Using plausible circumstances from several fictitious families, The Times has mapped out some hypothetical health care scenarios as examples for the (Byzantine, insufficient) ways in which the proposed House and Senate plans would address them. It’s like the world’s shittiest board game! Come join me, won’t you?
(Ooh, ooh, ooh! I get to be “Healthy Employed Single Mother making $38,000!”)
Here’s the scenario, then: 34-year-old healthy, employed single mother of two small children - Convolutasha and Minutia - making $38,000:
The family could receive assistance to buy insurance from an exchange and out-of-pocket medical costs would be capped. Democrats say an exchange, and a public plan, could stimulate competition among insurers and hold down premiums. If the family still cannot afford to buy insurance, they could apply for a hardship waiver.
The italicized coulds are mine, for added emphasis, as are the glorious names of the children. But maybe you get my point: That’s a lot of coulds. Could to me means: “possibly, but no one knows for certain.” If, when I proposed to my current fiancee, she responded with, “I could marry you,” well, then that wouldn’t be terribly encouraging for me.
And it doesn’t bode well for sweeping proposals that were supposed to be rolled out by August 1st (which is not happening, by the way).
Have you also noticed the fun, new terms that keep popping up seemingly each day - words like “exchanges” and “hardship waivers”? I don’t know what these things are, but it sounds as though they’re certainly going to be accompanied by a whole litany of convoluted bylaws. And then, when this whole thing bubbles over into an oozing bureaucratic quagmire, the Republicans will really have something to mirthfully frolic around Washington about - in their knowledge that the Dems are in fact creating the Kafka-esque nightmare that the GOP has claimed it would become.
Okay, so how about this next doozy: Small business owner, married couple with an adjusted gross income of $70,000. According to the given scenario, they have a mouthy 17-year-old son, and the wife has high blood pressure. Under their current health plan, high blood pressure would be considered a pre existing condition, whereas mouthiness would not.
The couple may pay less in premiums because the proposals would limit the ability of insurers to charge higher rates because of health status, gender and other factors. The family could also buy insurance for themselves, and their employees, through the exchange.
And yet there’s still no guarantee that they’d be paying cheaper premiums with the new plan. Hell, they might end up paying more. And it only gets worse:
The family will most likely be required to have insurance or pay about $1,282 in penalty (2.5 percent of adjusted gross income over a certain level, which is $18,700 for a couple)
The couple would not be required to provide insurance to their employees, or help with premiums because the business's annual payroll is less than $250,000.
If they buy insurance for employees through the exchange, they could receive a tax credit to help pay the premium costs. Credits are available to employers with 25 or fewer employees and average wages of $40,000 or less. The amount, up to 50 percent of premium costs, phases down as employer size increases.
Penalties, exchanges, subsidies, premium costs, tax credits. Yikes. Or, we could just avoid this whole hot mess and opt for a single-payer plan.
But the thing that stuck with me most yesterday, while reading this, is that based on what I’ve seen so far from these two plans, there is still no safety net for the working poor nor for individuals of any socioeconomic strata who must endure catastrophic medical circumstances:
All the bills offer some kind of assistance to lower-income people who do not get health benefits through the workplace. The bills would provide premium subsidies to millions of people and would establish limits on consumers’ out-of-pocket costs. But lawmakers and consumer groups say insurance could still be out of reach for many families with modest incomes who receive small subsidies or none at all.
And here I was, naively thinking that the whole purpose of this thing was to cover everyone.
I’m beginning to see evidence of the same arrogance, greed, complacency, and myopia among current House and Senate Democrats that ultimately brought the Republican political machine to its knees four years ago.
Which begs the question: As a politician, it really worth it to sell your soul to a special interest group if doing so ultimately costs you your job?