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ObamaCare Clusterfuck: Small problems from ObamaCare's lack of universality (small, if they're not your problems)

First, foster children. KHN:

A little-known provision of federal health law now extends Medicaid coverage to former foster youths until they turn 26, regardless of where they live or how much they earn. The only requirements: They must have been in foster care when they turned 18 and have previously received Medicaid, the state-run insurance plan for the poor known as Medi-Cal in California.   

Nationwide, an estimated 180,000 former foster youths are eligible and another 25,000 will qualify each year, according to the child advocacy group First Focus, which worked to get the provision into the Affordable Care Act.  Youths are entitled to coverage even if they live in states that aren’t expanding their Medicaid programs. ...

Laudable effort. Now here are the problems:

But many enrollment workers are unaware of the provision, raising the risk that the young adults who are entitled to the coverage will be wrongly denied.

There isn’t a universal database of foster children, and social service providers may not easily be able to find them in county computer records. And the youths may not have evidence of their time in the child welfare system.

An even greater obstacle, according to advocates, is that a state is not required to provide Medicaid coverage to young adults who aged out of foster care in another state. Youths who have moved across state lines since their time in foster care may not qualify.

In addition, the former foster youth themselves may still be unaware that they are eligible for the free coverage, which includes preventive care and vision, dental and mental health services. Organizations that work with foster youth are trying to inform them through alumni groups, social service providers, community colleges and health clinic

So, as opposed to a single, universal "Everybody in, nobody out" single payer program, we have a maze of special cases and kludges, and substantial expertise required to navigate a broken system that shouldn't even exist.

Second, people who use the ER* in preference to a doctor. As it turns out -- and I know this will surprise you -- poor people are quite capable of making rational decisions, this being one such. KHN again:

In expanding Medicaid coverage, the architects of the national health care overhaul hoped to change the way low-income people obtain health care, moving — as Morgan did — away from emergency rooms and into the offices of doctors, where more consistent supervision [compliance] may improve their health.** ....

But some health care experts say that in many cases it will take time and considerable coaching to change their behavior. People tend to use health care more after they obtain coverage, and those unfamiliar with a traditional doctor-patient relationship may stick with what's familiar. ...

"Having insurance coverage gets you only halfway there," said Dr. Elbert Huang, associate professor of medicine at the University of Chicago and a former senior adviser for planning and evaluation in the U.S. Department of Health and Human Services. "There's this huge deficit of knowledge about how to use the health care system that still needs to be overcome before people can benefit from having health insurance. It's like you've given people a license to drive, but they don't have a map."

And giving them directions is tricky, said Steven Glass, executive director of managed care for the Cook County Health and Hospitals System, which runs CountyCare [an early rollout of the expanded Medicaid program under ObamaCare].

"Using health insurance is much more complicated than using car insurance," said Glass. "Health insurance literacy [that is, explaining the many details of a complex system that shouldn't even exist] is something health plans need to address. It's something we've identified, and we're still trying to understand the gaps. People don't know how to use the health insurance and have to be taught and coached through what that is."

In Cook County, nearly a year into CountyCare, Stroger Hospital still serves just as many ER patients as ever — an average of 383 people per day. More than half lack insurance coverage, and many of them stop by in the evening. Similarly, about a third of patients at the University of Illinois at Chicago's emergency room come in after 5 p.m., officials said.

"People have figured it out," said Jeffrey Schaider, chairman of the department of emergency medicine for the Cook County health system. "If you're working 7 a.m. to 8 p.m. every day, when are you going to see your primary care doctor?"

Duh. Salaried, political or creative class people just don't get that taking time off work loses people money. And they assume that you can always find a doctor.

"It's not an irrational choice," said Dr. Mark Mackey, vice chairman of clinical affairs in the University of Illinois Hospital and Health Sciences System's department of emergency medicine. "I don't have to wait. I can be seen right away. … We've really evolved into this rapid diagnosis and treatment center."

In other words, the ER respects poor people's time, in a way that doctor's offices do not.

"For Medicaid patients, the issue is who's going to accept them, and where," he said. "Doctors often practice on the Gold Coast or in well-off suburbs, not in the poorest areas. "That's not very helpful for patients who live in Lawndale or Englewood. Those areas of the city are medical deserts, and the Affordable Care Act doesn't solve the medical desert problem."

Man, wouldn't it be great if poor people could just... Go to the Gold Coast to get the care they need? Science fiction stuff, I know.

Third, the just plain unlucky:

ALBANY, Ga. — If Lee Mullins lived in Pittsburgh, he could buy mid-level health coverage for his family for $940 a month. If he lived in Beverly Hills, he would pay $1,405.

But Mullins, who builds custom swimming pools, lives in Southwest Georgia. Here, a similar health plan for his family of four costs $2,654 a month.

This largely agrarian pocket of Georgia, where peanuts and pecans are major crops and hunters bag alligators up to 10 feet long, is nearly the most expensive place in the nation to buy health insurance through the new online marketplaces created by the federal health law. The only place with higher premiums are the Colorado mountain resort areas around Aspen and Vail, a high-cost-of-living area unlike Georgia.

In these places, government subsidies are shielding people with low and moderate incomes from the full cost of the premiums. Randy Gray, a flower shop owner in Albany, is paying just $32 a month, with taxpayers picking up the remaining $805. "That's just too good," he said.

But for those earning too much to qualify for federal financial help, the premiums can be overwhelming. A 60-year-old making $47,000 in Albany would have to pay a quarter of her income for the least expensive mid-level "silver" policy, the level most consumers are buying.

Even some people who qualify for federal assistance, such as Stacie Brown, owner of a pottery shop, are balking.

Even with the subsidies, this is the kind of inconsistency that drives me bananas. I just don't see how it's fair. I'm a random US citizen: Why should I have to pay more for health care in one zip code than another?

NOTE * Hospitals, naturally, would like to rid themselves of any obligation to treat people in the ER, which ObamaCare is helping them to do.

NOTE ** Never asssume ObamaCare has anything to do with improving health care.

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psychohistorian's picture
Submitted by psychohistorian on

Your are doing an excellent job of educating me and I hope others about the clusterfuck that is Obamacare.

I only see this changing if the rest of the "economic" system collapses as it seems to be doing. Maybe then we can have a grown up discussion about social responsibilities, contribution and support that will lead to different incentives towards basic human needs like water, air, food, shelter, health care, education, etc.

Until then its damn the torpedoes, full speed ahead with propping up the class system, plutocrats and competition to the Nth power.

I hope your mouth is starting to love you more.....don't have too much fun in Thailand because some of us (me) are jealous.

Submitted by lambert on

... for a table listing all the posts on this topic. There are a lot!

* * *

As far as jealousy, see this post; assuming currency arbitrage between the US and other countries works, some place like Thailand or Ecuador is necessarily something like my Plan A at some point in the not-too-distant future. Me and others. Maybe like James Joyce I'll write my real masterpieces from exile! In other words, this is not a vacation, per se; rather, IMNSHO, the way to figure out of you can live someplace is to live there. On the dark side, I'm worried about having left the house; on the bright side, things are not dull here at all!

Alexa's picture
Submitted by Alexa on

just heard 'AP' announce that even though there is no final decision yet, the Administration is considering allowing policyholders in the 'private' insurance market to keep their policies (and I suppose not pay a tax penalty) for three more years.

[Of course, it won't help all of these policyholders--in some states--as Dromaius has pointed out.]

My 'guess' is that Dems are in a sheer state of panic about losing the Senate, and are acutely aware that the ACA fiasco may cost them the 2016 election, as well.

It's almost universally accepted that Repubs will gain House seats, so Dems recently abandoned that fight altogether.

Three years?

Hmmmmmmmm--pushes that deadline beyond the 2016 Presidential election.

Can't accuse 'this crew' of subtlety.

;-)