The Face of the Uninsured

The Sacramento Bee puts a face on the uninsured with their special feature on the plight of Tony Andrade, 47, who was diagnosed with bladder cancer. His medical bills have swelled into the tens of thousands of dollars and the calls from bill collectors keep coming. Nearly four years ago, he lost his home when he could not keep up with the payments.

In many ways, Andrade, 47, is the Everyman of President Barack Obama's push for overhauling the country's health care system: working, but for low wages, without health benefits – in the company of 37 million employed Americans who are uninsured. When Andrade first noticed the drops of blood in his urine he made a choice familiar to the uninsured – he went to an ER that he knew by law would have to see him whether he could pay or not. Like many of California’s 7 million uninsured, Andrade earns too much to qualify for Medi-Cal, the state's version of Medicaid, but too little to buy insurance on his own.

Andrade knows something is afoot in Washington, but feels disconnected from the political debate. He suspects any help it brings won't come soon enough to pull him out of this mess. Though he did qualify as medically indigent and was able to have the tumor removed through a county program, he soon discovered that the cancer had spread to surrounding tissue and that more surgery was needed. And then, another setback. The contract between Andrade's doctor and the county is under review, caught up in the county's budget woes. His surgery is on hold again.

Read the whole story. It's worth the time. It's a good reminder about why we need health care reform.

Comparing the Health Plans

Over the weekend the House of Representatives narrowly passed a health care reform bill that would cost approximately $1.1 trillion over 10 years and insure approximately 36 million Americans who currently do not have coverage. The action now turns to the Senate Conference Committee, where the work begins to consolidate the House and Senate bills.

For some assistance in understanding the differences that need to get worked out, the New York Times offers a helpful interactive web page. We offer an example below:

Require nearly all Americans to carry health insurance or pay a penalty

House version
Would include mandate.

Penalty: 2.5 percent of adjusted gross income over a certain level, which is $9,350 for singles and $18,700 for couples.

Exempt those with incomes below the above-mentioned thresholds, American Indians, people with religious objections and people who can show financial hardship.

Senate Health Committee
Would include mandate.

Penalty: Up to $750 a person a year.

Exempt American Indians and those who can show financial hardship.

Senate Finance Committee
Would include mandate.

Penalty would be phased in gradually: $200 a person in 2014; $400 in 2015; $600 in 2016; and $750 in 2017.

Exempt American Indians, people with religious objections, those who can show financial hardship, households with incomes lower than 133 percent of the federal poverty level ($29,327 for a family of four) and people who would have to pay more than 8 percent of their income to buy the lowest cost plan available to them.

White House
Open to a mandate as long as people who cannot afford insurance are exempt. During the campaign, President Obama proposed mandates for children only.

“I am open to your ideas on shared responsibility. But I believe if we are going to make people responsible for owning health insurance, we must make health care affordable. If we do end up with a system where people are responsible for their own insurance, we need to provide a hardship waiver to exempt Americans who cannot afford it.” (Letter to Senate leaders, June 3)

Interest groups
America’s Health Insurance Plans, the insurers’ lobby, supports individual mandates. But the trade association says the penalties for going without coverage are modest under the Senate Finance Committee’s bill. This creates “a powerful incentive for people to wait until they are sick to purchase coverage,” and could drive up insurance premiums, the group has warned.

Drug companies and insurers could benefit from mandates, which could provide millions of new customers.

Labor unions and consumer groups support mandates for individuals as long as employers are required to help pay for coverage.