By lambert strether of Corrente.
And we go to Happyville, instead of to Pain City. –Thomas Pynchon, Gravity’s Rainbow
In this series, we’ve been looking at how ObamaCare, through its inherent system architecture, relentlessly creates first- and second-class citizens; how it treats people who should be treated equally unequally, for whimsical or arbitrary reasons. It’s all in the luck of the draw! If you live in the right place or have the right demographic, you go to Happyville. If you don’t, you go to Pain City.
We’ve looked at the whimsical differences between the citizens of Libby, MT, and all other citizens; the banked and the unbanked; those herded into Medicaid and those who are not; the arbitrary distinctions between creatures of the Beltway and all others, between the covered and the not covered, and between those who will be marketed to, and those who will not; the sheer bloody randomness of relying on credit reporting agency data for income validation; and discrimination based on jurisdiction and geography. In this installment, I’d like to look once more at geographical discrimination, give on update on the creatures of the Beltway, and look at “churn.”
First, on geographical discrimination, this from the Portland Press Herald:
An Aroostook County resident who buys a health care plan on the new federal insurance exchange could pay in premiums than a Portland resident for exactly the same coverage, according to information released Wednesday by the Maine Bureau of Insurance.
The insurance industry lobbied for the changes, arguing that it costs more to deliver health care in rural areas. The legislation made it easier to charge different rates based on which county a buyer lives in starting in 2011.
$1000 is a lot of money! How can this differential possibly be justified in a program that’s supposedly there to aid citizens? It costs the Post Office more to move the mail from Aroostook County, but a first class stamp costs the same nationwide. We don’t change Social Security benefits by where people live. So why health care?
Answer: Because Obama and the Democrats had one key goal in designing ObamaCare: To preserve the health insurance industry. (As we all know, Liz Fpwler, a Wellstone VP on secondment to Max Baucus’s office as chief of staff, wrote the bill.) If that’s your goal,regional variation discrimination by geography makes perfect sense. However, if health care is a right — and, to be fair, Obama does occasionally makes a rhetorical gesture in this general direction — geographical discrimination makes no sense at all.
Finally, let’s look at “churn.”
Under the law, if a person’s annual income is below 138% of the federal poverty level — or about $15,850 — he or she qualifies for coverage under the Medicaid expansion.
This is not correct. You do not “qualify” for Medicaid in the sense that you have the choice of refusing it. You are forced into Medicaid, on the basis of your income.
If a person’s income is between 138% and 400% of the federal poverty level, he or she qualifies for federal tax subsidies to purchase private coverage through the state insurance exchanges.
However, normal life events — such as getting married or divorced, having children or taking a second job — can alter an individual’s income and push him or her back and forth between the two coverage levels, according to experts.
According to a 2011 study published in the journal Health Affairs,
Researchers found that those most at risk for fluctuating coverage are seasonal and hourly workers, as well as young adults who are not covered by their jobs or their parents’ health plans.
Health care officials who work with large Medi-Cal populations say fluctuations in eligibility cause the quality of care to decline and the cost of care to increase from added administrative expenses. Medi-Cal is California’s Medicaid program.
(To this I would add that if you’re over 55 and forced into Medicaid, your expenses will be clawed back from your estate.)
So, if you’re a seasonal or hourly (read: poorly paid) worker, or young, you’re faced with the stress of integrating into a new health care network whenever a “major life event” happens. Pain City, over and over again! So the Bible says, and it still is new…
What frosts me is that none of this suffering is needed. It’s all an inevitable consequence of ObamaCare’s system architecture. ObamaCare throws Americans into different buckets using a complex and confusing system of eligibility determination, and people inevitably get thrown in the wrong buckets, or land between buckets, or there aren’t even the right buckets for them. Adding to the mix is that buckets differ by state, both legally and in terms of insurance markets, and so what should be a simple, national system of Medicare for All instead creates second-class citizens all over the place, both within and between states.
Obama chose to go that route. Under a single payer system, where health care is a right, the eligibility paperwork is very simple. There is one form, and it’s already been filled out: Your birth certificate. And that’s how it should be.