Hard working Americans struggle without health care

Americans must make real change at the ballot box! Vote for health care for all.....

Health care shouldn't come down to the size of your wallet

At age 61, my dad is one of the roughly 6 million self-employed Americans without health insurance with no foreseeable light at the end of the hospital halls.

He has atrial fibrillation, or in layman’s terms, a bum heart. It can be mitigated, but it isn't cheap.

My uncle died recently of cancer. He was self-employed and uninsured at his diagnosis. They're just two of the legions who work hard to make ends meet and achieve success with little wiggle room in a health care system that isn't there for them when they need it.

That's not the American Dream.

Everything is an uphill battle. The cost of vital medications and hospital visits competes with bills, groceries and keeping the power on. Do you sell the house, the boat and the land — tangible equity for the future — or tough it out to inevitably end up back in the ER?

There are a lot of decision makers who use health care as a political chess piece. Meanwhile, they remain shamefully blind to the reality that the current set-up doesn't work for too many Americans. This isn't a game to be won for one party or another. It's not every man for himself. Lives are at stake.

The Legislature is bandying about ideas that would put cities on the hook if a felled tree takes down transmission power lines. They’re looking to get the whole state on Daylight Saving Time year-round and arguing over whether a statue of Walt Disney or Mary McLeod Bethune better represents Florida in the U.S. Capitol.

The U.S. government has shut down twice this year. It's only February.

But what we’re not hearing is substantive discussion on how to help people with the realest problem of all: their health.


The old adage remains: You don't need insurance until you need it. Not having a roof over your head is fine until it rains.

Canada, although not perfect, figured out how to do it decades ago. Most Europeans don’t bat an eye at hospital visits.

In the U.S., people make decisions about whether to even visit a doctor based on whether they’re able to pay for it. They, like my father, don’t take medications prescribed to them because they cost too much. The out-of-pocket expenditures for lifesaving treatments and specialists is exorbitant and out of reach for most working people.

So they go without.

There is a move afoot in the Florida Legislature to adopt a Medicare-for-all system that would extend health care and prescription drug coverage as a right, not a privilege linked to the size of your wallet.

My dad’s lack of insurance came up in the car ride on the way to Tallahassee Memorial HealthCare last week. He was hesitant to even go, but without a primary care doctor, it was the only option with the immediacy that comes with heart palpitations.

Nurses asked about insurance. Every doctor asked about it when discussing treatment options. They reassured us they would do everything they could regardless.

It was a dark subject at time when relief was the only thing on everyone’s mind. It was hard not to turn sour and vitriolic about the health care system.

Two years ago, 45 percent of uninsured adults said they didn't seek coverage because the cost was too high, according to a study by the Kaiser Family Foundation.

For some, figuring out how to stretch finances to pay for a serious medical treatment is the cloth nightmares are cut from.

I'm healthy and insured. Not everyone has that comfort, even my own father. I wish I could just hand mine off. I'd relinquish it to someone in dire need in a fraction of a second.

We can do better. As an educated society, don't tune it out. 

Make real changes at the ballot box.

Karl Etters can be reached at ketters@tallahassee.com or @KarlEtters on Twitter.

Republican unhealthy insurance coverage

"Senators clearly could use some extra time to figure out how to bridge a giant gap between policy theory and reality."~Altman

Drew Altman writes in The Virginia Pilot newspaper:

Drew Altman is President and Chief Executive Officer of the Henry J. Kaiser Family Foundation. He is a leading expert on national health policy, who publishes and speaks widely on health issues.

The Congressional Budget Office (CBO) said that 22 million people would lose coverage under the Republican proposed insurance plan and, moreover, that coverage in the non-group market would become far stingier than it is today. 

By Tuesday, June 27, the GOP bill was pulled back for revision.

The quick sequence was revealing: Senators clearly could use some extra time to figure out how to bridge a giant gap between policy theory and reality.

The CBO report illustrates how policy making can become divorced from the reality of people’s lives. Here are three big examples of how the Senate health-care bill, as currently configured, sounds one way in theory (and in talking points), but would work out quite another way in practice.
First, the bill phases out the Affordable Care Act’s 90 percent federal match for expanded Medicaid eligibility over four years, reducing it to each state’s regular matching rate. The theory is that this phase-down period would provide time for states to decide whether they want to replace the lost federal funds and continue their Medicaid expansions.

But consider these estimates of how much it would cost states to replace those federal funds: California would have to come up with $12.5 billion when the phase-down is fully implemented in 2024, a 400 percent increase; Ohio would need $1.6 billion, a 272 percent increase; Nevada, $343 million, a 243 percent increase; and West Virginia, $178 million, a 168 percent increase. The impact on the other expansion states would be similar.

There is no way states can replace funds of this magnitude. If the expansion states try to replace even a significant share of the money, they will be forced to increase taxes or make significant cuts to other parts of their budgets, including for public schools, higher education, environmental protection and corrections. And because the federal match would be phased out incrementally beginning in the first year, states would have every incentive to end or freeze their expansions quickly. The idea that a phase out would give states time to plan and adjust is driven by a belief that states can operate Medicaid with far less money if they have greater flexibility. In this case, with funding cuts this large, it’s simply wishful thinking. (Besides, Governor's have a habit of creatively applying federal monies.....)

That leads to reality gap No. 2: the theory that the 14 million people who are covered under the ACA’s Medicaid expansion could buy private coverage with the tax credits offered under the Republican plan, in effect privatizing the Medicaid expansion. This is the biggest reality check in the Senate bill. (People who receive Medicaid coverage by their very definition cannot afford to pay premiums sold in the private insurance markets. HELLO?)

Senators clearly could use some extra time to figure out how to bridge a giant gap between policy theory and reality.

Let’s look at a typical adult covered by the Medicaid expansion. He is a 35-year-old man who lives in, say, Minden, Nev., makes $15,000 a year and may even have voted for President Donald Trump. Under the Senate plan, he could buy a policy costing him about $400 per year after using his tax credit, but his plan would come with a deductible of more than $6,000 a year. (The Senate plan’s policies are calibrated to cover just 58 percent of costs.) On a $15,000 income, he cannot afford to get sick with a policy like that. Assuming he has a car to get to work, pays rent, eats food and otherwise has the same basic expenses as any other human being, such a policy would be far from affordable for him. In fact, this is why this hypothetical Trump voter was uninsured before Medicaid was expanded in his state; like millions of his counterparts across the country, he could not afford private coverage.

The Senate plan also trims back the pool of people in the non-group market who will be eligible for tax credits, by reducing the threshold from four to 3½ times the federal poverty line. That leads to reality gap No. 3.

Consider a 60-year-old woman in the town of Strong, Maine, making just less than $45,000 a year. She has high blood pressure, takes daily medication and needs regular monitoring because of her previous thyroid cancer. Under the ACA, she is eligible for a premium tax credit of about $7,000 and a comprehensive policy with a premium cost to her of about $4,500 in 2020, when the Senate health-care bill would take effect. Under the Senate plan, she would not be eligible for a tax credit. A similar plan under the Senate bill would cost her more than $15,000, or one-third of her income.

Gaps between the theory and practice of policy are not some Republican creation. Under the ACA, many people have struggled with costs or were forced to change plans and provider networks annually to keep their premiums down.

But the current Senate bill takes this divergence to a new level. Private insurance cannot be better than Medicaid if it is unaffordable; states do not have some magic way to cover millions of people with far less money.

The bill may now be altered, and senators will certainly hear from constituents over the July 4th holiday recess. 

Congress must listen carefully to what constituents have to say. 

As it’s written, the Senate health-care plan would substantially widen the gap between policy theory and the real world — making coverage unaffordable for millions more Americans.

Drew Altman is president and chief executive of the Henry J. Kaiser Family Foundation. He originally wrote this for The Washington Post.