Posts Tagged ‘Obamacare’

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How could you design a fundamentally unhealthy healthcare system? On one hand, have healthcare and health insurance provided by private, for-profit companies; on the other hand, make sure the rest of the private economy keeps workers’ wages and salaries from increasing.

The result of such a system would be that healthcare costs and insurance premiums continue to increase and workers can’t pay their medical bills.

And, of course, as a new study by the Kaiser Family Foundation and the New York Times confirms, that’s exactly what has happened in the U.S. healthcare system.

Overall, about a quarter (26 percent) of U.S. adults ages 18-64 say they or someone in their household had problems paying or were unable to pay medical bills in the past 12 months.

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Not surprisingly, problems paying medical bills are more common among people with lower or moderate incomes, with high deductibles, and with some kind of disability.

Insurance status also has a strong association with medical bill difficulties, with over half (53 percent) of the uninsured saying they had problems paying household medical bills in the past year. However, as previous surveys have shown, insurance is not a panacea against these problems. Roughly one in five of those with health insurance through an employer (19 percent), Medicaid (18 percent), or purchased on their own (22 percent) also report problems paying medical bills. In fact, overall among all people with household medical bill problems, more than six in ten (62 percent) say the person who incurred the bills was covered by health insurance, while a third (34 percent) say that person was uninsured.

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In fact, many of those with medical bill problems report struggling with bills less than $5000, including 24 percent of the insured and 22 percent of the uninsured who say their bills amounted to less than $1,000. While these lower amounts may seem small, even a bill of $500 or less can present a major problem for someone who is living paycheck to paycheck. In fact, when asked to describe their financial situation, about six in ten (61 percent) of those who’ve had problems paying medical bills say they either just meet their basic expenses (43 percent) or don’t have enough to meet basic expenses (18 percent).

The survey also shows that medical bill problems can have real and lasting impacts on individuals and families in terms of their standard of living, their financial stability, and their ability to access needed health care. While insurance provides some protection against incurring medical bill problems in the first place, once these problems occur, the effects on individuals and families are often as serious for the insured as they are for the uninsured.

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The problem of affordability stems from the combination of rapidly rising healthcare and insurance costs and slowly rising incomes, both of them a product of the way our economy is currently organized.

Clearly, we need a much better prescription for our unhealthy healthcare system.

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Elections, of course, have consequences. In the case of Kentucky, Republican Governor-elect Matt Bevin has threatened to dismantle Kynect (the Kentucky version of the Affordable Care Act) and to create a Right to Work state.

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Just so we understand what stands to be lost as a result of this election, Kentucky led the nation in the largest drop in the percentage of residents without health insurance from 2013 to 2014.

The percentage of uninsured Kentuckians dropped to 8.5 percent in 2014 from 14.3 percent in 2013. The drop of 5.8 percentage points was double the national decrease of 2.9 percent. The report says 366,000 Kentuckians were uninsured in 2014, down 250,000 from 616,000 in 2013.

The vast majority of the newly insured enrolled in the expanded Medicaid program, which covers previously ineligible individuals whose income is up to 138 percent of the federal poverty level.

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In addition, Kentucky (pdf) had 189,000 union members in 2014. (In addition to these members, another 30,000 wage and salary workers in Kentucky were represented by a union on their main job or covered by an employee association or contract while not union members themselves.) Thus, union members accounted for 11.0 percent of wage and salary workers in Kentucky, just under the national average of 11.1 percent.

According to the secretary of state’s office, election turnout in Kentucky was only 30.7 percent. Bevin (with 52 percent of the vote) defeated Democrat Jack Conway (who received 43 percent) to become only the second Republican governor in the state in four decades. Bevin’s election gives Republicans control of the executive branch along with a commanding majority in the state Senate. Democrats still have an eight-seat majority in the state House of Representatives.

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The New York Times has mapped the percentage of the U.S. population that still, two years into Obamacare, remains without health insurance.

The remaining uninsured are primarily in the South and the Southwest. They tend to be poor. They tend to live in Republican-leaning states. The rates of people without insurance in the Northeast and the upper Midwest have fallen into the single digits since the Affordable Care Act’s main provisions kicked in. But in many parts of the country, obtaining health insurance is still a problem for many Americans.

Here, for comparison, are some additional maps—starting with slave and free states in 1860, rates of poverty in 2011, and red and blue states in 2014:

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