Art by Jimmy Ernst, from WikiPaintings.
Today's Obamacare victim is Betsy Tadder, 52, of Rockton, Illinois, an over-the-border suburb of Janesville, Wisconsin who told Fox News that her current health insurance plan is being canceled as of December 13:
A little digging shows that Tadder, 52, works as an assistant in a little husband-and-wife cosmetic dentistry practice, in a job she's held for 29 years. It's not surprising, alas, that they don't give her adequate benefits, it's even possible that they really can't afford to. It's very surprising that she needs to buy a family policy since her husband Robert, 54, works as an assembler for Lowes in Janesville, an employer that offers offer a truly excellent health plan—why aren't they using it?
They also have a son Alex, 24, listed as "production director" for a campus radio station in Marquette, Michigan, which sounds like he's some kind of graduate student making just next to no money at all. Good luck, Alex! I've been there (though I never got paid for the radio work, I had a poverty-level assistantship). He probably doesn't have to spend a penny on medical care (maybe Betsy's boss gives him a break on taking care of his teeth), but he's going to be happy that his mom's new policy can cover him for the next two years, thanks to that provision of the Affordable Care Act, just in case something does go wrong.
If the couple really don't qualify for a subsidy, then they must be taking home close to $80,000 a year, which makes it a little hard for me to feel super-sorry for them, but the numbers she gives are just about right: I find at the Kaiser Family Foundation that they'll be paying around $890 a month for that cheapest Bronze plan, and $1075 for a Silver. She's mistaken, however, in saying that the plan has a $12,700 deductible.
In fact, it doesn't have a deductible at all. The $12,700 is an out-of-pocket maximum. The way the policy works is, the policyholders get their free stuff—exams and preventive and wellness care—for free, and copays for the regular pcp and specialist visits and medications, and pay 30% of everything else up to that maximum, after which the insurance company covers 100%. That is, after you have paid the $12,700 and the insurance company has paid $29,633.33. At which point you'd be in bad shape, no doubt, but a lot better off than you'd have been without the policy. And the price has nothing to do with covering pediatric dentistry.
If there was a plan with outrageously high deductible of $12,700, it wouldn't give you a penny until you'd shelled out that much. That's the kind of plan Obamacare has made illegal, causing all those cancellations you've been hearing about. That's, frankly, the kind of plan she's been getting for herself and her husband for $454 a month, another piece-of-shit policy that the company can no longer offer.
Why were they not on Robert's company plan in the first place? My guess is it's a classic case of penny-wisdom and pound-idiocy; the Lowe's policy presumably takes a big bite out of your paycheck to make you contribute somewhere around 25% of your policy (which could certainly be north of $500 per month, but how much?); the Taggers decided that rather than pay that union-dictated money they would forego the 75% paid by the company. Lowe's HR wouldn't let Robert do that unless he was covered in some other way, so Betsy has been paying for junk insurance, essentially throwing her money away to save a few bucks up front and perhaps make some dumb libertarian point, like "I'll go bankrupt if I fucking want to, nyah nyah nyah."
Legally speaking, the discussion is academic. She seems to have been lying, saying employer coverage isn't available when it is. They should be on Robert's plan, period: as Kaiser tells me,
So, cry me a river, sweetheart. You were nothing but a problem for the rest of us, who would have ended up footing the bill if you really did get sick. That's the kind of free-riderism the ACA is intended to fix. You've been doing pretty well, up to now, thanks to the organizing and struggle of the workers who made that Lowe's job as remunerative as it is; it won't hurt you to start paying your share like everybody else. And if you don't like the attention stay away from Fox.
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| See, See Rider, 1946. |
Right now, she pays $454 a month for health insurance, and the cheapest plan being offered as a replacement costs $871, she said. Tadder explained that the new plan includes benefits she doesn't need, like pediatric dentistry and maternity coverage.
Essentially, the government is telling her that her current plan is not good enough. [jump]
>After a week of trying, she was able to sign on to healthcare.gov and look at those options.
"I could stretch my budget to afford a policy, but the deductible is $12,700 dollars. I don't have $12,700 dollars to pay for a deductible on ObamaCare," said Tadder.
She explained that she's caught in the middle, making too much to be eligible for a "break" and too little to afford the new premiums.
"Do I insure one member of my family? Do I insure two members? Can I afford to do two members or none of us? I have a feeling that at the end of this year, we will be without health insurance," she said.
A little digging shows that Tadder, 52, works as an assistant in a little husband-and-wife cosmetic dentistry practice, in a job she's held for 29 years. It's not surprising, alas, that they don't give her adequate benefits, it's even possible that they really can't afford to. It's very surprising that she needs to buy a family policy since her husband Robert, 54, works as an assembler for Lowes in Janesville, an employer that offers offer a truly excellent health plan—why aren't they using it?
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| Mona Lisa in Water, 1974. |
In fact, it doesn't have a deductible at all. The $12,700 is an out-of-pocket maximum. The way the policy works is, the policyholders get their free stuff—exams and preventive and wellness care—for free, and copays for the regular pcp and specialist visits and medications, and pay 30% of everything else up to that maximum, after which the insurance company covers 100%. That is, after you have paid the $12,700 and the insurance company has paid $29,633.33. At which point you'd be in bad shape, no doubt, but a lot better off than you'd have been without the policy. And the price has nothing to do with covering pediatric dentistry.
If there was a plan with outrageously high deductible of $12,700, it wouldn't give you a penny until you'd shelled out that much. That's the kind of plan Obamacare has made illegal, causing all those cancellations you've been hearing about. That's, frankly, the kind of plan she's been getting for herself and her husband for $454 a month, another piece-of-shit policy that the company can no longer offer.
 |
| White Space, 1951. |
Legally speaking, the discussion is academic. She seems to have been lying, saying employer coverage isn't available when it is. They should be on Robert's plan, period: as Kaiser tells me,
In general, employees who are offered insurance through work are not eligible for subsidized exchange coverage, so long as their insurance meets specified requirements. You would only be eligible for subsidized exchange coverage if your income is between 1 and 4 times the federal poverty level and you would have to pay more than 9.5% of your household income for your own coverage through the insurance offered by your employer.
So, cry me a river, sweetheart. You were nothing but a problem for the rest of us, who would have ended up footing the bill if you really did get sick. That's the kind of free-riderism the ACA is intended to fix. You've been doing pretty well, up to now, thanks to the organizing and struggle of the workers who made that Lowe's job as remunerative as it is; it won't hurt you to start paying your share like everybody else. And if you don't like the attention stay away from Fox.
