Healthcare Coverage “Losers”

We recently posted a video of those we considered “healthcare coverage winners” due to the coverage they enjoy. Sadly, today’s video addresses the disappointing topic of those we feel belong in the “healthcare coverage losers” category. Please watch the video.

The most obvious category of healthcare coverage losers is the uninsured. We highly recommend planning so that you NEVER have a gap in coverage. The consequences of being uninsured can be devastating to your health and your finances. Many uninsured individuals will have difficulty even making medical appointments and those providers that will accept them may charge outrageous prices compared to what the practice normally receives from private insurers.

Another specific category of uninsured are those individuals in the 10 states that didn’t expand Medicaid. As a reminder, in states that did expand Medicaid, the only qualifier for Medicaid eligibility is that one’s income is at or below 138% of the Federal Poverty Line (FPL). The Affordable Care Act subsidies have been expanded to allow people with incomes between 100% and 138% of the FPL to qualify for premium assistance if they live in a state that did not expand Medicaid. To our dismay, if one lives in a state that did not expand Medicaid, income is below 100% of the FPL, and they do not qualify for Medicaid due to situations such as pregnancy or disability, they are often not eligible for any assistance with purchasing health insurance.

In our opinion those individuals who pay the full cost of their coverage but have very limited networks are also healthcare coverage losers. Remember the example of the couple in the recent video whose 2023 premiums will exceed $3,000/month? Many of these individuals are paying thousands of dollars for their coverage and yet their doctors are not in the Plan’s network so they are paying doctors out-of-pocket or changing doctors or a combination of both. In many states, the network of providers does not extend beyond one’s immediate geographic area which can be a hardship for families dealing with serious illness, especially in small or rural states.

Finally, another category of terribly disadvantaged individuals with respect to healthcare coverage are women of childbearing age in states with severe restrictions or bans on abortion. Some states have banned abortion even in cases of rape or incest. It is also unfortunate that in states where abortion is allowed due to the mother’s life being at risk such as cases of severe preeclampsia or an ectopic pregnancy, the medical environment has become terribly difficult for both patients and providers due to legal murkiness and hyperbole. We can’t help but believe there is much more room for common ground than the current environment provides.

It’s quite maddening that our “healthcare coverage losers” category is so varied. Those who can afford coverage but simply decide not to be covered are not very sympathetic characters. The other categories, however, those caught in a coverage gap because their state didn’t expand Medicaid, those paying dearly for coverage but with access to very limited provider networks and those who might have the best coverage Americans can enjoy but can’t access abortion services even in extreme situations without difficulty, range from very sympathetic to tragic.

We can do better America!

Please spread the word about our efforts to increase healthcare coverage literacy. A system that isn’t understood is unlikely to be improved except due to organizational self-interest or political motivations.

Please let us know your thoughts and interests! Thank you.