No, because my definition of " available" means that you can get health insurance coverage regardless of your ability to pay. We have that in America, just like Germany. A country that no one claims lacks universal healthcare. [I do dislike that we conflate “healthcare” and “health insurance coverage”, because you can receive coverage even without it in the United States, so arguably we do have universal healthcare and universal health insurance.]
No, you can either be so poor that you are qualified for Medicaid, or so poor you’re not qualified for Medicaid but are able to get PPACA subsidies. There really is no gap. The people you’re talking about would be making a choice that they don’t want to spend any portion of their disposable income on health insurance.
You still receive the care even if you don’t have $5000. You just now have a $5000 debt. If you’ve actually looked at the exchange plans the people most likely to hit numbers like that chronically (diabetics are a big class) actually get a lot of that stuff covered even before hitting their deductible.
Also, when people whine about lack of universal healthcare they’re talking about not having health insurance coverage. This woman had that, so your complaint here is not about lack of coverage, it’s about how that coverage works, a different issue than the coverage being available universally.
Not true. Not everyone who’s too poor for subsidies qualifies for medicaid. Off the top of my head, there are a lot of states where the republicans have refused to take federal money to expand medicaid coverage, so you won’t get it just for being poor - you’d have to be a kid, a pregnant woman, disabled, or various some other groups that medicaid covers.
Prolly mentioned this before, but, generally people like Stan Brock, the English ex-cowboy in his 70s who hired the LA Forum for a week to give out free medical care to Americans in 2009 don’t have to minister to Germany.
Independent UK — The brutal truth about America’s healthcare 2009
In America, the offer of free healthcare is so rare, that news of the magical medical kingdom spread rapidly and long lines of prospective patients snaked around the venue for the chance of getting everyday treatments that many British people take for granted.*
In the first two days, more than 1,500 men, women and children received free treatments worth $503,000 (£304,000). Thirty dentists pulled 471 teeth; 320 people were given standard issue spectacles; 80 had mammograms; dozens more had acupuncture, or saw kidney specialists. By the time the makeshift medical centre leaves town on Tuesday, staff expect to have dispensed $2m worth of treatments to 10,000 patients.
Selling insurance over state lines so insurers can all locate to the state with the fewest consumer protections is what they want. Hopefully they can’t get it with the ACA setting basement standards.
How much would it cost to mandate all insurance in America have a 10k annual out of pocket maximum for out of network care? That would prevent situations like this one. I assume since it is not uber common for people to get those kinds of bills out of network it would only cause insurance rates to jump by a few percent.
“Had she gotten sick in any other country on earth she would be dead as every country on earth except our is a poorly run, dirt poor dictatorship. etc etc etc” It is like debating with a 4 year old about whether his mom is the best mom on earth. You can’t win.
I don’t think things are going to get better anytime soon.
There are sooooooooooooo many ways you can fall through the cracks in the US health care system:
[ul]
[li]You could live in a state that didn’t expand medicaid[/li][li]You could have medicaid but not find a doctor who accepts it[/li][li]You could have insurance but the premiums, copays and deductibles makes it hard to afford to get covered or get care. [/li][li]You could go to a hospital unconscious and be charged out of network because they took you to the hospital that wasn’t in network[/li][li]You could go to an in network hospital or lab, but the people who work on you are out of network. If you have insurance with an out of network limit great but a lot of insurance does not.[/li][/ul]
And to top it off, if the SCOTUS overturns the subsidies in about 36 states you won’t get subsidies soon. The ACA was a step in the right direction but it isn’t going to make medical care more affordable or stop bankruptcies due to health problems.
I may move to Vermont or California for health insurance someday. This country is so fucked up on this issue.
You clearly have no idea what you’re talking about, or your idea of ‘care’ is vastly different than mine. It appears you’re saying that people with chronic conditions magically get their prescriptions, medical supplies, and health care covered even if they can’t pay. I can tell you that absolutely is not true. Don’t have the money to pick up that insulin from the pharmacy? You don’t get it. Don’t have the money to pay the cost of those insulin pump supplies because you haven’t met the deductible? Sorry, that payment is required up front. Even the nicest doctor will eventually drop non-paying patients. ER visit? Sure, they’re required to patch you up, but will send a bill, and good luck getting that prescription refill after you leave the ER.
Yeah, this magical coverage of people with chronic conditions certainly didn’t apply to me when I was unable to work in the mid-2000s. Actually, I believe the stance of the state of Florida was “fuck you and your asthma”.
Explaining to people that the out-of-pocket cost for the preventative medication that keeps me out of the ER is $300 a month, was fun. And that was one medication. I use 3 for my asthma (in keeping with EBM standards of care).
Um, what? There’s no such thing as being “too poor for subsidies.” If you have income under 400% of the poverty level you’re eligible for tax credit subsidies, those making under 250% are eligible for both tax subsidies and cost-sharing subsidies on Silver Plans, those under 138% are eligible for Medicaid (in some States.) Some States have expanded Medicaid under a PPACA program in which the Federal government pays for most of the cost of the expansion.
If you are over 400% then you can afford your own health insurance, if you say you can’t then you’re making choices to pay for other stuff instead, no different than anyone can make any choices about their lives.
If your claim is that there are people between the the Medicaid cutoff FPL and 400% FPL level who don’t qualify for Medicaid (unless in a Medicaid expansion State) who still can’t afford health insurance with subsidies, I’ll cry foul. I bet they can afford many things that cost more than health insurance on the marketplace and are simply choosing not to spend money on health insurance because it isn’t instant gratification.
It simply is true. The gap doesn’t exist. The amount of subsidy you get is based on your income. If you make 80% of FPL, which in some States may not be low enough for Medicaid, you get a bigger subsidy than someone making 120% of FPL. There is no legitimate reason anyone between the Medicaid cutoff and the subsidy cutoff (4x FPL) should be unable to afford marketplace plans.
If you’re eligible for cost-reducing subsidies, these are the subsidies available at under 250% of FPL, then at the very highest income in that range your costs are capped at 9.5% of income, the cap is lower as your income goes lower. No reason anyone who has income should be unable to put 10% of it into healthcare. If they don’t have income then they’d be Medicaid eligible.
No one will ever be unable to afford insulin. It’s not possible. Anyone who can’t afford insulin is choosing stupidly.
Insulin pumps are not required to control diabetes, they are a nice to have. Obamacare’s own website says the typical marketplace plan will cap a diabetic out at $2,500 per year out of pocket for someone with my income (far above the 400% FPL cut off for any subsidy or assistance–I just checked this on HealthCare.gov.)
As I said, once you’re at 250% of FPL or lower, your costs are capped at 9.5% of income. This is on Silver plans and includes copayments, deductible, and coinsurance, the subsidies do not just help with premiums, below certain income cut-offs they reduce what you pay out of pocket. There is no coverage gap, only a choice some people may make to not have coverage.
Last year I had several cysts removed from my scalp. This involved a plastic surgeon cutting them open and remove the interior sac then cauterizing the wound shut, and the use of an outpatient surgical clinic attached to a local hospital. The cost was just under $1000 (that was my cost, I have an HDHP, no idea what portion of that is after insurance negotiated rate deductions etc), I received the bill in the mail three weeks after the fact.
Typically my dentist and GP mail me bills. I’m not saying no doctor demands payment up front, but since leaving the military I’ve had the same dentist/optometrist/GP (only doctors I see regularly), maybe they treat new patients differently.
I’ll try to explain this in specific terms you will understand. In Virginia, the standard cost for a Bronze plan for an average person is $500 a month. Those making more than about $130% of the poverty limit (about $20-22K yearly), are eligible for subsidies. Those making less than that were to have been covered by Medicaid expansion which our state turned down. The subsidies ONLY exist for 130%-400% of the FPL, not for those making MORE of LESS than that.
Here are the numbers:
If you make > 80K yearly-you pay the full $500 a month
If you make 20-80K yearly-you get a subsidy
If you make <20K yearly and too much for Medicaid-you pay the full $500 a month.
What you are not getting is that the subsidies stop when you make little enough to have qualified for the Medicaid expansion that the state turned down.
I see it with my patients: those that make $18K yearly have to pay the full $500 a month for coverage while those who make $20K yearly only pay about $100 a month.
Now do you really expect somebody making $18K yearly to spend $500 a month for health insurance?