Of late I've noticed there is some confusion some folks have about the ACA, specifically over affordability of plans for the working poor.
For instance, there's a diary on the rec list right now that tells the story of a lady named Opal who has encountered a great deal of hardship because she chose a very high deductible bronze plan on the ACA exchange. The plan had a $5,000 deductible that also applied to prescription drugs, as a result Opal couldn't afford the $500 for her medication, she got ill, and now she's in terrible straits.
But, at least according to the facts the diarist gave about the matter, this was all completely avoidable. The diarist says that Opal and her husband had income that was just high enough to qualify for premium assistance under the ACA. Thus, I'm assuming their income was just above 133% of FPL, which for a household of two is above $20,868.
The diarist says that Opal and her husband ended up choosing a high deductible bronze plan, which cost pennies a month, because a better plan would've cost $100 a month or more, which they couldn't afford. Others in the comment section chimed in about how terrible the ACA was that it doesn't provide more affordable plans, that people of that income level can't afford $100 a month. And it is true, for a couple making $20,000 combined, $100 a month is a very tall order.
But the thing is, there were better plans available that cost significantly less than $100 a month under the ACA. If folks had done just a little bit of research on the matter, they could've found out that under the ACA there are plans available for low income people, specifically those making between 133%-250% of FPL, called "enhanced silver" plans which are designed to specifically have low copays, low or no deductibles, and low premiums.
Such plans vary from state to state, but here's a chart of such plans here in California, with average copay amounts, deductibles, and premium amounts:
So as you can see, the lower your income is, the less you have to pay. For example, if your income falls between $15,856 and $17,325 in California, which definitely would fall under the definition of "working poor", you only pay between $19-57 a month in premiums. Your copays for visiting a primary physician is $3. For generic drugs, $3. For brand names, $5. And there's no deductible.
The chart above applies to individuals, so here's a chart that shows what the income levels are based on household size:
In addition to that, what the Covered California chart I've posted above doesn't show and which the following more general ACA chart does show, these enhanced Silver plans also cover much more in the way of major medical expenses:
Thus, if you have a Silver plan, and your income is between 138-150% of FPL, your Silver plan would cover 94% of major medical expenses rather than the 70% coverage you'd get under a basic Silver plan; if you're between 151-200% of FPL, your Silver plan would cover 87%; and if you're between 201-250% of FPL, your Silver plan would cover 73%.
And this isn't just in California – these enhanced silver plans are available everywhere, even Texas. The exact copays and deductibles may be different, but percentages of major medical expenses covered – 94%, 87%, and 73% that I've listed above – apply everywhere.
Now, circling back to Opal in Texas. As I've said, the copays and deductibles in Texas for enhanced silver plans are different from California. However, just based on the information provided about Opal in the diary, and assuming Opal is middle aged, so that I err on the high side of what her premiums might be, here's what I found on Healthcare.gov for Tarrant County:
In other words, there is an enhanced silver plan that has a $500 individual deductible, no drug deductible, has no charge for generic prescription drugs, would cover 94% of major expenses, for just $21 dollars a month, not $100.
Again, assuming the diarist was accurately stating Opal's information, she could've gotten a significantly better plan than the one she got for just a little bit more money a month.
But either Opal and her husband erred in not finding this plan or their navigator screwed up by not telling them about it. So assuming the information the diarist gave is accurate, it's clear that a much better option was available to Opal and her husband.
Look, I realize the law is complicated. In helping folks get educated about Covered California these last five months, my belief that single payer is the way to go has only solidified. It's because I've seen first-hand just how perplexing the health insurance system in America is.
However, I strongly urge that before you begin railing against the ACA's inadequacies, please get adequately informed about it first. Especially when, for all its flaws, the ACA is providing help to so many people. I know because I've seen it myself, repeated dozens and dozens of times over the last five months. Because of the ACA my uncle can get treated for his diabetes and thyroid problems and my mom has coverage through MediCal in case God forbid she gets cancer or some other terrible illness.
Yes, single payer is the ideal. Virtually everyone I worked with in educating and signing up people for Covered California are single payer supporters. But they also know that it will not happen overnight, that we cannot just do nothing until we get single payer, that in the meantime we need to do what we can to help people.
The ACA most definitely needs to be perfected. Criticism and suggestions for improvement are vital to this end. But let's ensure that criticisms are based on accurate information about the law. The ACA has enough trouble with all the misinformation out there about it, let's not contribute to that. It not only causes people to misguidedly oppose the law, it also can also result in people like Opal not getting the help that they could've gotten under the ACA if they'd had the right information.