The Americans dying because they can't afford medical care | Hacker News Reader

The Americans dying because they can't afford medical care

theguardian.com

35 pointselorant9 comments

I don't fully understand why the anecdote at the beginning of the story happened. Colorado is one of the states that expanded Medicaid. Why did the person in question not get on Medicaid during the window after she lost her job at Walmart? Did she not know about it? Do I not have a correct understanding of how the ACA and Medicaid work?

Is this type of thing common knowledge? Laws and benefits change all the time. It's entirely possible she didn't know.

Also, the way it works is on annual income. If she had already earned greater then 138% of poverty level that year, she wouldn't have been eligible.

If she was less then 400% on the year and greater then 138%, she would be eligible for an exchange plan that is subsidized, but she would've been on hook for the some or all of the subsidies when paying taxes if she ended up getting a new job.

It also depends on the kind of insurance she lost. If it was a non-exchange individual plan, she wasn't even eligible for the subsidized exchange plan.

Source: https://www.healthinsurancecolorado.net/lost-job-apply-for-m...

What you've described is already too complicated, and serves as a barrier to entry. Kind of like purging voters and making people check every month to make sure they're still a "real voter".

This is one of many reasons why we need automatic voter registration, and single-payer healthcare.

For reference, 138% of the FPL in 2016 was $16,394. She was laid off in May (let's she got one pay check), meaning that if she was making $44,000 or more, she would not be eligible. After 10 years on the job, it seems likely that she would be making that much.

> Also, the way it works is on annual income

No, it's not, while annual figures are often cited, most things about Medicaid are on a monthly basis:

https://www.healthfirstcolorado.com/apply-now/?tab=do-i-qual...

If I had to guess, administrative burden:

https://www.russellsage.org/publications/administrative-burd...

This is why auto enrollment is so important.

You're absolutely right. We shouldn't expect people who are already under the stress of losing work and finding new work to also go through arduous application processes for healthcare. But I still want to understand whether the ACA at least covers this case so that theoretically, if she had applied, things would be OK, or if there is a more serious gap here that even a knowledgeable person would not have been able to get medical care.

Others have mentioned administrative burden and confusion about eligibility, both of which are huge problems. I'll touch on a few others.

Even if you're eligible and you apply, there's no guarantee that your application will get processed or approved. There have been people on the exchanges whose income fell below a certain threshold, so they lost their subsidies, but then didn't have their Medicaid application approved. So they ended up paying more money because their income went down (in an area without the ACA donut hole).

There's also processing time for the application. At least in some states I believe they'll reimburse you if you get approved, but what happens if you don't? Or, perhaps more pertinent to this situation, what happens if you get your new job while you're application is in progress and then have to cancel the application before it's approved?

Keep in mind the article makes it sound like she was actively looking for a job. If you think you can get a new job in a few weeks you probably wouldn't want to get involved in the administrative mess for benefits you wouldn't actually receive.

The ACA has a lot of sharp edges that most people aren't aware of until they run into them. Look up the family glitch and Medicaid churning for a couple of other examples. It's a good example of why universal programs are far superior to means tested programs. Means tested programs often turn into Rube Goldberg messes when they try to cover all the edge cases.

>and confusion about eligibility

My states health insurance is so ridiculously ambiguous. I mean there is no simple chart that says: Do you fall under this category or this category, etc. etc.? They make you fill out like 15 pages of stuff to just SEE if you qualify. It's not even an official application either. And at the end, it just says "you may be eligible."

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