Surprise, High Health Deductibles Defer Treatment and Kill People!

New Orleans     Sometimes the gap in understanding the impact of wealth differentials, or what in the old school we called class differences, is so stark that it just blows the top of my head off.  An example today in The New York Times was so clear that it forces me back to beating a drum I was hitting all too recently about the impact of high deductibles for so called “skinny” health plans that were allowed by Congress and the Obama administration to qualify under the Affordable Care Act.

The headline was promising: “High Deductibles, Deferred Treatment.”  Ok, it was a “no, duh” thing, but sometimes there’s no harm in stating the obvious until people get the point.  Then reporter Reed Abelson provides this assertion about deductibles, writing, “High-deductible plans have become commonplace, a deterrent used by companies to lower health care costs by discouraging unnecessary tests or treatments.”  He doesn’t challenge that claim.  He offers it for all of us to swallow whole, hook-line-and sinker!  No, Reed, high-deductible plans are not a “deterrent” to “lower health costs.” Among other things they are a way being used by companies to force their lower waged workers to elect NOT to take the measly, but “qualified” health policy they offer their workers, so that they have NO insurance whatsoever saving the company 100% of the costs and allowing them to avoid 100% of the penalties.  Wakeup and look around at what is happening to lower income, service-based workers in nursing homes, home care, mental health facilities, janitorial, wait staff and other jobs, please!

The story tries to recover.  Since the reporter can’t fathom the millions of workers priced out of health coverage by their low wages and their companies’ draconian health plan, he does understand some random study since it has a Harvard connection and, lo and behold, finds that women with insurance deductibles of at least $1000 will delay or defer treatment.  I could provide the names of literally thousands of women working in nursing facilities under contract with our union that would jump at the chance to have health insurance with only a $1000 deductible.  Instead, the economics of the situation make it more financially attractive to pay the penalty for not having health insurance than to pay 9% of their gross wages and thousands of dollars in deductibles before they access any health benefits.  Need I mention once again that this is all about the company avoiding 100% of any health care costs for its hourly workers and not about “discouraging unnecessary tests and treatment.”

Abelson helpfully notes that half of all “covered” workers are enrolled in plans with a deductible “of at least $1000” and that 11% of covered workers have a deductible of $3000 or more.  The phrase “covered workers” is the critical one here.

The tragedy in the failure of our national health program and the loopholes it allowed employers is in the uncounted millions of workers and their families who are deliberately priced out of care.  Perhaps you can imagine the intended consequences for millions of working families who have deferred necessary tests and treatments because there are caught in the gap between not qualifying for Medicaid and their companies’ skinflint policies.  We could start with the hundreds of thousands of headstones in the nation’s cemeteries of men and women dead before their time of preventable causes.

Write that story in the New York Times!


Finally, the IRS is Enforcing Affordable Care Act!

New Orleans     How many times do we get to talk about good news and the IRS in the same sentence?  Darned few, and that’s not likely to change anytime soon.  But, having the IRS finally get off the dime and start enforcing the Affordable Care Act is fantastic news.  The bottom line is that they are making larger businesses step up and comply with the employer mandate to cover their workforce.  There are some other areas where they need to also toe the line, but we’ll get to that after we look at the business scofflaws.

The IRS piddled around with the employer mandate.  The Obama administration gave everyone a break for a year in 2015 because businesses were claiming they were just getting their arms around the law.  Then the IRS had to get their act together to figure out who was doing right and who was doing wrong, so the clock kept ticking longer until they mastered the equation in late 2017.   Now with one-third of 2018 ticking off the clock the IRS has sent out notices to more than 30,000 businesses with penalty letters for the 2015, and they are ginning up to get the penalty notices out for 2016 and 2017 tax years PDQ.

Remember the employer mandate meant that companies with more than 50 full-time workers had to be provided with health care or face fines of more than $2000 per worker.  Keep in mind that we’re talking about 1,500,000 workers at a minimum that should have been offered health care but weren’t.   Odds are that many of these companies thought they were getting away with it and are likely to face penalties for the subsequent years as well.  Now that they are being caught, these bum outfits are screaming like stuck pigs.

Should we feel even one iota of sympathy for any of them.  Heck no!  Especially since the Act did not put caps on the deductibles, so that many companies complied by offering these so-called “skinny” plans that met the minimum standards on paper, but whose $4000 to $6000 deductibles made the plans worthless and unaffordable to the individuals given the small amount they were making on their jobs.  The companies then qualified and escaped the penalties, the workers were barred from the shared costs in the marketplace, and there was often zero participation by workers costing the companies nothing at all.  With loopholes that large any company so heedless of either the law or its workers should absolutely pay the full weight of the penalty.   Let’s make sure they do.

Now if the IRS would also jump on the huge, tax exempt nonprofit hospitals that are cheap skating their charity care and enforce the requirements that they step up or lose their tax-exempt status as required by the Act, we would see some health care going to low income families that desperately need it.  Many of these families work for these same selfish companies, so it is time to square that circle.