Couple profiled by New York Times represents archetypal case for bipartisan post Affordable Care Act reform
The worsening plight of a relatively small number of people under age 65 not covered by employee medical benefit or government sponsored plans may well set the course of a deepening debate over how best finance the medical care for working age Americans. These pre-Medicare eligible households aren’t poor by any means. They earn more than four times the federal poverty level. But that makes them ineligible for premium assistance and for some, out of pocket cost subsidies available for plans purchased on state health benefit exchanges.
That leaves them exposed to the relentless rise in medical care costs that are pushing up premiums, producing annual increases well into the double digits and monthly payments on a par with mortgage and rent payments. They may be self-employed or working for employers that don’t offer medical benefits such as a working couple profiled in this New York Times article. Of this cohort, especially hard hit are those aged 50 and older who pay higher premiums based on the higher actuarial risk of their utilizing high cost medical services.
They may feel resentment toward low income adults (like the one featured in the Times article) who qualify for Medicaid under the Patient Protection and Affordable Care Act’s reforms and who receive free care as they struggle to cover both monthly premiums and high out pocket costs. Previously, the two components had a distinct inverse relationship. High premiums meant low deductibles and vice versa. Not anymore. The financial stress on household budgets now cuts both ways in the non-group medical insurance market.
The couple mentioned in the Times article, Gwen and Matt Hurd, could drive the policy debate because their situation is likely to draw political sympathy from both liberals and conservatives. While though their numbers are relatively tiny in the overall voting population, families like the Hurds appeal to American cultural values of working hard and “playing by the rules,” as former President Bill Clinton put it. Policymakers of all political stripes will find it difficult to leave them to their own ends as they face the onslaught of rapidly rising medical costs that translate into steep premiums and out of pocket costs. Particularly when their dire circumstances receive national media attention. They are poster families that make the case for further reforms in the post Affordable Care Act period.
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