We have once again found ourselves screwed by employer health insurance, keeping good healthcare unaffordable for the middle- and low-income people.
Around this time last year, my husband became eligible for insurance through his job at MOD Pizza. He was only supposed to be part-time, but they were always short-staffed, so he kept getting more hours, even though he did not want them. We were doing okay financially between his job and whatever hours I got at mine, and then we were forced to take his employer insurance, which was much more expensive than what we had through the healthcare marketplace and covered nothing until we hit the deductible.
I was so angry that I vented through writing, as I often do, in the form of a post on Medium (Healthcare in the United States: A Broken System Defended by Ignorance) and in a letter to President Joe Biden. I received a response weeks later from Biden (or, more likely, one of his team) that was fairly generic but confirming that healthcare was one of the top issues on his radar.
I had this similar problem back when I was a store manager for Joann. My health insurance was okay, then, under Trump, it suddenly cost more and covered less. That was when I had to have my hysterectomy, of which my health insurance covered only the amount over my $6000 deductible. We couldn’t afford to pay, so my student loans were put on hold and eventually the bill went to collections. We had incurred credit card debt to pay for my specialist visits that led up to the surgery—surgeries actually, because I had to have two. That was the only way we could find the source of my pain, and that source was early uterine cancer.
We had debt, both medical and, I’ll admit, some irresponsible spending because I made decent money, plus expensive health insurance taken out of every paycheck, rent, utilities, groceries, and all other expenses that go with maintaining a household. We had to use the money we had saved to buy a house, which wasn’t enough anyway. For six weeks I was on short-term disability, which meant less money coming in while medical bills were piling up. Yes, I thought I had a good income, but, realistically, we were still classified as low-income, even on a store manager salary.
Before Joann, I was the wine shop manager for the Pennsylvania Renaissance Faire and had health insurance through the healthcare marketplace, or what many people call “Obamacare.” I paid about $200 a month and had a small co-pay. My premium was based on my income, which was a mere $27,500, a pathetic salary for a retail manager, but it was a smaller business and I had a lot of freedom on the job. I also had zero benefits at that job, so I was able to pick my insurance through Healthcare.gov, and I decided to go with a better plan because of concerns over my health. I made the right choice: I was in and out of the emergency room three times the first half of the year because of an illness that is still a mystery.
The thing that a lot of employers and human resources personnel do not seem to understand is that you cannot turn down health insurance through your employer to keep a marketplace plan. Well, you can, but you must then pay full price for the marketplace plan. Once you are offered insurance, you lose your eligibility for tax subsidies to lower you monthly premium.
Unfortunately, there are people who lie and continue with better coverage at a discount—all we can hope is that someday they are caught, because it is a form of tax fraud and is not something of which to be proud. It drives prices up and gives more argument to why the healthcare marketplace should not exist rather than reinforcing the need for overall healthcare reform.
Then there are the employers who suggest applying for Medicaid. That’s what happened to us last week—advisement to apply for help to get medical coverage through the state. How pathetic does a company have to be that they know they pay so little that some employees cannot afford the coverage that they offer? I already knew that we did not qualify—our application had automatically been sent by Pennie, the Pennsylvania healthcare marketplace, and we were denied within a couple days. Our income is currently around $26,000, but we cannot get any type of help, mostly because my mother lives with us. Her income does not pay our rent, but she does buy groceries and usually covers the electric and gas bills, so, technically, her income is part of our household.
So we found ourselves facing a dilemma: obviously my husband needs insurance for his epilepsy medications, but do I? I mean, I should, with my doctor monitoring cholesterol (which has gone down), sugar, and my thyroid, but was it really worth another $237 a month for me to have insurance? Thanks to an error in the Wellspan Health system where our insurance info was deleted, I know that a doctor visit costs $107, which is much less than the $267 we would pay between the insurance premium and the co-pay ($237 premium plus a $30 co-pay). Even a mammogram would be about $280. Since I only go to the doctor once or twice a year, it is certainly cheaper to not have insurance and pay in full than to pay $2844 over a 12-month period.
What gets me is that this is the system so many Republicans and their supporters argued in favor of: a system that forces a low-quality health insurance on those who are employed full-time. We learned after MOD Pizza that it was better to work less hours and choose our plan through Pennie. We learned that working full-time just gets you more expensive insurance that covers less, a 401k that loses money, and additional stress from working and STILL living paycheck to paycheck.
Unfortunately, with my husband’s current job, he is also eligible for health insurance as a part-time worker, so we could not afford for me to also have insurance. Though, as I stated earlier, it certainly is cheaper to pay full price for medical care than to pay for overpriced spousal coverage. Honestly, all I want is the ability to stay with our marketplace plan with the premium subsidies based on our income. At a current income of $26,000 a year, we should certainly be allowed that choice. We don’t want free healthcare—we just want it to be affordable.
And believe me, my sense of self-preservation is strong enough that if I need medical care that I cannot afford, I will find a way to get it, even if I can never pay the bill. This is my life we are talking about—my actual life. I don’t play around with that. No one should have to choose between food (or rent) and healthcare. Not in a so-called “developed” nation that claims to be one of the greatest in the world.
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