Redefining affordable

By Pippa Abston, M.D.
Pippa Abston’s blog, Feb. 2, 2013

In a move that goes beyond redefining the word “is,” the IRS has released its final rule on what will be considered “affordable” premiums for families. Although you will not be on the hook for a tax penalty if the premiums for your entire family exceed 8 percent of your income, an increasingly common problem, you will not be eligible to purchase a subsidized plan on the coming Exchanges as long as your individual premium for your employer plan is 9.5 percent or less of your household income.

Do you see where this is going? Let’s say your employer really doesn’t want to pay the wrist-slap penalty for failing to provide you with an “affordable” insurance option. So she finds a policy that costs exactly 9.5 percent of your total household income, which includes your spouse’s two part-time jobs. You have two children, and your spouse’s jobs don’t include benefits because they are part-time. Could a policy covering all four of you cost 38 percent of your income?

I used to have an option for individual or family coverage through my employer, but now there are premiums based on number of persons in my family. Even those of us with decent incomes are going to be hard-pressed to come up with that money, and remember — this is only the premium. It does not include the “cost-sharing” of co-pays, deductibles, and non-covered services.

For low-paying jobs, where it would be hard to find a policy that meets the criteria of essential health benefits for 9.5 percent of salary, look to insurers and the feds to get really creative finding loopholes. Less of your body might be essential than you now imagine. There are already waivers for so-called “mini-med” insurances until 2014. Do you really believe the waivers will disappear on schedule? I’m not holding my breath. Some sort of redefinition is probably already in the works.

If a state refuses to participate in the Medicaid expansion, your children might still be covered if you are under the poverty line. Children in families up to 300 percent of poverty are generally eligible for the SCHIP programs (ALLKids in Alabama). But what about you and your spouse? Oh, well, the IRS says. You don’t have to buy insurance — we won’t penalize you. You can “keep the coverage you have,” even if it is no coverage.

Can you hear me now? As long as private insurers are part of our health care system, our health is at risk. The insurers need to keep our care costs high, so they can rake in their allowed percentages, so there will be little effort to make serious improvements to health care that would keep us healthy at less cost — steps like eliminating subsidies for producers of toxic and obesity-promoting foods, getting corporate food out of the school lunch program, repairing the broken FDA, reducing our exposure to environmental poisons, or financing our public health system effectively.

Let’s get serious about health care reform — we need Medicare for All, now more than ever. Look at the estimates for taxpayer funding under this system, a pre-paid plan with no co-pays or deductibles. It’s affordable for ALL of us, no creative redefining needed. Medicare for All — everybody in, nobody out. Look for a chapter of PNHP (Physicians for a National Health Program), Healthcare-Now, or other single payer groups in your area, and find out what you can do to make it happen! If you are in North Alabama, we’ll be expecting you.

Pippa Abston M.D., Ph.D., F.A.A.P., is a general pediatrician who sees patients and teaches medical students and residents in Huntsville, Ala.

http://pippaabston.wordpress.com/2013/02/02/redefining-affordable-the-future-of-health-insurance-premiums-under-the-aca/