Saturday, March 19, 2016

Keep an Eye on Obamacare

When my husband died a year and a few months ago, I was surprised and relieved to find that the health insurance of the Affordable Care Act really was affordable.  I figured I might just keep it as my private insurance when I became eligible for Medicare.


When you become age-eligible for Medicare, I have since found out, you cannot keep your Obamacare.  Your options become dizzying, and not in a good way.

I turn 65 in July, so for the past few months I have poured over Medicare books and stared at my computer screen for hours before becoming discouraged and just quitting for the day.  When I take it up again, the bad news starts to sink in, but it doesn't get any better.

But I am not here to whine.  I am here to bitch about the politics of health care for seniors.

I have had a hard time finding out what was available even a few years ago before Part D -- the prescription drug plan -- was enacted into law, so I can't tell you how much better Medicare was in years past.  But my guess is that the republicans -- with some Democratic compliance -- have been chipping away at Medicare for decades now.  Their preference, of course, is to privatize it entirely, but they are content -- as much as such a bunch of malcontents can be -- with destroying it one step at a time.

Let's start with the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.  It may be that there was no drug coverage before 2003 (I can't even get that info on Wikipedia, so if any of you out there can enlighten us as to what people did for prescription drugs before W came into town and got his hands all over it I would be very appreciative.).  From 2003, the drug component -- Part D -- of Medicare proved to be a real boon -- for the pharmaceutical companies.  And there was a sadistic element to the bill that one has to admire.

First of all, it is purchased from private pharmaceutical companies, with the government subsidizing some of the cost.  But you are not required to buy this coverage.  HOWEVER, each year that you do not buy Part D coverage, your cost for when you do decide you need it goes up.  Each year.  It is called a "late enrollment penalty," and this is the way Medicare explains it:

 Medicare calculates the penalty by multiplying 1% of the "national base beneficiary premium" ($34.10 in 2016) times the number of full, uncovered months you didn't have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium.
I imagine the drug companies were tickled at those terms.  But wait!  There's more.

You may have heard of the "donut hole," which Medicare more civilly refers to as "the coverage gap."  Not civil either way you look at it.  This bizarre rule means that -- while you continue to pay your monthly premiums, and after your deductible and copays -- if your pharmaceutical needs are so great that your drug cost reaches $3,310 in 2016, your coverage stops  Then you pay out-of-pocket until you have paid $4,850, when your "catastrophic coverage" kicks in.  By that time, your life if not your health can truly be considered catastrophic, so at least that is aptly named.

I still have to stop and let my mouth drop open when I consider those two key provisions of this totally shitful law.

 After you have contemplated Medicare Part D for a few minutes, we can move on to the truly brilliant way the republican Congress has managed to screw up Medicare with barely a ripple of outrage.

Effective for new Medicare recipients, beginning this year, the monthly premium has gone up from $104.90 per month to the astounding $121.80.  And the deductible has gone up for new recipients from $147 to $166.  This is despite the fact that in 2016 there was no corresponding cost-of-living adjustment to social security benefits.  And there was no COLA because Congress determined that the cost of living had not gone up because gas prices went down.  And then proceeded to raise the cost of living by significantly raising Medicare costs.

Slipping this change in for new enrollees means that most of us just pay what we are told, without realizing just how much the cost has gone up.  By not requiring people already enrolled to pay the increase they manage to stem what would probably have been a shitstorm.

Here's something else to consider.  Our less-than-esteemed members of Congress don't have to deal with this at all.  In one of a very few exceptions, they are allowed to keep their government subsidized health care after they retire.  Pretty cool, isn't it?  As Fred Astaire said, "Nice work if you can get it."

I could go on about Medicare, but I really want to end with some thoughts about Obamacare.

I imagine that we are not allowed to keep Obamacare after we hit 65 because it is, so far, a truly affordable and comprehensive health insurance program.  The government pays steeply for this, but the savings are also tremendous and -- hey -- it actually keeps more people healthy.

Those republicans, fat and happy and with their own pretty damned good government health insurance, will lose sleep over the fact that the government is paying for other people to get good, affordable health care.  They will not rest until they have chipped away at Obamacare the way they have done with Medicare.  Over the years to come, as long as we let them, they will increase out of pocket costs and cut the government subsidy until, just as with Medicare, those who are living on a tight budget, will just have to go without needed health care while they pay mandated costs.

And even at that point our elected officials will resent the fact that we are at all able to continue to breathe their air.

So, forewarned, keep an eye on our Obamacare, and let's not let the right wingnuts put this over on us.  Again.


  1. I just heard from a "Cherry" reader in answer to my question about Part D. There was no drug component to Medicare prior to this bizarre drug plan. I wonder if the "compassionate conservative" George W. Bush was responding to the needs of the people, or to the drug companies who were incensed that senior were getting affordable drugs from Canada and the internet.

  2. Thanks, Agnes. Good critique. I am also trying to navigate the incredibly byzantine ways of Medicare. How in hell did America get into this mess? Why can't we have universal healthcare like the rest of the civilized world? The answer is corporate greed, pure and simple