Sunday, February 16, 2014

Young and Healthy: The Obamacare Paradox

    One of the selling points of the Affordable Care Act was that the requirement that everyone would have to purchase health coverage, even those who were young and healthy.  The dollars brought into the system by those least likely to need medical care were going to help pay for others, including those with pre-existing conditions, who need more care.  But beyond the mandate with its relatively low penalty, how could the young and healthy be convinced to sign up?  Low premiums, of course.  But herein lies the contradiction.  How can young people, even healthy young people, paying very low premiums possibly contribute enough to the system to sustain it for the less healthy?

    A recent example from Organizing for America shows the challenge faced by the law's supporters.  The item is entitled I found my golden ticket (well, platinum) and tells the story of self-professed "young and healthy" Eva Juni:
I'm young and healthy—something I'm grateful for every day. But it was a long road to get here: I've struggled with clinical depression since I was 12 years old, and have been on anti-depressants ever since.  
Look: I'm a healthy person, and I make healthy decisions. That includes taking care of myself—and it should include taking care of my mental health. Staying healthy isn't just about your body—it's about your brain, too. It's easy to discount the importance of mental health when talking about overall health care, but it shouldn't be.  
I've worked hard to get to where I am today, and I'm proud to say that I'm stable and have been for a long time. But affording that stability—at least for the past few years—has not been easy. I, like many young Americans, was lucky to be covered under my parent's plan until age 26. While I was extremely relieved to be able to receive medical coverage, the plan didn't cover all that I needed it to: My mental health medication still cost nearly $250 a month.
    Even on her parent's plan, Eva was paying $3,000/year for her depression medication, and that does not even include the cost of the premium.  Then, Eva turned 27, and her stress really began:
So, when I aged off my parent's plan, I had to make a tough decision: Buy a health care plan that didn't cover my medication and pay hundreds more on top of it, or go without coverage and put the money toward paying for my treatment? Most plans I could afford only covered catastrophic events anyway, so I went without coverage for eight long months—eight stress-filled months, where even the smallest mole was terrifying because of what it could be.
    Even though there were some plans, granted most of them for "catastrophic" coverage, that Eva admitted she "could afford", she chose to forego coverage for eight months until the Obamacare exchanges opened up.  Against the odds, Eva managed to use the exchange to obtain coverage, and not just any coverage:
Luckily, when the health care marketplace opened up, I found my golden ticket—well, platinum, really. My new platinum plan is just $45 a month, thanks in part to the fact that I qualify for financial assistance—and my medications are just $28. It blows my mind that this is available to me, especially after struggling with coverage even in the best of circumstances for the last few years.
    Now, instead of $3,000/year for medication (plus thousands more for a premium,) Eva is paying $73/month, or $876/year for top-of-the-line platinum coverage, which includes her medication.  And who is paying the $2,124 difference?  "Financial assistance," a euphemism for the US taxpayer.  Obviously, Eva is not the kind of "young and healthy" person that Obamacare's supporters have been talking about.
    Eva concludes her story with the following observation:
I was amazed by what I found on the marketplace—and you could be too. Check it out. You could be pleasantly surprised (or, in my case, just plain blown away).
    I imagine Eva is not the only one who will be "just plain blown away" by her story.

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