Buy the Government, Scare People's Pants Off, Jack Up Prices
U.S. Health Care Terrorism in One Screenshot
This morning, subscribers to KFF Health News’ Morning Briefing got a simple lesson in how American health care engineers huge profits and mass death at the same time. One screenshot tells the story:
Under pandemic regulations, states were required to keep anyone who qualified for Medicaid covered indefinitely. For a brief, blessed moment, the rules relieved 72 million American residents of Medicaid’s Trilogy of Terror: fear of getting a raise, fear of getting a better job, and fear of the calendar.
Normally, if you’re on Medicaid and your income goes up, you have to tell the state right away, and in many states you can lose your coverage at the end of the month. Even without a change in your wages, every year you have to prove to the state that you are suitably poor enough to deserve coverage, and hope that your state Medicaid agency believes you and you didn’t forget to give them one of your intimate financial documents.
If you’re a single parent with one child in a Medicaid expansion state and you’re not pregnant, you’ll lose your own coverage when your wages top $13.08 per hour for a full time job (children keep their coverage up to higher family income levels, as do pregnant adults). Winning the Fight for $15 may cost your health insurance if you don’t win a union too, but at least there’s subsidized Obamacare, which is also based on income. With luck, after proving your impoverished worthiness, you won’t be one of the 44% of people in the individual market who the Commonwealth Fund says are underinsured.
Rank terror is the lifeblood of this system. Parents especially will do anything to protect their children from illness, injury and death. If the rules force people to grovel to get a sick child in front of a doctor, who wouldn’t plop down on their knees and beg? Who wouldn’t repeat this ritual humiliation every 12 months?*
With the end of the pandemic, American medical terror has returned in one massive wave. Millions of people face uncertainty and the possibility of untreated illness and injury as they reapply for eligibility determinations. Health insurance companies, whose political power has persuaded the government to hand them tens of millions of terrified customers, are ready to make money. The four headlines tell an interesting tale:
Modern Healthcare reports that the federal regulators are “pausing” re-determinations in some states. Those states may not only be stripping excessively wealthy $15-an-hour single parents of their insurance, but some $13-an-hour parents as well.
According to Politico, the feds haven’t - yet - decided to fine states who strip some $13-an-hour parents of their coverage alongside the hundreds of thousands of $15-an-hour parents whose staggering wealth demands they lose their health insurance. So, the federal government is making sure that states legally and fairly choose which people must face terror and untreated illness and injury in a health care system that spends twice as much as those in similarly wealthy countries. But not too aggressively.
Forbes points out that millions of people leaving Medicaid means an Obamacare boom as people try to buy coverage in the individual market. The health insurance industry has spent enormous sums of money persuading politicians in Washington DC and state capitals that they can manage health benefits more efficiently than government. A web of laws and regulations now require or create incentives for Medicare-, Medicaid- and ACA-eligible people to sign up for private insurance. 72% of people on Medicaid are enrolled in private managed care plans, so health insurers will make money either way. But everyone who gets coverage through an ACA exchange enrolls in a private health plan, so….
….According to Axios, 2024 Obamacare premiums are likely to go up despite lower general inflation. “[H]igh medical costs could still make consumers pay more for Affordable Care Act health insurance in 2024.”
The federal and state governments structure the rules for getting health benefits that force people to live in constant fear of losing coverage. Private industry wages a decades-long lobbying campaign to gain control of distributing those benefits. Tens of millions of fearful people are forced to apply for those benefits over and over again, and when they make just a little too much money, they have to start paying premiums, making time-sensitive consumer pricing choices literally under the threat of pain or death.
Medical terror, U.S. style. With healthy returns to shareholders, of course.
Two things:
Healing and Stealing is often critical of health care media and reporting, so hats off to the editors at KFF Health News. Sticking “On next year’s ACA premiums…” into their headline summary is a nice touch, alerting subscribers to the connection between mass disenrollment, the coming ACA boom and prices.
I’m embarrassed to say that this the first of the “too-long-for-Twitter quick takes” between longer articles promised at the launch of Healing and Stealing. It only took a few hours, so hopefully that will be a promise honored more fully going forward.
A LITTLE EXTRA FOR THE DATA CURIOUS
The wage rates and Medicaid eligibility referred to in this piece are drawn from two sources: the U.S. Department of Health and Human Services 2023 federal poverty guidlines, and; the Kaiser Family Foundation’s Medicaid Income Eligibility Limits for Adults as a Percent of the Federal Poverty Level. KFF collects state level thresholds for Medicaid eligibility for all categories. This is for non-pregnant adults - children are often eligible in families with higher incomes than adults, so the $13.08 per hour example would not apply to children’s coverage. The ACA allowed Medicaid-expansion states to set adult eligibility at 138% of the federal poverty level.
The federal poverty level is reported as annual income. Healing and Stealing divided those amounts by 2080 hours, or 52 weeks x 40 hours, to get a full time hourly wage figure for the poverty level. The result was multiplied by 1.38 to yield the hourly full time wage threshold. In table form:
