” ‘Flory said she doesn’t think the terminations are an accident. “When people fail to jump through these hoops to stay on the program, the state saves money,’ she said.
However, in most of these countries just about everyone who can afford to do so, avoids the public system and buys private care or private health insurance. There typically is a tax subsidy for private insurance – especially if provided by an employer.
How might something like that work in the United States? A fair and efficient way of structuring it is to offer everyone a tax credit of, say, $2500 for an adult and $8,000 for a family of four – the amounts the CBO estimates that new enrollees cost Medicaid. If people enroll in Medicaid, the money goes to Medicaid. If they choose private insurance, the tax credit applies against premiums. If they do nothing, the money goes to safety net institutions who deliver free care (but car insurance quotes may ask for payment if patients have assets).
In a previous post, I described such a system as a form of universal coverage. It’s at least as close to that as we are ever going to get. See a more detailed description here.
Think about that. We are now four Site years into a national health care reform whose original goal was to provide “universal coverage” to every man woman and child in the country and instead of that people are participating in a lottery to determine who will get care. Obviously something is not working very well.
‘The population who were already on Medi-Cal [California Medicaid] before Jan. 1 is a lot more expensive for the state to cover, she said. The federal government pays only half of their health care costs, compared to 100 percent of the costs for those who qualify under the [Affordable Care Act’s] broader eligibility guidelines.’ ”
“The California Department of Health Care Services sent everyone who needed to renew the necessary application in the mail, but advocates like [Jen Flory, a senior attorney at the Western Center on Law & Poverty] say people have struggled to complete cheap car insurance it. The form is complicated, asks for information the recipients hadn’t provided in the past and is available only in English and Spanish.
On the other side of the country something equally bizarre is happening. In Arlington, Virginia people are participating in a lottery to find out who will get free health care. Those who lose out generally don’t get any care until next month’s auto insurance quotes lottery. As Patricia Sullivan explained in the Washington Post:
The clinic — one of more than 50 free clinics in Virginia — prides itself on providing “whole-person” care for more than 1,700 patients, meaning that regardless of what brings people in, they can get treatment for any physical or mental health need. Spanish-speaking interpreters are always car insurance quotes available, and there are also volunteer translators in many other languages.”
‘There’s a lot of confusion, and it’s a language access issue,’ said Connie Lo, health programs coordinator at Asian Americans Advancing Justice Los Angeles. ‘Most of our clients are limited English proficiency. They don’t even know what these packets are for and why they’re receiving so many documents together that they can’t even read.’ ”
Public opinion polls have consistently shown that one of the things people like least about our health insurance system is the lack of portability. When you leave one employer to work for another you can take your 401(k) plan with you. But you can’t take More information your health insurance. Why is that?
Is there a better way of organizing a health care safety net? Most of the countries south of our border – and indeed most of the countries in the world – have a free health care system available to everyone. It may not be the best care. There may be rationing cheap auto insurance by waiting. But there is no enrollment, no paperwork and no lottery. You can think of this as Medicaid for everyone, with no administrative hassle.
Over the past decade or so, however, a number of employers and their employee benefit advisors seem to believe they have found a loop hole: Health Reimbursement Arrangements (HRAs). These accounts are funded by employers and Treasury regulations explicitly allow employees to use the money to pay premiums. But Site internet can the insurance be individually owned?
Zane even believes that lower-paid employees who qualify can claim federal subsidies when they buy their insurance on the exchanges. This in effect amounts to double dipping – getting one subsidy at work and another in the exchange.
There are other problems that are nationwide. In a previous post, I argued that is that in the very act of getting health insurance to more people, Obamacare is reducing the funds safety hospitals have to deliver care to the most vulnerable populations:
There’s just one problem. The insurance has to be group insurance. That’s the kind of insurance you eventually lose when you leave the group (switch jobs). Most states explicitly outlaw employer’s buying individually owned insurance (which employees can take with them) with pretax dollars. Even if a state hasn’t outlawed it, most lawyers think the practice is illegal under federal law.
The reason is the tax system. Federal tax law has a generous provision for people who obtain Visit here health insurance at work. Unlike wages, the premiums the employer pays for employee health insurance are not counted in the employee’s taxable income. When you add together federal and state income taxes and payroll taxes, the ability to buy insurance with pre-tax dollars is worth almost half the cost of the insurance to many middle-income employees.
“What the legislators over looked was that about half of the newly insured would enroll in Medicaid (an insurer whose payments to hospitals is scheduled to fall far below previous expectations), that Medicaid patients would continue to patronize safety net hospitals, that patients with newly subsidized private insurance would have large deductibles and copayments that they can’t possibly pay out of pocket, and that those with better insurance will go to some other hospital.”
“Being chosen in the monthly lottery can be life-changing for those who are poor and without health insurance in Arlington, one of the nation’s wealthiest counties. Each month, about 100 people line up for the chance, a multilingual mix of hope, desperation and determination.
Page 1 / 2
Comment Now Follow Comments
Reprints & Permissions
Compounding the problem is the fact that the state of California has a financial incentive to prefer enrollees car insurance quotes who count as part of “Medicaid expansion” over renewals of people who were already in the program.
John C. GoodmanJohn C. Goodman Contributor
I offer market-based healthcare solutions.
Opinions expressed by Forbes Contributors are their own.
HEALTHCARE, FISCAL, AND TAX 11/25/2014 @ 10:13AM 591 views
What’s Wrong With Our Health Care Safety Net?
Comment Now Follow Comments
California expects to enroll 2.6 million additional low-income families in its Medicaid program this year. But here’s a surprise: an even greater number of people who were previously on Medicaid may not renew. That’s right. The total number of people with Medicaid coverage may actually go down. Both changes are due to Obamacare.
Some experts say “yes.” Zane Benefits, for example, has been promoting a plan it says allows companies to reimburse employees who buy individual insurance with pre-tax dollars. And it’s been getting away with it. That’s partly because most states practice a “don’t ask; don’t tell policy.” If an insurance agent doesn’t ask where the premium dollars come from and the buyer doesn’t disclose the source, the agent is off the hook. (In Texas, by contrast, agents have an affirmatively obligation to determine where the money comes from.)
One thing that can be said in favor of a lottery is that administrative costs are almost zero. In California, by contrast, one reason people are not renewing their Medicaid coverage is that they are being drowned in a sea of paper work. As Jenny Gold explains at Kaiser Health News: