condition and they wouldn’t cover me. I still can’t understand why I couldn’t get coverage for everything except the migraines, the medicine is expensive but still would have been cheaper to pay for that out-of-pocket and have a cheaper than $350/month plan.
Then the Affordable Care Act came along and I got health insurance at a much nicer rate of $205/month. Then another year later the rates went up to $218/month. My business is now a bit bigger and I can afford this somewhat, but between this and the enormous credit card bills every month I can’t really afford anything else, like eating or rent (luckily I have help with that so I’m not cold or hungry, but it’s pretty miserable).
2016 plans come out and my health insurance company has merged with another, and the rates for my mediocre plan are going up to $278/month. I decide to try applying for Medicaid now that my state has expanded coverage. The paperwork is horrid. The online site doesn’t work. I give up, several times, only to remember I can’t afford to give up.
I find out that I can use the online site only in IE. Ok, fine. I apply. They say I need to send in my tax returns, but I can upload them online. No, I can’t, the plugin doesn’t work. I mail them from the post office to my local county assistance office. The two buildings are literally next door to each other.
Two weeks later I get a letter saying I can’t get Medicaid if I don’t send in these forms. I did send them in, two weeks ago. They only have all my personal information including social security number on them, no big deal that they’re just lost somewhere. Great.
After lots of arguing I find that I can upload the forms online only in Firefox. Ok, done.
Two days later I get a letter saying I’m approved (I guess making only $4,000 a year is great for Medicaid approval times.) I can go to a website and enroll in a health plan. It works in all browsers, I do a happy dance.
Oh, “your plan won’t start until January 15th,” because they lost my paperwork and everything was set back 2 weeks. This means I need to renew a standard full price plan just for those 2 weeks of coverage.
Meanwhile, in full-price insurance land, Blue Cross, which as you’ll remember had merged and was now offering different plans, sent me a letter saying that they couldn’t auto-renew me and I would need to sign up for a new plan on healthcare.gov. Great, I can’t afford $278 even for a month so I wanted a cheaper plan anyway. I sign up for a barebones $205 plan with the intent of canceling it by February once Medicaid kicks in.
The next day I get a bill from Blue Cross for $278 saying they auto-enrolled me in the original plan after all. “Pay us now.”
Knowing I just signed up for a different plan I assume I will get an updated bill for $205.
A week later I get a letter in the mail saying that my application has been canceled due to nonpayment. Still wondering if I should care or just plan to not have health insurance for 2 weeks. Or maybe they’ll send me a new bill after all. And either way I still have state help so if I rack up huge medical bills in those 15 days I’ll be ok, but I like to cover my bases, you know?
Meanwhile, back to free health insurance land, since receiving the initial notice I have received a piece of mail from a different local/state agency every single damn day telling me something that I don’t really care about. I have an access card, and a community health care card, and maybe someday I’ll receive an actual health care plan card. I’m expected to carry all of these with me at all times. I guess since all my credit cards are maxed out I have the room in my wallet. I also received several informational pamphlets, and a form saying I should be receiving a health care plan from my employer, and can’t I use that one instead? Self-employment, what?
I really just want this to be done. I want to have a bit of time when I don’t have to ask for help paying my bills so maybe I can work on the rest of my life. I want some energy to work on my business so I can maybe start making a decent income. I’m really so frustrated that it’s 2015 and this is a problem I need to deal with, healthy people are better for society but it’s so hard to manage that in this country.
Well that was cathartic. Now back to waiting.
As I explained in my 'blog, the cost of premia is going to continue to spiral out of control until the programme folds.
The ACA attempts to pay for healthcare by taxing health itself. Those who are relatively healthy but buy insurance pay premia far in excess of their expected cost to the insurers. However, these people are also the most likely simply to forgo insurance, unless the penalty for doing so is quite high. The ACA could not have passed had the public expected penalties on that order.
So, in the first year, some of the healthiest people chose not to insure, and this caused premia to increase in the next year. In that next year, insurance was a poorer bargain for the healthiest of those who had insured in the previous year, so some of them chose not to insure that year. The penalties increased, but not as fast as the premia.
This dropping-away, followed by increases in premia, causing more dropping-away, will continue; the penaltues don’t catch-up. But I think that it will be less than two years before the programme is taken to have failed.
The response to that failure will be determined by who controls the White House and the Congressional leadership. A majority of the public will want the ACA scrapped and for the government to back-off, but much of the political elite (Republican as well as Democratic), backed by about 35% of the public, will seek an overhaul that sees the Federal government becoming still more involved.
There are two historical reasons for healthcare costs for the increasing costs of healthcare seen even before the ACA. First, many various fairly direct interventions by the government in healthcare delivery, such as allowing the AMA effectively to control the supply of those legally allowed to practice medicine (by controlling admissions to medical schools). Second, during World War II, wage-and-price controls (to hide the costs of war) caused firms to look for ways around those controls to attract workers, and employer-provided healthcare became wide-spread, perverting the rôle of insurance and putting two layers (employer and insurer) between consumer and producer.
If we don’t unwind these interventions, then things will get worse and people will suffer; unfortunately, the unwinding also involves suffering, and people see that suffering more clearly. People want what amounts to magick.
Yeah I am not informed enough on economics to take a stand on what should or shouldn’t be done, but I think there are so many layers to this problem past what you mentioned and systematically going after them would help just as much. I have mixed feelings about saying the government should regulate insurance companies but they scam people and waste so much money and I really don’t see how healthcare is any less important than having safe roads and bridges. But I admit I’m biased and basing my opinions on my own medical history and probably missing a lot of the bigger picture as a result.
There are plenty of economists who will tell you that the state ought to get out of the business of creating and maintaining roads and bridges. 😉 (And the only people who seem to think that it does a good job in that business are those whose income is linked to having the state at it.)