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UPDATED AND CORRECTED ObamaCare HappyVille Story

Rainbow Girl's picture

A writer named Jen wrote an article (published at Alternet) entitled: "Why Quitting My Job and Going on Medicaid Was My Best Option When I Got Cancer ~ There Shouldn't be a Stigma About Using Medicaid,"

This story is a happy one for the author. But it highlights the cruel arbitrariness of ACA-ObamaCare, a system in which where it not for the fact that the author's home state -- Minnesota -- adopted Medicaid expansion under the ACA, she would have been forced to either forego cancer treatment or incur a lifetime of debt.

Jen tells her story as a twenty-six year old woman working in NYC, diagnosed with cancer and finding what she thinks is debt-free medical salvation in Minnesota Medicare. In so many ways this is a happy story. And yet there are undoubtedly people like Jen who, merely because they're sole debt-free option would be Medicaid in one of the 19 states that have not expanded Medicaid under the ACA, would face the cruel Hobson's choice -of life-long debt versus life. This is a cruelty baked into Obamacare. As of recently, 19 states still have refued to enact expanded Medicaid. So for anyone in the author's predicament for whom expanded Medicaid would be the only debt-free solution to non-debt-causing cancer care, they are out of luck under ObamaCare's scheme if their home state is Alabama, Florida, Georgia, Idaho, Kansas, Louisiana, Maine, Mississippi, Missouri, Nebraska, North Carolina. Oklahoma, South Carolina, South Dakota, Texas, Virginia and Wisconsin.

The author also does not mention the Medicaid Clawback Provisions, i.e., that Medicaid would be a life-long lien on her estate if she were 55 years old or more." See also here, Paul Craig Roberts' important piece on this well buried subject. This is important information for persons affected by the Clawback Provisions - persons aged 55 and over.

I am happy that Jen was able to get the cancer treatments she needed through Minnessota's Medicaid program -- she was in a not-well-paying job in her dream field of education, past the age she could be (under ObamaCare) on her parents' policy, but also too poor for ObamaCare subsidies. Thus she could not afford to pay for cancer treatment out of pocket, or to pay even for an ObamaCare policy to finance her treatment ("shared responsibility payments" sure add up). Noting astutely that "medical debt can last for ever," she looked around for a solution that would avoid being buried in a mountain of medical debt "for ever."

Lucky for her, the ObamaCare roulette wheel system for distributing health insurance across the country(*) worked out for her - she went to HappyVille(*) because her home-state of Minnesota happens to one that opted for Obama's Medicaid-for-The-Impoverished-Working-Class option. The only way she could qualify was to quit her job and go back to Minnesota and get covered by Minnesota Medicaid.

This she did, and was happy and is grateful that Medicaid MN covered 100% of every aspect of her treaments and she was not treated as a second class citizen in the process. The reader senses especial gratitude when Jen notes that the Neulasta injections after each chemo treatment (to boost white blood cells lost in the treatment) cost $5,000 per injection. She calculates that she had 11-12 of these, so it would have cost her $55,000. And this is just the Neulasta costs, she has "no idea" how much her whole treatment cost.

Thanks to MN Medicaid, Jen has been able to return to New York City where she will go to grad school and "become a productive member of society again."Jen's gratitude is touching: "And, most of all, it's allowed me to continue to follow my dreams and not let my life get bogged down by shitty circumstances beyond my control. And for that I am beyond thankful."

She wraps up by recommending to anyone who "joins the Cancer Club" not to be afraid of going the Medicaid route, getting past the "stigma."

As uplifting as this story was, it left me a bit queasy. Happy for Jen, but reminded of the cruel arbitrariness of ObamaCare where people just like Jen would not have her option because they are from one of the 19 states that have not adopted expanded Medicaid under the ACA. or if 55 years old or older, would be subject to the estate lien clawback provisions of Medicaid. The author writes that she is "nauseated at the thought of what her medical debt could have been" and has "no idea" how much Medicaid paid for her full treatment. If Jen had been 55 or over, the $55,000 that Medicaid paid for Neulasta and the tens-hundreds of thousands of dollars that Medicaid paid for her chemo, scans, doctor's visits, etc. is, are in fact a Huge Debt she has in the form of a Medicaid lien against her estate..

This is a happy story for the author of the article. She also shares her views on what Obama (and Biden) have done for "the whole healthcare reform thing" and the economy and a "resilient middle class:"

I am a loud and proud liberal Democrat. FDR is my favorite U.S. president, and I think President Barack Obama will go down as one of the best presidents in modern American History. It's not just the whole healthcare reform thing -- which was, in the words of Vice-President Joe Biden "a big fucking deal" at the time it was signed into law in 2010 (after all, most U.S. presidents since Theodore Roosevelt have tried to pass some sort of healthcare reform legislation), and which has been even more successful than even its strongest proponents calculated. President Obama has taken this country from the depths of a recession into a period of economic stability, been the first president in U.S. History to support same-sex marriage (which then set the stage for SCOTUS to make that the law of the land), and has been an overall champion of a strong, resilient middle class for the 21st century.

I do not personally agree with the author's praise of Obama's ACA as a grand achievement. Above all, it is a tragedy and an indictment of Obama's ACA - a bail out of the insurance industry disguised as a social program - that so many others in Jen's circumstances do not go to HappyVille simply because they would have to rely on Medicaid in Kentucky or Maine, or one of the other 19 states that have not adopted expanded Medicaid under the ACA.

(*) See, generally, Lambert's superb series at Naked Capitalism on "ObamaCare's Relentless Creation of Second Class Citizens," link here to Part II of the series.

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Chromex's picture
Submitted by Chromex on

Um the article linked to says the clawback provisions only apply to services for ages 55-64,
If I am right, this does not mean I am a happy Obamacare supporter, nor do I think the witless 26 year old quoted above should be quite so happy.
Her example should be used to basically point out
(a) the whole "shared responsibility" stuff is bogus- How many of us, if we get cancer , could afford such things regardless of our work ethic or supposed "laziness"?'Shared responsibility" should be retitled "blaming the victim for the obscene costs of treatment"
(b) While some type of medicare for all is the only solution, the 26 year old above was fortunate that all her costs were covered. That is NOT the experience of most medicare recipients or any medicaid recipients I know. I favor expanded medicare for all.

Rainbow Girl's picture
Submitted by Rainbow Girl on

For some reason I had thought that the Medicaid Clawback Provisions applied to people in all age brackets, not just persons 55 and over.

Which is wonderful news for Jen, the author of the Alternet article, and as a result, unless there are readers of Jen's article who are 55 or over, publicizing her story to all who are in the under 55 age bracket and fortunate enough to have a Medicaid-State option available is a great service indeed.

That said, I agree wtih Chromex that Expanded Medicare For All (including dental care, prescriptions, and eliminating the tapeworms of "cost sharing" that have made Medicare de facto unaffordable to vast numbers of Medicare-eligible American taxpayers) is the only humane and just and medically justifiable solution.