Friday, October 4, 2013

Medicaid subsidy gaps explained Bollywood-style

I need $2,273 by midnight on Dec. 31, 2013. If I can get it, I win $440.

This is a strange story involving health insurance, a COBRA, the Supreme Court, several hundred members of Congress, a guy with Hussein for a middle name and Texas Gov. Rick Perry’s hair. 

Fortunately for me, no matter what happens, it ends with my getting married to a lovely woman far above my caste—by which I mean she has a health-insurance plan – early in the spring of 2014. Until then though, I have quite an adventure lined up.

(*Cue Bollywood theme music and follow me below the fold*)

Here’s my story.  I graduated with a PhD. in Political Science from the University of Michigan in May. Since the lousy economy crashed the job market for aspiring professors, I found myself unemployed and my university health insurance (which I had thanks to these amazing people – pay your union dues folks) ran out in August. Currently, I’m on COBRA insurance and paying UM about $240 a month to continue my coverage.

Since I’m unemployed, I’m living off my meager savings and COBRA really takes a bite out of my budget. I’m not eligible to be covered by my fiance's employer until after we get married.
I made $9,217 in the winter semester at Michigan as a Graduate Student Instructor, teaching, of all things, a class on “U.S. Health Care Policy.”

Incidentally, that’s a really good wage for a grad assistant (remember these friendly folks? Yeah. If you don’t have a union, get yourself one.)

But if I don’t gain any income for the rest of the year, I technically qualify as “poor,” seeing as my income would be under $11,490 a year.  

Enter the Patient Protection and Affordable Care Act aka “Obamacare.”  According to the terms of the law, passed by several hundred members of Congress and signed by one Barrack Hussein Obama, anyone with a household income of under 138 percent of the poverty line qualifies for Medicaid when most of the provisions of the law kick in on Jan. 1, 2014.  All the states had to expand their Medicaid programs, with the help of generous federal subsidies. Households with incomes between 100 and 400 percent of the federal poverty line qualified for subsidies to help them buy insurance.
Problem solved, right? I can ditch COBRA, enroll in Medicaid for a few months, then join my spouses’ employer plan when we get hitched and combine households.

*Cue Ominous Gavel*

Hmm, that sounds like the Supreme Court. Oh, right – in the summer of 2012 the court ruled that ACA was in fact legal. However, it also ruled that it would be coercive for the federal government to force the states to take oodles of federal dollars and expand their Medicaid programs, which made the expansion optional. Apparently, the federal government has no right to coerce the states, especially under circumstances in which the states are coercing their own citizens (Incidentally, this doctrine was upheld when in Shelby County vs.Holder the court gutted a key part of the Voting Rights Act, which had reined in certain states who liked to prevent black people from voting.) 

Well, I now happen to live in Texas, where our esteemed Gov. Rick Perry took his magnificent hair on television after the court decision and announced that his state would not take the Medicaid expansion. In fact, to be really, really, clear he signed a bill from the legislature that made it illegal for any future governor to expand Medicaid without the legislature’s approval.

This turn of events opens up an interesting quandary for folks hovering around the poverty line. Anyone who is slightly above the poverty line is eligible to get generous subsidies on the exchanges.   But, if you’re slightly below the poverty line, you can’t get subsidies. You see, when all those Congress people made the Medicaid expansion mandatory, they figured that it would be redundant to make people below the poverty line eligible for subsidies.  When the Supreme Court blew a hole in the law, it gave a whole bunch of governors the ability to extend a gigantic middle finger to poor people in their states. Needless to say, 19 Republican-dominated states gleefully took advantage of this fact.

To get back to my premise, that’s why I need to earn more $2,273 in gross income by midnight on Dec. 31, 2013 – I have to scrape up enough to reach the poverty line for this year. If I can hit $11,490, I can ditch COBRA, sign up for the exchanges, get a reasonable silver plan for two months and pay 2 percent of my income – about $20 a month, until I marry a beautiful, intelligent woman with access to employer-sponsored health insurance.

(Brief time out here – I can estimate my 2014 income will be above the poverty line, which will likely be true, and qualify for subsidies. However, you can see the bigger point of my quandary here.)

If I can’t, I’m out $440, which is the difference between paying my COBRA and paying for a Silver Plan. Ouch.

(*Sad trombone*)

But I think I can scrape up enough part-time work to get there.

(*Cue traditional closing credits Bollywood dance number featuring John Roberts in judge robes dancing with a large COBRA*)

Now here’s the real “ouch.” I’ve been quite playful in this post, because my situation is temporary. Life isn’t much fun right now, but my employment prospects aren’t bad, even if I don’t end up in my chosen field. And my fiancee has a good job. We’ll be OK and we’re pretty darn lucky. We’ll have health insurance – likely even if Obamacare gets repealed. And even if things don’t work out for me temporarily I’d have to pay a couple hundred bucks – which I really can’t afford, but I can make it work to prevent a coverage gap. In the long run, that’s no big deal.

But there are literally millions of people sitting between their states’ current income caps for Medicaid and 100 percent of the poverty line. They don’t have my long-term prospects. Because of a quirk in the law opened up through a bad Supreme Court ruling and the mendacious cruelty of some state public officials they get banned from funds – in many cases adding up to thousands of dollars every year – to which their somewhat richer peers get access.

These people are our fellow citizens and our fellow human beings. 

Leaning on your state legislature, no matter how recalcitrant they may be, to accept the Medicaid expansion will save thousands of lives every year. This is the next phase of health reform – taking care of unfinished business in the ACA opened up by the court.

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