[Vision2020] Insurance in America

[Ron Force]

http://www.nytimes.com/2012/04/05/opinion/down-the-insurance-rabbit-hole.html?ref=opinion


April 4, 2012
Down the Insurance Rabbit HoleBy ANDREA LOUISE CAMPBELL 
Cambridge, Mass. 
ON the second day of oral arguments over the Affordable Care Act, 
Solicitor General Donald B. Verrilli Jr., trying to explain what sets 
health care apart, told the Supreme Court, “This is a market in which you may be healthy one day and you may be a 
very unhealthy participant in that market the next day.” Justice Antonin Scalia subsequently expressed skepticism about forcing the young to buy 
insurance: “When they think they have a substantial risk of incurring 
high medical bills, they’ll buy insurance, like the rest of us.” 
May the justices please meet my sister-in-law. On Feb. 8, she was a 
healthy 32-year-old, who was seven and a half months pregnant with her 
first baby. On Feb. 9, she was a quadriplegic, paralyzed from the chest 
down by a car accident that damaged her spine. Miraculously, the baby, 
born by emergency C-section, is healthy. 
Were the Obama health care reforms already in place, my brother and 
sister-in-law’s situation — insurance-wise and financially — would be 
far less dire. My brother’s small employer — he is the manager of a 
metal-fabrication shop — does not offer health insurance, which was too expensive for them to buy on their own. Fortunately, my 
sister-in-law had enrolled in the Access for Infants and Mothers 
program, California’s insurance plan for middle-income pregnant women. 
AIM coverage extends 60 days postpartum and paid for her stay in 
intensive care and early rehabilitation. 
But when the 60 days is up next week, the family will fall through the 
welfare medicine rabbit hole. As a scholar of social policy at M.I.T., I teach students how the system works. Now I am learning, in real time. 
For health coverage, the baby fares best. He is insured through Healthy Families, California’s version of the Children’s Health Insurance Program, the federal-state plan for lower-income children ineligible for Medicaid whose families cannot afford private insurance. California is 
relatively generous, with eligibility extending up to 250 percent of the federal poverty level of $19,090 for a family of three; 27 states have 
lower limits. 
When the AIM coverage expires, my sister-in-law will be covered by 
Medi-Cal, California’s version of Medicaid, because she is disabled and 
has limited income. But because my brother works, they are subject to 
cost-sharing: they pay the first $1,100 of her health costs each month. 
Paying $1,100 leaves them with a monthly income of just 133 percent of 
the federal poverty level. If my brother makes more money, their share 
of the cost increases. 
They must also meet the Medi-Cal asset test: beyond their house and one 
vehicle, they can hold $3,150 in total assets, a limit last adjusted in 
1989. They cannot save for retirement (retirement plans are not exempt 
from the asset test in California, as they are in some states). They 
cannot save for college (California is not among the states that have 
exempted 529 college savings plans from their asset tests). They cannot 
establish an emergency fund. Family members like me cannot give them 
financial help, at least not officially. If either of them receives an 
inheritance, it will go to Medi-Cal. Medi-Cal services that my 
sister-in-law uses after age 55 will be added to a tab that she will 
rack up over the rest of her life. When she and my brother die, the 
state will put a lien on their estate; their child may inherit nothing. 
Even my brother’s hobby runs afoul of the asset test: he enjoys working 
on old cars, which he can no longer keep. 
These are the limitations under which 7.5 million Medi-Cal recipients 
live. Nationwide, more than 50 million people are covered by their 
states’ version of Medicaid. Some states are more lenient in their 
income and asset tests, others less so. Nowhere is life in these 
programs a picnic. 
That said, Medicaid is an important safety net for the poor, and the 
Obama reform would expand the program to cover all Americans under 133 
percent of the poverty level (currently one has to be both poor and 
categorically eligible — a child or a pregnant woman, for example). But 
for the middle class who are thrust into Medicaid by circumstance, the 
program’s strictures are truly life-altering. My brother and 
sister-in-law desperately wanted to buy insurance and now wonder how to 
escape Medi-Cal’s forced penury. My sister-in-law will qualify for Medicare after the mandatory 24-month waiting period for disabled people, but Medi-Cal will be the secondary payer. 
Their best hope is the survival of the Obama reform. Perhaps my brother 
can get a job that offers health insurance for the family, but without 
the reform’s protections, like the prohibition on denying coverage for 
pre-existing conditions, removal of annual and lifetime insurance caps, 
and reinsurance for large claims, there is no guarantee that they could 
obtain insurance. More likely, they would buy insurance on a health 
exchange. Here in Massachusetts, where such an exchange is in place, 
they could have purchased a plan with an affordable premium (at their 
income level, the monthly premiums range from $39 to $91 per adult). And these money and insurance issues would not have added to the other 
stresses in their profoundly changed lives. 
Instead, their financial future is shattered. Family and friends are 
raising money to buy a wheelchair van and to renovate their home for 
accessibility. The generosity of the local community is stunning. One 
incident in particular struck me to the core. A woman from a small 
community nearby had something for us. A cancer survivor, she had decided to “give back” by placing donation cans in 
stores around town. She had finished her drive and consolidated the 
money. The small coffee can she handed over to me and my sister-in-law 
had a slit in the lid and was decorated with pink felt and ribbons, now a little smudged from handling. Inside were several hundred dollars in 
small bills. We burst into tears. This is social policy in the richest 
nation in the history of the world. 
Andrea Louise Campbell is an associate professor of political science at the Massachusetts Institute of Technology.
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://mailman.fsr.com/pipermail/vision2020/attachments/20120405/243dfb88/attachment-0001.html>