Healthcare and the Election

Part III in the health care reform series featured in the Columbia Journalism Review published today. Reporter Judy Lieberman introduces us to Annette Murph, 54, who cannot work due to medical problems and so cannot afford health care insurance. "What irony!" Lieberman writes of Murph's situation. "The American way of health care forces those with serious medical problems to battle an inhospitable system that, at times, seems designed to keep them from getting care rather than meeting their medical needs."

Here is a summary of the medical situation facing Annette Murph:

• She got high blood pressure and arthritis when she was 28—from her mother and grandmother.
• Nine years ago, doctors diagnosed diabetes—her parents, cousins, and uncles all had the disease.
• Her thyroid gland is abnormal, and she has had two heart attacks; two first cousins died young from heart attacks.
• Two years ago she underwent knee replacement surgery (which was unsuccessful), and can no longer work as a buffet attendant at one of the casinos that line the Mississippi River not far from her home.

Her financial situation isn't much better:

• Since she left her job, she has accumulated over $15,000 in unpaid medical bills.
• Although Social Security disability payments qualify her for Medicare, there is a two-year wait for coverage, and she still has six months to go.
• She can't  get continuous coverage under Medicaid because her $758 monthly income is too high. In Arkansas, a single person can make no more than $108.33 a month to qualify for that program.
• Murph turned to Medicaid’s program for the medically needy—less than ideal for someone who needs regular care. Every three months she must re-qualify for coverage. If she doesn’t qualify again, she pays her bills out of pocket.

Ok, so how does she fare under the Presidential candidates' health plans, especially given that the candidates aren't talking much about people like Annette who fall through the cracks? According to Lieberman:

Under McCain's Plan
McCain’s $2500 tax credit to buy a policy wouldn’t do Murph much good: she lacks the money to pay for the rest of the premium, and she wouldn’t qualify anyway. No carrier would take her on. She wouldn’t qualify for his still-vague guaranteed access plan, but it probably wouldn’t help her either. She would be unable to pay the inevitably high premiums, and she wouldn’t qualify for subsidies since she already qualifies for Medicare and Medicaid. Getting benefits from those programs often disqualifies people from state high risk pools, and the McCain proposal might work the same way. In sum, his plan wouldn’t hurt her but it wouldn’t help much, either.

Under Obama’s Plan
Obama and his surrogates have pushed a strategy that builds on the preexisting “public-private partnership”—citizens can get coverage from an employer, buy their own, or go to a public program. Murph is already in the public part, which would probably make her ineligible for his proposed public program for people without access to employer coverage or other public programs. ... Obama calls for expanding Medicaid, a move that could help her get continuous benefits while avoiding the onerous “spend down” process. But an expansion would take lots of money from both the federal and state governments, and state Medicaid budgets are perennially tight. The test of Obama’s commitment to greater coverage will come in the expansion of federal programs, while maybe even compressing the waiting period for Medicare for those getting Social Security disability payments. If the public programs don’t expand to catch more people or make things easier for those already enrolled, those like Annette Murph will still be in the same fix.

Comments

[Andrew]

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