Posted: Thursday, April 25, 2013 6:00 am
By THERESA BROWNGOLD
A recent guest opinion about the shortfalls of Obamacare is rife with irony starting with the name of the organization of which the writer is president, “Citizens Council for Health Freedom.” Freedom for whom? Over 60 percent of bankruptcies in this country are due in part or total to medical bills.
There is no patient freedom if one cannot access care. And where is the freedom in going to the emergency room, getting a $14,000 bill and being told you are responsible for $7,000, as just happened to a family member. Care in the United States is heavily rationed by one’s ability to acquire good insurance. Obamacare came about because of this public health crisis.
The long reach of Citizens Council from Minnesota to Bucks County via the guest opinion of our local newspaper is just more political gunfire in a war we are all so tired of. I offer this rebuttal.
The writer makes the point, albeit unwittingly, that Gov. Corbett should expand Medicaid. The Supreme Court made this provision of the Affordable Care Act optional for states. I agree with the writer. We should not have an “entire class of lower-income individuals” left uninsured. Lay that one at the feet of our Pennsylvania governor who refuses to expand Medicaid. Pennsylvania taxpayers will see their share of Medicaid expansion money go to states like the writer’s. Minnesota is covering its low-wage earners by expanding Medicaid.
The writer says, “Experts say more ‘sticker shock’ is coming this summer when insurers release their Obamacare-priced premiums.” Perhaps the “experts” are referring to the price-gouging that could happen before consumer protections kick in. Starting in September insurance companies must justify their premium increases by providing consumers with a “clear disclosure form” justifying the increase. Proposed increases over 10 percent will trigger a more rigorous review by independent experts. The writer would have us believe she thinks this provision of Obamacare does not go far enough. I agree.
And she fails to mention the Medical Loss Ratio provision of the law that requires insurance companies to send rebates to premium-payers if the insurance companies don’t spend 80-85 percent of the premium dollars on actual medical care or care-related services. If insurance companies collect too much, they will have to send out rebate checks.
Today, high deductible health plans (HDHP) are being sold as a way to shift costs to consumers. With HDHPs we pay a premium, and on top of that we need to save thousands of dollars to use for medical bills. Only after we meet that large deductible will the insurance coverage start. High deductible plans require an important understanding of how one can leverage one’s health for financial gain. Obamacare limits the sale of these policies to those under 30 who may be in the best position to leverage their health. (Although I doubt many will fulfill the fiduciary obligation of an HDHP by saving thousands of dollars for a health crisis.) The unfettered sale of HDHPs would leave us with a problem we have today — the under-insured amassing great medical debt because the deductibles are way too high.
The writer gets very technical and is correct when she says that buying insurance cannot be more than 9 ½ percent of the insured employee’s income, and the calculation does not take into consideration the cost of insuring a family. The IRS has taken a very narrow legal interpretation of the statute as we move forward with implementation. No one could have predicted this narrow legal definition, least of all the authors of the law. Many groups are working very hard to change this.
The glitch is easily fixable by Congress but, sadly, a benefit for American families will most likely be used as a political cudgel as the writer has done in her guest opinion. I, for one, will be a strong advocate for American families, and work to have the entire family outlay for premiums be calculated in the percentage of income calculation. We can fix this.
Let us never forget that for-profit insurance companies serve shareholders not patients. If an insurance company can find a way not to pay your medical bills, it will. That’s how profits are made. Obamacare imposes much-needed consumer protections on the health insurance industry.
Theresa BrownGold, New Britain, is a documentary portrait painter who uses art to examine the impact of social issues on real people. She speaks about the health care law and her art project, Art As Social Inquiry, at conferences, churches, senior centers and other venues. www.artassocialinquiry.org
© 2013 phillyburbs.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Here is the flier for Art As Social Inquiry 2013 events.
Directions & Gallery Hours.
I just listened to 5 minutes of Paul Ryan’s speech posted by Kaiser Health News — the one you’ve been hearing about where he got booed at an AARP convention in New Orleans.
I’m wondering why he is using the language of the “other side?”
Notice how Paul Ryan is throwing around the word “subsidy” – a word from Obamacare — when he is really referring to the “voucher” or “premium support” in his own plan to change Medicare?
I’m guessing his goal is to sound reasonable. Is this kind of manipulation designed to make you “feel good” about the guy? And if you feel good, you will want to believe his message and vote for him?
Paul Ryan’s ideas regarding Medicare(and Medicaid for that matter) are anything but reasonable. They are draconian.
SO WHY IS PAUL RYAN NOW USING THE WORD “SUBSIDY” when he talks about the changes he would like to make to Medicare?
The Ryan plan would change Medicare into a voucher program, or as Ryan is now calling it a “subsidy” program (NOT to be confused with the healthcare law.) Here’s how ABC News describes “voucher.”
If implemented (the Ryan plan), the government would no longer pay doctors to treat Medicare beneficiaries. Instead, beneficiaries would buy their own private insurance plans, and the government would give people money to pay to buy health plans from an approved list.
In his speech, Ryan calls his vouchers “SUBSIDIES.” Is Ryan trying to confuse people? “Voucher??? Who me…naaaaaah….it’s a ‘subsidy’….get it?” And the difference is????
Let’s sort out the mess.
Subsidies are a part of the healthcare law and are for people who are NOT on Medicare.
In traditional Medicare like we have today, you are eligible for the program just because you turn 65. You sign up. You are NOT given a subsidy/voucher when you enroll.
Medicare as we know it today does NOT send seniors into the private insurance market to buy what they can with the subsidy/voucher they have. The Ryan plan does.
The Ryan plan would also change the eligibility age for Medicare to 67.
Obamacare provides subsidies. Traditional Medicare does NOT.
Ryan uses the language of Obamacare when he calls his voucher a “subsidy.” This tells me that the new healthcare law must be gaining ground in people’s minds. Ryan wants to draft off of the growing popularity of Obamacare by using a word associated with the healthcare law he has worked to undermine.
A subsidy is very simply, financial assistance. Subsidies in the healthcare law are for lower income workers between the ages of 19-64 (NOT Medicare) who do not get insurance through jobs. The individual pays his share of the premium and gets help for the rest. Otherwise these workers would not have access to health insurance. And their medical debt gets cost-shifted to those paying the premiums. Kaiser Health News has a subsidy calculator.
Many middleclass Americans are uninsured or under-insured. This social disaster wreaks havoc in so many lives. We are the only first-world country where a citizen can go bankrupt from medical debt
All politicians use wordplay to win audiences. The point? Know the facts. Make up your own mind.
Many have asked for my “green drink” recipe over the years. I have probably mixed up my morning energy booster on and off for maybe 25 years? I don’t know? It’s been so long. The white plastic on my amped-up blender, VitaMix, has yellowed. And the once clear plastic pitcher has turned the color of smoky quartz.
The green drink has been much more on than off for the last ten years. I ward off the aches of middle age with a pitcher full of the elixir every day.
The recipe can change daily depending on what I have on hand. I like to go organic for the fruits and veggies whose skins I eat. When I peel the skin, I usually don’t buy organic – budget issue. (This just makes good sense to me.)
RULE OF THUMB: More fruit, less green to acclimate. Less fruit, more green as you learn how to make it good.
I recommend you start easy and maybe go with spinach, parsley and celery and lots of fruit. Move to kale and other hearty greens as your body starts to crave the goodness of green.
The machine is important. Any ol’ blender will not due. You need a super-duper pulverizer. I like the VitaMix, as I said. In over two decades I had only one thing go wrong. Somehow the “spinner thing” that turns the blade in the blender stopped working. Engine still hummed along fine. VitaMix sent me a $17 part and all has been well for years. The reconditioned models are fine.
Here’s what I put in my green drink this morning. When you start to make green drink on a regular basis, you’ll make it up as you go.
Parsley A LOT. At least a cup packed tightly
2 stalks of celery
Handful of raw spinach
1 small fresh tomato (Or add canned tomato juice. Or leave this out altogether.)
1 frozen banana (ripen a bunch of them, peel and freeze)
1 peeled lemon (or peeled grapefruit. Loving this these days)
Chunk of peeled fresh ginger, about 1″ thick (leave out if you don’t like the taste)
fill pitcher 1/2 way with water (with all the stuff in it)
Blend it with a Vitamix if possible. Really make it smooth. If taste is too “hardcore” add more fruit, less greens.
This recipe makes a lot. I drink it all day. Cut down on quantities if you want to make a glass or two.
The important thing is to experiment. Start googling juicing recipes. Some of my family members have become juicing aficionados and make all different kinds of drinks. You can get inspired from info on the internet.
Freezing banana is a new kick I’m into. If you don’t have frozen banana, just put in a regular banana and add a handful of ice cubes.
Sometimes I get bags of frozen fruit just to have on hand to throw in if I don’t have a lot of fresh fruit around.
You need something frozen. So if you are not using frozen fruit, be sure to add ice cubes.
If you are really starting feel good, consider adding simple exercise to your routine like a walk every day. And, if you don’t meditate, consider contemplating the beauty of the simplest thing in life just for 60 seconds a day – the way your child smiles at you; how many shades of green are in a field. Just get out of your thinking head for a brief time every day.
Your body will smile and thank you.
Hope you can join us at one of the four stops in Bucks County, PA to see the art and get straight talk about Medicare. Also enter a rally to win a portait/oil sketch by me. See you there, Theresa
Obamacare levies a 3.8% real estate tax????????
FALSE!!!!!!!!!!!! PANTS ON FIRE FALSE!!!!!!!!!! EARNING A PLACE IN HELL FALSE!!!!!
CUT YOUR TONGUE OUT, MAY YOU BURN IN HELL FALSE!!!!!!
This outright lie is so irresponsible it is akin to yelling FIRE! in a crowded theater.
Firstly, the tax exemption on the sale of your house that was in place before Obamacare STAYS THE SAME. There is a longstanding tax exemption on the sale of your primary residence. $500,000 for couples; $250,000 for single
Obamacare does NOT touch this tax exemption for the sale of your primary residence.
What does it all mean?????
Let’s say you’re married (filing taxes with your spouse) and you bought your house for $100,000. You are allowed $500,000 in PROFIT when you sell your house before any taxes kick in. That means you’d have to sell your $100,000 house for at least $600,000!!!!!! (OMG, I need a benefactor for this art project. Talk to me.)
“The surtax does not interfere with the current tax-free exclusion on the first $500,000 (joint filers) or $250,000 (single filers) of gain you make on the sale of your principal home.” (bankrate.com)
Obamacare doesn’t change any of that. So what does change? The LA Times does a good job explaining a change in a capital gains tax that will affect VERY FEW Americans. Let’s look deeper.
OBAMACARE IN REAL LIFE:
Okay, so let’s say you and your spouse sell your $100,000 house for $625,000. (Good on you!) You earn $525,000 in PROFIT — that’s pure P-R-O-F-I-T. Got that?
So the first $500,000 in PROFIT is not taxed ($250,000 for single). NADA, NOTHING, NO TAX! TAKE A TRIP TO EUROPE! as per the longstanding exemption for profit on the sale of your home.
Now you have $25,000 additional profit over the $500,000 tax exempt profit for you and your spouse.
Are you taxed 3.8% on the $25,000??? Well, probably not.
Let’s say that you and your spouse’s combined income is $175,000. (I’ll take it!) But this year you have to add the $25,000 profit from the sale of your house that is over the $500,000 profit exemption. That brings your income to $200,000.
You and your spouse still do NOT qualify for the 3.8% tax. You would have to make over $250,000 as a couple.
So let’s look at an example of a couple earning over $250,000/year.
Okay, you and your spouse make $240,000/year when you combine your incomes. But this year you have to add the $25,000 profit from the sale of your house that is over the $500,000 PROFIT exemption.
That brings your income to $265,00/year. Remember, no matter how much money you and your spouse earn, Obamacare exempts everything under $250,000 for a couple.
But what about the $15,000 over $250,000 that you made this year? Yes, you would pay an additional $570 on the $15,000 over $250,000 in earnings. That is five hundred and seventy dollars.
You and your spouse sold your $100,000 house for $625,000.
You earned $525,000 PROFIT on the sale of the primary residence.
$500,000 of profit is EXEMPT from tax as per the longstanding IRS exemption.
You add the $25,000 that is not exempt to your total income for the year.
Total income below $250,000 for a couple NO ADDITIONAL TAXES
$15,000 over $250,000 income, you pay $570.
So you have earned $265,000/year; you pocketed $500,000 from the sale of your house tax-free; and you paid additional $570 in taxes.
What’s the problem here?
I commented on a July 12, 2012 blog post on the site, THE INCIDENTAL ECONOMIST . (I capitalize because I have a blog crush on them.)
The blog is called ”Grateful for Health Insurance” by Austin Frakt. Several bloggers contribute to The Incidental Economist.
A lot of the posts at The Incidental Economist crunch numbers and wax poetic over graphs, which, frankly, make my eyes glaze over. (I was absent for graph reading or maybe just daydreaming. Yes yes, I can force myself to read them but I choose not to. I did get and love algebra, however.)
But I’m really hooked on their explanations and the vast mind power they bring to the subject of healthcare.
In his post Mr. Frakt diverges a bit and writes about the human side of healthcare especially in Massachusetts. Here is my response.
Photo Courtesy of NPR
Massachusetts has had the courage to create a system of personal responsibility coupled with reasonable measures for hard-working people to get medical insurance. And now they are tackling medical costs (as I understand from my reading).
I encountered the Massachusetts healthcare system through a woman whose portrait I wanted to paint.
I tried to get an interview with this woman from Massachusetts for my art project, a series of portrait stories on healthcare. She lost her high-paying job and eventually her insurance. She told me she “hated” living in that liberal state. She didn’t support Obamacare.
Then she came down with cancer as an uninsured person in Massachusetts. I asked her how she got care. She told me she could get treatment because the state made provisions for someone at her income level (now very very low).
I asked her why she took the treatment when the state’s move to universal healthcare was very against her politics.
She really was shaken. She started telling me, “Well, her sister wanted…etc.” I said “But you chose to save your own life in a state that has a system that enabled you to access care?”
I told her that her story embodies the entire debate over Obamacare. I SO wanted to paint her portrait to have her story be part of my art project. I told her that I would even paint her from behind, anonymously. I would tell her story just as SHE wished to be understood. But, alas, she declined.
This woman’s story IS the whole point of Obamacare. Until it happens to us personally, the crisis of trying to access healthcare isn’t real.
July 9, 2012 Letter to the Editor in The Intelligencer newspaper (Pennsylvania).
“Health Law Opponents Ready to Party” was a headline today in Politico. The country awaits the US Supreme Court’s decision regarding the constitutionality of some or all of the Affordable Care Act also know as Obamacare. Here is my response:
Not so fast. It ain’t over until the 9 Justices, fully insured by a federal employee insurance program or that socialized insurance program called Medicare, decide that a gov’t levying taxes is unconstitutional. The healthcare bill called the tax a “mandate.” Gov’t has unequivocal authority to levy tax. The Court’s work is not to judge semantics. That’s Grammar Girl’s job.
If the far Right gets the ruling it desires, it would be helpful for those of us who are so intimate with the struggles of the uninsured, the under-insured, the bankrupt, the ruined lives…
...the populace that lives in fear of losing insurance because a child may need it so desperately, the small employers who stop offering insurance altogether…
…the 60 year old woman who married her friend for his benefits so she could piggyback on his insurance and get treatment for cancer…
...it would be helpful for those of us so intimate with the machinations of a for-profit industry that calls paying actual claims a “medical loss,” that will not extend coverage to individuals with pre-existing conditions looking for insurance on the individual market…
…that engages in delay tactics to put their financial interests ahead of the clients’ claims, that lowball claims making the insured chase the money so medical bills can get paid….
...it would be helpful to us if the Right explains what exactly was accomplished by a $235 million smear campaign to make people afraid of a law they don’t even know.
Confuse, conquer and win politically was what the American people got. A person unable to see a doctor regularly for a chronic condition has nothing to do with politics.
The intention behind the massive campaign to distort the law was to create fear in the minds of Americans and influence them politically, and have them be against something in their best interests. It worked.
You can’t be against Obamacare when you don’t even know the law. Put another way, you have to know something to be against it.
Many of us do know the law and applaud the consumer protections and measures that will bring stability to the insurance market and create access for the many millions shut out of insurance coverage.
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- Punk Rock Singer / Sports Coach at Private School
From time to time I will post a picture of a portrait and share what I have learned. I must often research what my subjects tell me because I don’t understand their predicaments. I painted this portrait of a punk rock singer/sports coach in 2010. Two years later, I look back and reflect. (There’s a nifty tool from Kaiser Health Foundation, an online calculator, to help you determine if your income qualifies you for a subsidy to help you pay for insurance if you work but can’t afford insurance. I’m jumping ahead but nevertheless…)
I was drawn to this story because I wondered how is it that we positioned ourselves as a society where a young musician who supports herself by coaching sports teams at an expensive private school does not have the means to get or access to health insurance? How is this possible in a first-world country? Is she doing something “wrong?”
I had already been painting stories for over a year at this point. I interviewed this subject just a couple of months after the Affordable Care Act a.k.a. Obamacare was passed. I didn’t understand what the law would mean. My focus had been on just telling the stories of real people – not really knowing where it would lead but sensing that we had really better start telling the truth because Americans were suffering.
In fact, after Obamacare passed I thought I would wind down the project. I thought the nation had taken a first big step toward addressing the problem of lack of access to medical care for many millions.
But the vociferous opposition to Obamacare compelled me to research the law fully. Two years later I have come to understand what the law would do for this woman.
This subject is an individual who does not get insurance through her job. She is considered a part-time employee. She would shop for insurance on the new online marketplace in her state in 2014. This marketplace houses many different private companies selling all types of policies. For companies to sell in this new marketplace, they must agree to certain rules like they can’t exclude people with pre-existing conditions. But PRIVATE companies are selling the insurance, NOT the government.
A subsidy is a way for a person to take responsibility for her healthcare and purchase health insurance. This subject would never pay more than 2% – 9.5% of her income for her insurance premiums on the online insurance marketplaces depending on how much she earns. Her income puts her in the range of wages that qualify her for subsidies, a form of financial aid. If she made about $25,000/year she’d pay about $144/month. Here is an online calculator to figure out if you qualify for a subsidy to help you pay for health insurance.
Why do we want this? When people don’t have insurance it’s usually because they can’t afford it. They put off primary care and treatments that could stave off larger more expensive illnesses to treat. They might end up in emergency rooms, get whopping bills they can never pay. They then have medical debt that can bankrupt them. Doctors and hospitals aren’t getting paid for services rendered. Uncompensated care ends up in higher premiums for people and employers who do pay. When people don’t have insurance, it’s bad for everybody.
The subsidies are for people who are NOT getting insurance through a job and whose wages qualify them. The uninsured pay their share, get a subsidy and now have insurance when they need to access care. The marketplaces and subsidies do not start until 2014
Here is the original story for the portrait:
Punk Rock Singer, Part-Time Sports Coach (basketball, soccer, softball) for Girls’ Teams at a Private School in a Large City, Age 28, Uninsured: Subject has no health problems but realizes she’s getting older and her body is changing.
She has gone to a dental school for dental care. Subject does not get regular check-ups but has made a commitment to gynecological care through a non-profit organization.
Subject is waiting to earn enough money to be able to consistently pay monthly health insurance premiums. (Interview May 2010) (oil on canvas 40 x 30 in.)