Many Low-Income Workers Say ‘No’ to Health Insurance

[KamaAina]

http://www.nytimes.com/2015/10/20/business/many-low-income-workers-say-no-to-health-insurance.html

When Billy Sewell began offering health insurance this year to 600 service workers at the Golden Corral restaurants that he owns, he wondered nervously how many would buy it. Adding hundreds of employees to his plan would cost him more than $1 million — a hit he wasn’t sure his low-margin business could afford.

His actual costs, though, turned out to be far smaller than he had feared. So far, only two people have signed up....

Evidence is growing that his experience is not unusual. The Affordable Care Act’s employer mandate, which requires employers with more than 50 full-time workers to offer most of their employees insurance or face financial penalties, was one of the law’s most controversial provisions. Business owners and industry groups fiercely protested the change, and some companies cut workers’ hours to reduce the number of employees who would be eligible.

But 10 months after the first phase of the mandate took effect, covering companies with 100 or more workers, many business owners say they are finding very few employees willing to buy the health insurance that they are now compelled to offer. The trend is especially pronounced among smaller and midsize businesses in fields filled with low-wage hourly workers, like restaurants, retailing and hospitality. (Companies with 50 to 99 workers are not required to comply with the mandate until next year.)

1) Raise the damn minimum wage, already. 2) Single payer now!

[Gormy Cuss]

1. Yes and yes. n/t

[hobbit709]

2. My housemate makes $400/wk gross.

He can't afford premiums, much less copays and deductibles.

[closeupready]

6. Right - emergency rooms, still.

Health service providers continue to gouge the sick. It's a total disgrace.

[WillowTree]

10. Will he be able to affort the $695 penalty for not having coverage?

[hobbit709]

11. He didn't make enough to get hit with a penalty.

[ronnie624]

57. If he doesn't make enough to be penalized,

he can get coverage for little or nothing. He needs to look into the Health Insurance Marketplace.

[edhopper]

13. what would the subsidized ACA

cost be for him?

[hobbit709]

14. In TX? HAH!

[edhopper]

16. Sorry

didn't know.
That is one fucked up State.

So the problem isn't the ACA but the Red States that want to kill it.

[hobbit709]

17. The problem is that the ACA is still basically Insurance and not actual Healthcare.

Even if you could afford the marginal rate, you still can't afford the copay and deductible.

[edhopper]

18. depends on the plan

in NY you can get a plan for a little over $400 a month that is 80/20 with a $600 deductible.

The subsidizing levels are generous as well for the lower plans, and medicaid is expanded to about $15,000 annual. for the individual.

Don't get me wrong, I wanted Medicare-for-all, but this is better than what we had before.

[coyote]

23. Just for comparison

In Germany you can get public insurance at 133€/Month with zero deductible and zero copay.

[Myrina]

29. A $600 deductible + a 20% copay, on a $7-9/hr wage is NOT afforable.

Faced with paying $400/mo, and still knowing they'd have to cough up $600 as a deductible, would equal in a lot of cases, someone's entire month's take home income.

Yeah, I'd go without too.

[wordpix]

35. if you are poor (income under approx. $13K in my state), you can get Medicaid

Of course, that is IF your state agreed to Medicaid expansion

[edhopper]

42. exactly.

Blame the red states, not the ACA.

[former9thward]

48. $13K is $6.37 a hour for a full time job.

Federal minimum wage is $7.25 a hour or $14,790 a year. So if you are working full time you are not eligible for Medicaid even if you are working minimum.

[closeupready]

34. $400/m. is $4,800 per year. I know working people who can't afford that.

Not on top of car insurance, rising rents, school-related costs for their children, etc.

[edhopper]

41. that's without the subsidies

It can be much less for people with lower income.

[closeupready]

43. Do low-income workers receiving subsidies get assigned case workers?

Do they have to hide their toasters when the case worker comes calling? If they get married, are they charged with fraud if they don't stop collecting the subsidy/tell the government?

Sorry, that's not really a dig at you, just frustration about the hoops and backflips low-income people have to perform in the US.

[edhopper]

45. I think it's based on tax returns

So no.

[csziggy]

46. If you submit your tax return the ACA subsidies are automatic

In my case all I had to do was authorize the ACA website to access my previous year's tax return. They figured up the subsidy based on that. Since my husband retired in January, we are actually making less this year so I think our subsidy will increase next year.

They only look at actual income, not at assets or what you own.

[Myrina]

26. ^ This ^

n/t

[catrose]

30. Right

And I was told by someone at healthcare.gov that if my employer offered a plan, I couldn't choose my own. Hello, huge deductible and unaffordable care.

[Recursion]

52. You mean just like single payer?

Actual healthcare would be an NHS.

[ronnie624]

58. I'm sorry, but you are spouting nonsense. You need to stop it. n/t

[pnwmom]

60. Medicare is insurance, too, and it works. The real problem is that most of these people

live in states whose governors rejected the ACA-linked Medicaid expansion.

I helped a young friend get Medicaid in our state, and she never has to pay co-pays or deductibles. That's a state decision.

[Yo_Mama]

19. He is eligible for the subsidy in TX - subsidies are federal. He is not eligible for Medicaid.

Not with that income.

However, if you are offered qualifying insurance through work you are not eligible for the subsidies, which again is a federal policy.

And most work policies for lower wage worker industries tend to be only the required 60/40 plans, which leave lower wage workers unable to effectively use the plans if they get sick.

The only virtue for them are the free benefits, which are not a help if you get ill, especially for younger workers.

[dsc]

36. TX does have an exchange with subsidies

they didn't expand Medicaid.

[hobbit709]

37. And if you can't afford it even then?

[Fumesucker]

3. Do I pay for health insurance or the power bill or the car note or the rent?

Three of those are critical to everyday survival for low income workers, the fourth not so much.

[KamaAina]

4. Send the power bill to the dealership and the car payment to the power company.

Hey, it worked for Roseanne!

[MillennialDem]

21. I pay my bills online - but when I get those preapproved credit card offers I

send my paper copies of bills back in the business reply envelopes.

Never know when some generous soul might pay my mortgage! :p

[haikugal]

7. This is it!! Some people don't qualify for help but are still too poor to meet expenses

and pay for health care.

[YabaDabaNoDinoNo]

5. They are not saying no, They Can't Fucking Afford it!

Low wage Workers have no real choice except to die quickly.

[JCMach1]

8. Most would qualify for Medicaid if it wasn't one of those Repug states that rejected

the Medicaid option.

[KamaAina]

9. That way we'd be giving more benefits to these giant corporations than we already do.

Walmart, I'm talkin' to you.

[JCMach1]

15. Nothing is resolved until we get single payer, or something very much like it...

[hifiguy]

28. This is the truth and nothing but.

[former9thward]

49. Not if they are working full time.

They will be above the Medicaid limits.

[Runningdawg]

12. We have insurance in name only

We are both covered under my husbands work plan. It's the best deal we could get and still cost us almost 300 a month. For this 300, we won't be turned down at an emergency room but that's about it.
Co pays for a primary Dr are $50. For a specialist $85. The lowest price for a med (even a generic is $20) they go up from there.
I was told I needed a CT scan nearly 2 years ago. I guess now I know it's not something that's going to kill me. Then the going price was $2500 for the test. This year it went up to $3500. Total deductible under our plan is 5K.
Recently my husband had his first full physical from a Dr since he left the military 15 years ago. Our insurance refused to pay for any of the lab work, saying it was not necessary. Now we owe 528.00.
I used to be a nurse and now I know the absolute best I can hope for is to die at home knowing that I won't bankrupt my husband when I leave.

[taught_me_patience]

20. CT's don't cost anywhere near $3,500

Depending on where you live, you should be able to get a CT-Abdomen for $500-600, and a CT Brain for 400 or so.

[MillennialDem]

24. I got a whole lower body CT with contrast for $1,000 in IL

[wordpix]

38. "allowed charges" by insurance cos. are totally fabricated & should be investigated

e.g. My conventional chemo that's been around for decades costs $3600/round for admin + the drugs, according to NIH. But the "allowed charge" from my insurance co. is $23K, and the "provider charge" is $40K per round.

Interesting, the insurance co. charged me $3600 for my share per round. So the rest is gravy for Big Pharma, which got most of the money, close to $20K/round.

[zipplewrath]

22. Much of this was predicted

The employers were operating on pure irrational fear. There was no way that there would be anything close to 100% participation. Truth is, depending upon the demographics of his employees, this kind of result was fairly predictable. Even more so, many of his workers may already be covered by some spouses plan of one sort or another (as much as it might suck).

The sad part is that between the red states not participating in Medicaid expansion, and the economy still sucking in terms of full employment, the current data is suggesting that insured rates have only increase about 5% over all. The pessimistic predictions were closer to 7%. The cheerleaders were selling 12+%.

Until the plan is 100%, including the people who can't afford to use insurance at all, we're never getting close to what we want.

[hifiguy]

25. Not surprising. Not one bit.

What's the incentive for an employee to opt in to enormously expensive policies with exceptions and non-coverage areas you could drive a semi through? Add the sky-high co-pays and deductibles and all you have is a wheel of Swiss cheese that is functionally useless as "insurance."

Making sure Big Insurance (and Big Pharma) set the terms of the debate in toto was a complete disaster just waiting to happen. And anyone with an ounce of brains could see that.

Your Points 1 and 2 are the ONLY relevant ones.

[Runningdawg]

27. Hmmm...

I don't know where you got your info, or what type of health plan you have but I can tell you Blue Cross and Blue Shield of OK are charging 4 figures for a scan. Hell yes, I know they shouldn't cost that much - but they do. My MIL recently paid nearly $300 for a 5 minute ultrasound of her gallbladder. My husbands lab work should have been covered and should have been MUCH less than we were charged, but they will charge whatever the Insurance companies will allow.

[TheDebbieDee]

31. I agree with all the other posters in this thread that mention

these employees decide against getting health insurance because they earn so LITTLE money that they still can't afford health insurance.

My daughter recently enrolled in her company's health insurance plan and she is worried about how big a chunk the premiums will take out of her pay check...

[KG]

32. when i've been a low wage worker, i just did without health ins.

[closeupready]

33. I want to point out, the headline is leading.

Low-income workers would clearly say yes to health insurance if it was affordable. It obviously is not true that in places where health care is low-cost, people generally refuse to seek health care when they need it.

[hifiguy]

40. The ACA was never intended to put comprehensive insurance

in the "affordable" basket. Ever. Remember who wrote most of it - Big Pharma and Big Insurance. Real people - the proles like us - were immediately escorted from the room and told not to worry their silly little heads about it. The Rich would have our best interests at heart.

Just like the TPP/TTIP.

"Is it any wonder your wine is sour
When you let a liar choose the brew he pours you.
Is it a surprise that you've got no power
When you pay a thief to keep it for you.

Cold weather coming, people feel the fire.
Living on Dead End Street with no desire."

"Listen Now" written by P. Manzanera/W. and I. MacCormack (1977)

[wordpix]

39. Obama needs to address the thieves who keep raising ACA rates

so the execs can make their multi-million$ per year while we peons work for min. wage and can't afford any health insurance

[ohheckyeah]

44. Income isn't the

only indication of what a person can afford. It's outrageous that wasn't taken into account.

[pnwmom]

47. How many of these low-wage employees did the ACA make eligible for single payer insurance --

that is, Medicaid -- based on their low incomes? And were shut out by their Republican governors, not the ACA?

The people who succeeded in passing the ACA couldn't stop the Rethug states from rejecting the Medicaid expansion. Blame the Rethug governors, not the ACA, for that.

[Warpy]

51. Those plans with enormous deductibles are useless

especially to workers who are barely managing to feed themselves enough that they don't faint on the job.

Congressmen thought those deductibles were chump change, signaling how vastly overpaid they are compared to the rest of us.

If they want people to buy insurance, they need to lower those deductibles to a reasonable level and raise their damned wages. Expecting marginal workers to shell out money they don't have for "insurance" that doesn't cover their routine medical needs is completely insane. Those plans are totally useless.

[Recursion]

53. Right, because preventing medical bankruptcies doesn't help anyone

Get in a car wreck with a bronze plan and you end up owing the out-of-pocket max, which is a few thousand dollars. Which sucks. But it's not like owing $150K, like you would without the bronze plan.

[Warpy]

54. You don't know how marginal workers live, do you?

They can go just as bankrupt over that deductible as they can over the whole tab, especially if it's close to the policy year end and the deductible gets assessed twice and you bet your ass some carriers are going to try to pull that fast one.

These are people who have to resort to payday loans if the car they drive to work needs to be fixed.

Trust me, they are not afraid of medical bankruptcy. They have more immediate concerns.

[Recursion]

55. Having spent a year flopping on couches and day laboring, I do

They can go just as bankrupt over that deductible as they can over the whole tab

No: bankruptcy isn't even relevant to marginal workers because you are completely off the grid as it is. You get up, stand in front of the 7-11, go help somebody mulch his yard, and take payment in cash, which you try to save up, but always ends up getting stolen. Bankruptcy isn't even a question at that point because the system would have to admit you exist first, which it doesn't if you're on the cash economy.

The rare times you get a check for something (say, a well-meaning but clueless relative on your birthday) you have to either go to a check cashing scam storefront, or if you're lucky you can take it to the bank it was drawn on (though even they have started charging to cash their own checks now).

These are people who have to resort to payday loans

Oh, I dreamed of payday loans. They require having a paycheck and a bank account.

But, yes, you can dig yourself out from $6K, and you can't from $150K. Where exactly the line is I can't say, but it's between them. I was lucky I was in Massachusetts which let me buy a nearly-free catastrophic plan (though I had to pay for a pre-paid debit card to be able to pay the low premiums I did have -- though I also needed that for my prepaid cell phone, which you need if you're day laboring, so that was basically a sunk cost).

Side point: now that I think of it, the pre-paid cell phone thing was really the only service or product marketed to marginal workers that was actually a good deal and not exploitative. We need financial services that work like that.

[pnwmom]

59. Most of these "marginal workers" would be eligible for Medicaid if they lived

in a state that accepted the ACA Medicaid expansion.

It isn't the fault of the ACA that these low-income workers don't have Medicaid; it's the fault of the governors.

[closeupready]

56. I want to address this tomorrow.

Bookmarking for later.

[historylovr]

64. +1

[Skittles]

61. they don't want to spend on something they cannot afford to use

bad

[hfojvt]

62. I am curious

when it says "the law requires him to offer health insurance"

what does that mean?

How much of the premium does the employer pay and how much does the employee? And what about employee status? (single, married, with children, or married with children)

Ah, okay now I see the line.

My own question was about my eligibility for a tax credit through Obamacare. One person I talked to said that I was NOT - because my employer offered coverage. However, my employer only pays 50%, which still makes the coverage very expensive, costing about 27% of my income. Since that is not considered affordable, then I do qualify for a subsidy - which should save me about $3,000 a year.

[killbotfactory]

63. a more accurate title to this would be:

"GOP controlled States who rejected medicare extension under ACA shafted the low-wage workers on purpose"