And tired of hearing apologists tell us how great an advancement it is
First things first, let me be clear. To the extent that ACA has helped anyone, I’m glad of it. Some of its provisions are good and long overdue. If you’ve been helped by it personally, understand that this is not directed at you. This is for the rest of us who fail to see the so-called advantage.
Here’s my own case. It’s anecdotal, so I’m prepared for the tired “anecdotes aren’t data” retort. Maybe they aren’t, but they sure as hell are the raw material from which meaningful data may be extracted, at least once aggregated. I figure I’m hardly unique in my situation, so pick a factor you like and multiply my case by it accordingly.
As things go, I’m actually quite fortunate. I have a full-time blue collar job and gross about $27k/year. That just about puts me in the top 53% of earners in the US. I’m in an earnings range comprising ~13% of the US population. I’m even more fortunate that my employer provides 100% employer-paid health insurance, and the plan doesn’t entirely suck. But what if? What would happen if I decided to go it on my own as an entrepreneur and managed to eke out that same $27k/year, thus maintaining my current humble, yet enjoyable, standard of living?
Let’s see what I can get on the Montana exchange.
According to getinsured.com, individuals in my zip code can get a bronze plan for as low at $130/month.
Would you feel the bite of a $130 per month bill tacked onto the bills you currently pay? I know I would.
Let me break my life down for you in numbers. To be fair, none of this is “cry me a river” territory. I’m actually quite content for the moment.
In a typical month, I take home two checks in the ballpark of $700 each. Thanks to the little things that go wrong in life, I live paycheck to paycheck. Whenever I get one check ahead (a dream many of us share), something happens. Tires go bald. Teeth need pulled. Things need incisions and aftercare. Engine needs work. All the kinds of things that fall under the rubric of “shit happens.” Considering I’ve got a whopping $50 parked at an investment site (similar to eTrade) waiting for me to apply it to a stock purchase and earning a massive 3%, I’m doing far better than the vast majority of Americans on that front. Other than that, there is no safety net.
So I net $1400, let’s say. Rent is $545. That leaves $855.
Utilities are paid by the apartment management. *whew* Imagine the impact Montana winters would have on these numbers otherwise, to say nothing of other electricity usage, water, sewage, and trash collection. Once again, I’m one damnably lucky American in that I don’t have this expense.
My student loan bill is $130/month. Thanks to the magic of income-based repayment, I can afford to pay each month, but the debt itself essentially never, ever goes away. Oh, yeah, in theory it does in either 10 or 20 years of never a missed payment (depending on which fine print I read). $130/month is less than the interest I owe, but it keeps me out of default, which at least shields my SS income from interception should I ever actually reach an age where I can collect it. Only 20+ years to go! Woohoo!
So I’m down to $725.
I have an old beater of a pick-up that gets a stellar 12 mpg, but it’s paid for (and then some). Those $800 all-season tires to replace the bald ones were one of those little setbacks. At 12 mpg, it gets me to the store 1/2-mile away and back, but that’s about it. If I need to go to Great Falls for anything, I can expect to drop $60 of gas into that tank. Needless to say, my physical world is now very, very tiny as I don’t get out much. Even if I consider gas a negligible expense then, I still need to buy insurance. I pay for 6 months at a time, at about $300, so call that another $50/month.
I’m down to $675.
I like to eat food. As I cook for two, and tend to avoid most pre-packaged non-food crap, the food budget tends to the $200-$300/month range. For the sake of being thrifty, let’s settle on $200.
I’m down to $475.
For all practical intents and purposes, that $475 is my discretionary income. Everything else that comes out of that might properly be called luxuries, and I could hardly quibble with that. I think of that as my quality of life stash. If I’m to have detractors, this is where they get to pile on, because surely I should stop spending some of this money and not complain about an extra $130/month coming out of it.
Right off the bat, I’ll fess up. I’m a smoker. I make no apologies or excuses other than “quitting is really fucking hard.” If you’ve never quit, you don’t know. You have nothing to say on it. If you have, you know exactly what I mean, and congratulations to you for succeeding where so many fail, to wit, quitting depending on a substance as addictive as heroin. There goes nearly $200/month.
I’m down to $275.
I don’t have a cell phone, and I’m extremely fortunate to not be in a position to need one. That’s a leash I’ve managed to slip. A great many of you can’t even imagine that life. At least it’s money not spent. Instead, I’ve got the usual cable/internet/phone bundle. Here in Podunk, that comes to a whopping $160/month. On the bright side, as soon as this season of The Walking Dead ends, I’m cutting the cable. As it turns out, we’ve broken our attachment to every other piece of cable programming, and after much discussion have decided that the time has come. When I shop around our very limited broadband competition here, maybe I’ll be able to shave that monthly expense down to $100/month. Yeah, yeah, Internet is a luxury. I get it. You try living without it. I’ll keep chalking that one up to “quality of life” expense. So let’s go with my assumed savings, and keep this one at $100/month going forward.
I’m down to $175.
My other three regular frivolous expenses are Netflix ($8/month), Blizzard (for World of Warcraft, dropping soon) ($15/month), and my newsreader that I subscribed to for advanced features ($5/month). So $28/month.
I’m down to $147.
Well, then. There’s my $130/month for ACA coverage. What’s to bitch about, right?
Well, let’s look at what I would get for that $130/month.
One item that applies to me shows up as “no charge,” preventive care/screening/immunization. The other two “no charge” benefits are for children. Absolutely everything else is listed as “no charge after deductible.” What does that include?
Primary care visit, specialist visit, other practitioner office visit, lab tests, x-rays and diagnostic imaging, imagine (CT/PET/MRI), generic drugs, preferred brand drugs, non-preferred brand drugs, specialty drugs, outpatient facility fee, outpatient surgery physician/surgical services, emergency room services, emergency medical transportation, urgent care, hospital facility fee, hospital surgeon/physician fee, mental/behavioral health outpatient services, mental/behavioral health inpatient services, substance use disorder outpatient services, substance use disorder inpatient services, home health care, rehabilitation services, habilitation services, skilled nursing care, durable medical equipment, hospice service, and accidental dental. Pregnancy-related items fall under this same category, but obviously don’t apply to me.
So what’s that deductible we’re talking about? After all, once I pay it, all those benefits start kicking in, right?
Where the hell does that come from? At $147/month of left-over money, it would only take me 42 months to save that up while hoping like hell I have no other contingencies come up, especially medical ones. Ah, but that’s the figure we arrive at after I’ve splurged on all those fancy things like the Internet and cigarettes. If I were the very embodiment of Prudence itself (well, that’s a stretch…were that the case things might be different for me then what would I have to complain about?), I’d be looking at hitting a $6250 savings goal at $475/month (before all those silly luxuries). If I scrimped and saved all those pennies, it would still take me 13 months to save that up. 13 months where I’d damned well better not have any emergencies, especially not medical ones.
So if I did that, and only if I did that, would I derive any benefit from a policy I’d be required to buy were I not otherwise covered. For $130/month, I’d essentially get fucking squat. Zilch. Zip. At least with a mafia protection racket, I’d get to keep my kneecaps for my money. All $130/month gets me is a permission slip to walk into the doctor’s office one time, and that’s if they agree to bill me for the visit. Once that bill comes in, it would just be another debt to pay off, with no relief from the insurance company, never mind how many months I’d have shoveled $130 into their bank accounts. Should that doctor’s bill go unpaid for too long, 30, 60, 90+ days, maybe they’d cut off my billing privileges. Then I’d get to go to the ER for catastrophic care like all the other uninsured schmucks, except that I’d have the privilege of sending the insurance company $130/month for that access. And then I’d get the ER bill.
Maybe if I could just shit hard enough, $6250 would fall out, and then insurance might help me with the remainder.
On the other hand, I could go for insurance that actually works. By that, I mean the platinum level. All that in between crap? Those are just watered down versions of the story above. Unreachable deductibles are just that, whatever the size is. Everything beyond the bottom end of unreachable is just shit-flavored icing on a cake made of shit. With a platinum plan, I would at least get value for my money, provided I have a need develop, but hey, that’s why they call it insurance, right? You get nothing for your money until you need it, and you hope you never, ever need it, but if you do, then you have a safety net. It’s just that to have a safety net that actually works, I would need to pony up $391/month for individual only coverage.
That would get me no deductible, a $1750 out-of-pocket max, $25 copay, 25% co-insurance for generics, and a $100 ER copay with 25% co-insurance. Those are the numbers that show up through the detailed list. $25 copay, 25% co-insurance after deductible (which is $0). And then I’d have $84/month left over to do whatever the hell I want with it.
Just imagine what a person could do with $84 left over at the end of the month! That’s a trip to Great Falls that would leave me $24 more dollars to put into the economy somewhere, because it’s worth $60 in gas to spend $24 somewhere. Or I could just save it all. Or I could scrap Internet/phone and get a cell phone instead for limited access and maybe have $20 left over. Maybe.
Oh, sure, I can tweak some settings and get something sub-platinum with a $0 deductible. That one other option is still $326/month.
Or maybe I could spend $309/month for a $500 deductible plan.
The cheapest $1000 deductible plan (similar to what I get from my employer now) comes in at $264/month.
Let’s be clear here. My emphasis on the deductible is entirely necessary. If the deductible is unreachable, I may as well have no insurance at all.
The point I’m trying to drive home is that if someone is poor, and I’m not, by a long shot, it doesn’t take much of a barrier to count as an impossible barrier. Don’t reach that barrier? The coverage doesn’t help. All this kind of coverage does is put money in the insurance industry coffers. To the extent that ACA helps, once again, awesome for those folks. But for those of us down here straddling that top 50% of earners in the country line, here’s the message we get from the apologists.
Go work your 40 hours a week. Be entirely prudent. Wake up each morning, get dressed, get to work, do my job, go home, and bask in the glory of watching paint dry while I prudently save, save, save. After all, I’m one of the lucky ones in that top 47%. I can do all of that with a full belly, roof over my head, lights on, and catch up on the news with my cell phone. After 40 hours of grueling, physically demanding work, I should only get to look forward to more of the same, day in, day out, day after day, week after week, month after month, with no end in sight. Books are for the really privileged. Access to information is for the really privileged. Real food is for the really privileged. The option to get out of Farmville for a taste of another piece of America is for the really privileged. Pretty much the option to do anything other than work and wait for the opportunity to work again is for the really, really privileged. Oh, and clothing? Pardon us while we laugh at your rags.
Short version? Hey, you blue collar slobs, fuck you.
And if that’s the case, what are the apologists saying to the actually poor? You know, people who make less than me, who might not be lucky enough to have 40 hours a week of work, who still eat pre-packaged food because it’s cheap (but not food), who have utilities to pay, who absolutely have to pay for gas or other transit expenses, or, heaven forbid, actually have at least one dependent, perhaps children. The message is simple: what little you have, it is essential that you part with it so that the insurance industry can have it instead, and by the way, don’t expect to get anything for that money you send them.
In short, an even bigger FUCK YOU, in bold caps.
This is what our fake progressive president accomplished, and goddamn it, we should just be fucking grateful that we’re allowed to send the insurance companies any money at all. After all, they’ve at least earned it.