Each year I’ve been on Obamacare – this would be my third year – the Exchange policies have gotten worse and more expensive. Now I’m at the breaking point.
I don’t have insurance with work, so I have to go to the Exchange. (There is no such thing any longer as a private individual policy not negotiated through the Exchange during annual open enrollment, which ends tomorrow.) Exchange policies have high sticker prices: hundreds of dollars a month. The way it’s supposed to work is, up to about four times the household income poverty line, you get a generous subsidy from the government to offset the premium. Except I don’t. I’m in The Hole. I don’t get a subsidy at all.
The way the law was written, below 133% of poverty, instead of buying from the Exchange, everyone is supposed to go into Medicaid, the state health insurance option which works like health care does in every rational country. I’m below 133% of poverty – in fact I’m below 100% of poverty – so rather than buying a policy at all, I’m supposed to just get Medicaid and everything is free (well, hah, not really, but it’s coverage, of a sort, which I would not have to pay to have).
Medicaid is 50 individual state programs, not one federal program – the feds assist with block grants, but these are not enough by themselves, so the state has to kick in a lot of money. Tennessee has not put in enough. Tennessee has an insane tax structure – no income tax, only sales tax; it doesn’t bring in enough during good years, and the tax base plummets in bad years. The last time TN actually tried to make a go of Medicaid on the basis of its tax revenue, it blew up the budget. TN, like most states, is forbidden by the state constitution from running any deficit, so the Medicaid program was closed. It has remained closed to new enrollees without dependent children (you can’t exclude people with dependent children by federal law) since 2002. Thirteen years.
The new Federal money from the Obamacare “medicaid expansion” would have opened this up (at least partly, though I’m still not clear that it would have been enough money to cover every eligible adult up to 133% of the federal poverty line). I could have gotten in medicaid. But after the Supreme Court ruled that a state could withdraw from the Medicaid part of the Obamacare mandate, most states with Republican leadership did just that. Tennessee’s Medicaid is still closed.
So that puts me back in the Exchange, but because the Exchange subsidies were written under the assumption that everyone with incomes too low for Exchange policies would now be covered by expanded Medicaid, there is no provision for subsidies for people with incomes that low. So none are available. To get an Obamacare policy, I have to pay full sticker price.
If you know what a COBRA policy is, that means I have to buy what is essentially a COBRA policy. They’re not actually called COBRA and they don’t work under COBRA portability rules, but they cost like COBRA, because COBRA is “your insurance from your job, only now you also have to pay the part of the premium your employer was paying.”
The last two years I’ve been able to find policies I could actually pay for, even if they were pretty bad policies. They had high deductibles and high premiums, but not such high premiums that I couldn’t pay them, and the deductibles were low enough not to bankrupt me if I needed surgery, as, it turned out, I did. (That gall bladder isn’t going to be troubling me anymore.) They also covered my psychiatric drugs at affordable copays.
Well, Blue Cross, which administeres the large majority of Exchange policies in TN, about six months ago announced they were going broke on them. The thing about Exchange policies is that if you can pay you can have a policy – the insurance company not allowed to exclude or underwrite you just because you’re terribly ill and therefore expensive. They take everyone. The idea that having so many new people, most healthy, using Exchange policies would offset the cost of not being able to exclude and underwrite policies for the ill, has not turned out to be true. Not at all. So Blue Cross said they had to raise the prices by at least 50% on most policies or they would drop them all and leave the state, which would destroy the TN Exchange. (This is happening all over the country). The state regulator said they could. They didn’t have much choice – if they’d said no, a lot of adults with minors would have been thrown on Medicaid and the state absolutely cannot afford it.
So the premiums this year have just exploded. The absolute cheapest Bronze plan I’m eligible for is about $250 a month. This is literally the cheapest plan available to me. It covers effectively nothing – no coverage kicks in until I satisfy the deductible, which is $6,500: that just happens to be the Federal Obamacare upper limit on out-of-pocket expenses for a single nonsmoking adult. It doesn’t even pay for prescriptions until the $6500 is passed. After that it pays, but unless I get cancer or get hit by an uninsured motorist, I’m not using that.
I get to pay $250/month for a catastrophic plan that otherwise pays for nothing. The whole point of catastrophic plans is they’re supposed to be cheap – but this is not cheap. This one costs three thousand dollars a year just to have, and, if I get sick, another sixty-five hundred before I see a plugged nickel from Blue Cross.
If I want one that actually covers anything below the federal max out-of-pocket legal limit, well, those start in the mid-three-hundreds. Out of the question.
I might – might – be able to pay for the cheapest plan, even though then I have to find a way to pay for every doctor’s visit or prescription drug at retail out-of-pocket rates — fortunately all the drugs I take are generics and are relatively inexpensive (on the order of $150/year per drug, which in the US counts as cheap).
But why? Why should I do this? I go bankrupt if I get sick whether I have this plan or not.
And the other plans are just not going to happen. No way.
Obamacare has a penalty if you don’t have insurance – $695, or 2.5% of your yearly income up to the national average bronze-level annual premium, whichever is greater – but they have kindly waived it in the cases of people like me. If the premium is more than 8.5% of your annual income, you can waive the requirement to have insurance; similarly, if you live in a state that did not expand Medicaid and you fall in the Hole. I qualify on both counts. No penalty for me.
But that still leaves me uninsured.
Well, I’m going to find out what that’s like nowadays, because I don’t have any alternative.