A Millennial’s Take on Obamacare
I signed up. But long term, is it worth the cost?
Health and Human Services Secretary Kathleen Sebelius and President Barack Obama.
In my early 20s I lived and worked in Scotland and Canada. I was enrolled in their single-payer government health care systems, as are all legal citizens of those countries. I only accessed health care three times during my three years abroad. Each time was a test for sexually transmitted infections. Once I spent the better part of a day at a clinic because of the wait. But I was never charged a dime. (By the way, all results were negative, ladies.)
Like most young people, I’m prone to feeling invincible. In November my illusions were shattered in a clandestine boiler room in small-town Oregon. My foot got caught on a piece of upturned metal that briefly kept my leg from joining the rest of my body down an incline that functioned as a slide. A sports medicine professional diagnosed it as a torn ACL and recommended an MRI. The only problem is that I don’t have the money for an MRI and possible knee surgery.
I’m rich, just not in the money or property sense of the word. My credit union account doesn’t accurately reflect the value of my life’s work. I have a wealth of knowledge and experience. [Insert fancy way of saying I’m low-income.] I moved back to Milwaukee the day after I hurt my knee, though not because I hurt my knee. Then I made the classic millennial move and shacked up with my parents while seeking employment.
My resume is mostly videography jobs (my first degree). I’ve been able to land full-time and freelance gigs, but never with health insurance. Lately I’ve been freelancing as a journalist (my second degree), which doesn’t amount to a living wage, let alone enough for health care coverage. I don’t mind being poor because I love my work. But when I turned 27 and got kicked off my mom’s state health care plan my poverty became an issue.
Enter the Affordable Care Act, the most toxic political issue since the move to ban blowjobs in the White House. Before learning I was eligible for a subsidy I was resigned to my fate of settling down, giving up my freelance lifestyle and getting a “real job,” aka one with health insurance. It was only after dialing up the Marketplace Call Center and chatting with an exuberant young lady that I realized I qualified for a rebate. (I’ve never done my own taxes, so sue me!)
The Affordable Care Act was relentlessly advertised to millennials like myself, including an appearance by President Barack Obama on the brilliant but obscure web series “Between Two Ferns with Zach Galifianakis.” This makes sense as millennials are disproportionately uninsured. We’re also healthier by comparison, so our costs are generally lower than those of our elders. Under the Affordable Care Act, 18 to 40 year olds are basically subsidizing care for 40 to 65 year olds (who are not yet on Medicaid) and people with chronic conditions. The risk is pooled and resources are slightly redistributed. That modest bit of redistribution is what inspired opponents of the bill to label it “socialist.” This ideological divide is tugging at the soul of America.
The dominant American train of thought (which would no doubt prefer a gas-guzzling, private automobile analogy, maybe a “flatbed truck” of thought) sees this as the land of pure liberty, where an individual can make his fortune and keep every last penny, free from taxation. This way of thinking worships unregulated capitalism and secretly believes Leonardo DiCaprio’s character in The Wolf of Wall Street is a hero. This way of thinking is mostly found in the suburbs and rural areas, though it is peppered throughout the cities. And this way of thinking doesn’t care if poor people without health insurance get sick and die.
The other American train of thought fits this phrase and doesn’t mind riding a train, bus or even commuting via bicycle. This way of thinking sees America as a manic, multicultural, melting pot that won’t function unless we work together. While this way of thinking is usually not excited about paying taxes, it is aware of their purpose. These folks believe the market can’t be trusted to handle certain sectors of society, like prisons, schools, libraries and the fire department, and believe access to health care should be a right.
And this divide is why the Affordable Care Act has generated so much heated debate.
Don’t get me wrong, the Affordable Care Act is not a perfect program. Not even close. It relies on the same system; the same health insurance companies, the same pharmaceutical companies, the same hospitals and clinics. Still, it’s an important ideological shift. It’s setting a precedent. It’s a step in the right direction. Ten years down the road we will see that single-payer is the next logical step, or so hopes my friend John Weissert, a research associate at the Laboratory for Public Health Informatics and Genomics at the UW-Milwaukee’s Zilber School of Public Health. I asked him to explain how the program would work. These questions and his answers capture our conversation.
Who gains the most from the Affordable Care Act?
For people that are lower income it’s a better deal because they get a federal rebate. But for somebody who makes middle income, say you make $35,000 a year or above and your employer doesn’t provide insurance, maybe you work at a small business or you’re freelance and make over $35K, you’re basically being taxed.
What’s your take on Gov. Walker’s decision to reject the Medicaid expansion?
It’s an unfunded federal mandate. I think Medicaid should be expanded, but the problem is that they wanted all the good things about expanding Medicaid, that is the political coverage and providing more people with health care, but they didn’t want to spend the money to do it because it’s politically unpalatable.
How can we pay for it?
The biggest thing is to start taxing pharmaceuticals more. They got away scot-free in the Affordable Care Act. We just need to raise revenues. I’m a progressive, so I think there should be a progressive income tax, reinstate the estate tax, normalize the corporate tax, close corporate loopholes, that could generate a couple hundred million dollars. We could cut defense spending, you know, any one of a laundry list of progressive ideas to get more revenue for health care.
The other thing that nobody is really talking about is that there is no funding for additional medical residencies. We’re adding all these patients to the system, right? But there’s already a predicted shortfall by 2020 of 74,000 physicians, many primary care physicians. You can expand medical schools all you want, but if you don’t have residencies for those medical students, they’ve got nowhere to train. We’ve already completely filled up every single available residency in every possible spot, as of two years ago. And there’s no additional money in the Affordable Care Act to expand residencies. It’s a huge issue.
Okay, there’s a bunch of specific problems with this bill, but it’s still an improvement, right?
This is how American policy changes. It generally builds off previous policies and previous systems. Our tax code is an excellent example of that. We have one root system, and then we continue to layer it. The Affordable Care Act is not a revolution in the system. The Marketplace is the big idea. The government establishes a Marketplace that allows the current resources to function more efficiently, to provide more for various people. But it’s not a change in the system at all.
How does a single-payer system work?
Well, they administer less care. That’s the dirty truth. I was just talking with my aunt about this, she lives in France. She pays one Euro everytime she goes to the doctor. My uncle has MS, which is a chronic condition, and he doesn’t pay anything. That’s an incredible system. Here in the states, so many people go bankrupt when they get a chronic condition, or they don’t get treatment. It happens all the time. But another example within the same family is my cousin, who hurt her wrist. It was not really urgent, but it was giving her a lot of pain, and it was a six-month wait to see an orthopedic surgeon. So it’s a way of rationing care.
It’s the same thing for the elderly. They get very good chronic care, but if they need to have a stent put in or if they need some kind of dramatic surgery that could extend their life, maybe only by six-months, it’s non-existent. It’s the same for pharmaceuticals. In France, they have a government board established to determine which pharmaceuticals are worthy of getting payment and which pharmaceuticals should be free.
And we don’t have anything like that?
Can you imagine that?! It would be totally, politically unviable.
What does the FDA do then?
The FDA determines safety.
Whenever I watch late-night cable TV it seems like nothing but commercials for non-FDA approved drugs or commercials for a lawsuit against non-FDA approved drugs.
I know, it’s absurd. It’s basically a huge underground market. It’s so unregulated, there could be dog shit in there.
During the last week of open enrollment in the Marketplace I overheard some people wondering whether it would be cheaper to pay the fee than actually sign up for health care.
That’s bonehead thinking. Just look at the price tag. You think a new computer is expensive, that’s like one CT scan. One night in the hospital can be $10,000, depending on how many tests they run. It won’t even come with breakfast in the morning sometimes…
Which closed our conversation, dear readers, and brings us back to my situation. When my new insurance plan came in the mail, the outside of the envelope read “Generic drugs work just as well and can save you $$.” In your face, billion dollar drug industry! No wonder my local coffee shop has flyers for a Greenfield-based business called “Canada Drug Service.”
Opponents of the Affordable Care Act have nicknamed it “Obamacare” in an effort to channel hatred for our President against the legislation, which makes me want to reject the use of the nickname. However, the bill does epitomize Obama’s Presidency. He has not ushered in any fundamental changes, but the program is an improvement on the status quo.
If you were uninsured and signed up for health care during the grand opening of the Marketplace, I think it was a wise decision. If not, you’ll have to pay a fee next Tax Day, which will help make health care more affordable for more people. If you haven’t already, you should probably pay for that sweet relief of knowing you’ll be covered if anything happens. It might not be free, but it’s a kind of freedom. It’s an expression of liberty to be able to pursue your passion without fear of bankruptcy. Dare I say, it’s downright American.
“In my early 20s I lived and worked in Scotland and Canada. I was enrolled in their single-payer government health care systems”
Too bad Obamacare isn’t a single-payer health care system. Being a millenial that is what I’m dissappointed in. There were grand hopes to have a euro type system but instead got some kind of frankinsurance with high premiums (according to me) and deductibles.
The article calls the ObamaCare Medicaid expansion “an unfunded federal mandate” when it is pretty much the opposite.
It’s not “unfunded” at all for the first 3 years (2014 through 2016); thru 2016, it is 100% federally funded. Starting in 2017, the expanded Medicaid is mostly federally funded:
2017 95% federally funded
2018 94%
2019 93%
2020 and thereafter 90% federally funded
(For comparison, “regular” Medicaid typically only has 50% federal funding.)
It’s not a “federal mandate” as many states (including Wisconsin) declined to participate; if it were a “mandate”, no state could opt out. States can opt out because the US Supreme Court said they could.
As an urban conservative, I disagree with just about everything you said. But what completely diminished any credibility I was willing to give you was when you wrote this: “He has not ushered in any fundamental changes, but the program is an improvement on the status quo.”
Dude, really? In your down time as a freelancer have you bothered to at least read any major news publication (e.g., New York Times, Wall Street Journal, Washington Post, etc.) or watched any network news? The President, not Congress, has not only ushered, but skirted congressional approval, with 40 changes to the ACA.
Get your facts straight before you click “publish”
I’m a millennial, and I am now bankrolling this millennial’s health insurance because he made a conscious choice to be a freelancer, rather than get a “real job.”
It’s telling that supporters of Obamacare see only two sides… those who care about others, and those who don’t. Really, most people who oppose this just don’t want to support paying for healthcare for people who have just as much ability to get it on their own. Yes Joey, I’m getting the sense that you are smart enough and capable enough to earn your own healthcare. However, because I made the choice to work a boring desk job instead of my low paying dream job, I had my rates quadruple this past year in order to satisfy your whimsy of being a freelancer.
I support making sure people who truly do not have a way to get health insurance and healthcare on their own are covered. However, this little example is exactly what is wrong with the system. There’s no longer as much incentive to earn things on your own…
Dudes,
Network news is garbage. I read the papers and magazines.
Obviously there is a spectrum of thought. I was being facetious by painting the divide so wide.
When John called the expansion an “unfunded” mandate I think he was saying that after the first 3 years (which are funded) the federal government doesn’t have a plan for where the money will come from.
In addition to my dream job freelance writing I’m working two other jobs (one involves cleaning a bar, so dreamy!) to pay for my insurance/life.
Don’t hate the p(l)ayer, hate the game.
Your facts about the President ushering changes is factually wrong and it completely discredits anything you wrote before it. It also discredits your reputation, which as a freelancer, should concern you.
Andy, you would like to see people get insurance on their own, but do you know how much that would cost without ACA?
Let me use NY State as an example because NY is perhaps the only state that required all health insurance companies to post all rates, before and after ACA, and because NY was one of the few states that required insurers to accept every applicant, regardless of health. (I’m not sure if there was a waiting period before pre-existing conditions were covered.)
NY also had two other rules to simplify insurance pricing: (1) they prohibited gender-specific pricing; (2) they prohibited age-specific pricing. In other words, even before ACA, in NYS a healthy 18-year-old man would pay the same monthly premium as a 64-year-old woman with cancer and nobody could be denied coverage as long as they paid their premium.
You could argue that these rules were just more government-driven market distortions. I would argue that they mostly reflect the actual, average cost of health insurance across the population as a whole. I say “mostly” because ignoring pre-existing conditions drives healthy people out of the market and skews prices upward. Adding ACA’s mandate solves this problem.
Before ACA, NY State health insurance rates varied by county, by insurer and by whether or not you joined an HMO, but the absolute cheapest health policy for a single individual in July 2013 was $915/month (for an HMO if you lived in one of two tiny, rural counties). The most expensive individual policy was $3,319/month (for a non-HMO if you lived in the NYC area).
Many people who complain about ACA have no idea how much pre-ACA insurance cost if you were not young or in perfect health. Expecting people to pay an average of $900 or more each month for health insurance isn’t reasonable, yet that is what will happen if we go back to the old model.
BTW, now (with ACA) unsubsidized, “catastrophic” individual policies are available in every NYS county for under $200/month. “Platinum” plans are available in all but two counties (even in NYC) at under $450 (without subsidy and without regard to age or gender).
Tom, not sure where you get your data points. For me to buy a platinum plan in AL for my family of four was going to cost me $1,100/mo. It’s $900/mo through my employer. Before the healthcare law went into effect it was $650/mo. None of my coverage changed because my plan did not have maximums, pre existing condition clauses, etc. So costs went up, coverage didn’t change.
I have not met anyone who’s insurance coverage went up and their cost went down.
Interesting, how Andy, the Boring-Desk-Job guy and those like-minded, continue to blame people for acquiring something that is legally approved by the government.
Don’t hate the p(l)ayer, hate the game.
You could find my place on the spectrum in between Andy the Boring-Desk-Jobber and Joey, the free-Lance-a-Lotter. I work part-time for my city (boring desk job…jk,Andy! I actually choose not to find it boring and enjoy working with my co-workers) while I work my dream job: illustrating a World War II history memoir.
I’ve realized that I need to occupy both worlds in order to survive. My day job offers healthcare, but at a ridiculously high price. I’ve taken advantage of the opportunity to receive affordable healthcare and I’m very thankful for the initiative that President Obama has set forth. It may not be perfect yet, but it is narrowing the gap between the haves and have-nots.
Let’s face it: There are always going to be disobedient people in America. People that follow their dreams instead of relegating themselves to a job they hate (see Andy, the obedient Desk-Jobber) The question we face is, how do we wish to treat the perpetual mass of people that continue to defy what Andy believes ought to be? Like the author states, I imagine Andy wouldn’t mind seeing us dreamers die off, in order to see his rates lowered.
Which is another issue: cause and effect.
Andy: Joey’s decision to be a free-lancer did not cause your rates to quadruple. President Obama’s Affordable Healthcare Act is what raised your rates. Let’s all repeat together:
Don’t hate the p(l)ayer, hate the game.
http://www.pbs.org/newshour/rundown/why-does-health-care-cost-so-much-in-america-ask-harvards-david-cutler/
@Tom
1 .) it was a mandate before the Supreme Court struck it down as you say. 2.) Medicaid/ are is not a discretionary spending, it is a social contract, if you expand coverage you are mandated to continue that coverage. This is why Medicare hasn’t been touched for decades, millions depend on it. So once medicaid is expanded it will become an integral part of our social safety net.
3.) it is unfunded. Just because the federal gov agrees to cover a larger percentage of state expenditures doesn’t mean the government has a plan for how to fund that 90% come 2017. Look at the CBO projections for Medicare/aid outlays in the next 20 years and compare them with the projected deficit. Deficit growth will restart in a couple years and continue indefinitely unless expenses are cut or revenues raised, mostly because of Medicare-aid.
So yes , Medicaid expansion is an unfunded federal mandate. Do the politically favorable thing now (and the right thing in my opinion) and expand Medicaid. But pay for it later. And we will, both by cutting services ( rationing care) and by raising revenues ( probably on the middle class but hopefully not) .
Lastly, I support the authors contention that this legislation is not a revolution in how we provide healthcare. Maybe its a huge change in WHO we provide care for – but as it stands currently, it doesn’t fundamentally change healthcare delivery. If we did move to a single payer system – our entire system of consumer driven healthcare delivery would change. That would be revolutionary.
Andy never said he wanted you ‘dreamers’ , ‘takers’, ‘slackers’ or whatever you call yourselves today, to die off. He simply stated it would be nice if more people actually felt compelled to take a more active role in providing for their own needs. No one is blaming you, we blame Obama and the Dems who insisted this be voted on before we learn what is in it. What we would like to see from you is some desire to be a little more self sufficient and a little less reliant on the government. To you that sounds insane, to us it sounds like hard work and achieving the American dream.
Timbo, you kind of missed my point… it’s exactly as you say, hate the game (aka, Obamacare). I don’t blame you or anyone else taking advantage of it, I would do the same thing. But the fact is, the system is disincentivizing you and many others like you from getting health insurance without subsidy despite being capable. We’re no longer talking about helping those who need it, we’re helping those who just kind sorta feel like they’d like it so they can spend their money on their ipads and buying that hottie at the bar another drink. At least seemingly in your case.
Chris, you said it perfectly.
@smarter… (post 8):
The 2014 NYS individual insurance rates are here:
http://www.nytimes.com/interactive/2013/07/16/health/17insurance-document.html?ref=health
The 2013 rates are no longer on the web .
The rates I quoted are for INDIVIDUAL (covering just one person) policies. For 2014, individual NYS rates are converted to family rates by using multipliers:
Married couple (no children): 2x the individual rate
Single parent and child(ren): 1.7x the individual rate
Married couple and child(ren): 2.85x the individual rate
The cheapest NYS Platinum policy costs $365.57/month. This rate is for one person living in the Rochester area (regardless of age). To convert this rate to family (2 spouses and children) multiply by 2.85 to get $1041.87/month.
Rates in NY State dropped around 50% between 2013 and 2014 (even before subsidies):
http://www.nytimes.com/2013/07/17/health/health-plan-cost-for-new-yorkers-set-to-fall-50.html?pagewanted=all&_r=0
If you don’t want to read a long NY Times article, you can see a short summary here:
http://www.nytimes.com/interactive/2013/07/17/business/individual-insurance.html?ref=health
John (post 11): you say (of Medicaid) “if you expand coverage you are mandated to continue that coverage.”
This just isn’t true. States have the right to cut Medicaid whenever they want. Scott Walker recently cut Badgercare (the name Medicaid uses in Wisconsin). Indiana cut Medicaid in 2005:
http://www.nytimes.com/2005/01/11/national/11tennessee.html?pagewanted=print&position=
Medicaid is funded like federal programs: the federal government is obligated by law to fund it. You seem to be worried that the federal government won’t be able to fund it starting in 2017, but you say nothing about 2015 and 2016, even though money for those years hasn’t been appropriated yet either.
Lack of concrete funding applies to most federal programs. Do you oppose rebuilding the Zoo Interchange because more than $1 billion in promised federal funding doesn’t yet exist? Do you oppose US Savings Bonds because there is no money to redeem them?
All of this depends on the US keeping its obligations. But if the US defaults on its debts (if the Tea Party gets its way), all US money will become almost worthless–each $20 bill in your wallet is nothing more than a paper IOU–a government obligation.
@Tom D (Post 16)
Tom you’re mistaking the trees for the forest. The problem isn’t healthcare now, it’s our healthcare system in 10years or 20years when all the baby boomers become sicker as they age. Meanwhile, the cost for every procedure and hospital visit consistently grows faster than inflation. We spend ~ 19,000$ per person per year on healthcare in USA. That is around 20% of our GDP spent on healthcare. The UK spends roughly half that, while Cuba spends ~500$ per person per year. Yet all three countries have comparable health outcomes in terms of life expectancy and infant mortality.
We as a society, either through taxes or insurance premiums or co-pays, spend 20% of our GDP on healthcare and get little in return. This is opposed to a new zoo interchange where we get 50 years of low maintenance infrastructure. If healthcare expenditures continue to get worse as projected, our society (either government or consumers) wont have money to put else where in the economy. That’s a much more likely scenario for government default than a tea party coup.
That also gets to what I was saying the my first post. The ACA hasn’t changed the way we deliver healthcare, nor has it provided a means for curbing growth in healthcare costs. If we choose as a society to expand our social safety net and provide healthcare for more people, then we need to have a pragmatic plan for how to make it sustainable. I don’t know a single healthcare professional who thinks our current model is robust. Most see it on the verge of collapse. Without being apoplectic – I think we need to take a hard look at the way our healthcare system operates.