My housekeeper made a comment that her son goes to the ER for everything, “because it’s free”. Her son is 30 and chronically unemployed because he’s, well, lazy. He lives with her (and drives her crazy).
I thought that one of the purposes of Obamacare was to get everyone health insurance, so the ERs would not be used as pricey (but free) places for people to go for minor issues.
I don’t want political answers. I was just wondering how is someone like him supposed to “get covered” by insurance so that he’s not burdening the rest of us (as the hospitals pass on his costs to us all).
I think my coworker said her son is covered by Medicaid. I was asking her about the threshold for my kid’s insurance insurance in 2016 when she turns 26.
The lowest income households can use Medicaid. Above that, lower to middle income households can buy exchange plans with subsidies. Above that, households can buy exchange plans without subsidies.
In states like Alabama that did not expand Medicaid, there is an income range just above the Medicaid range that may be be problematic for the subsidies.
It will depend on the state. I have wondered what the motivation would be for someone like the man in the OP to enroll in any insurance plan, including Medicaid. It obviously takes some effort to enroll in any plan, even if the plan provides “free” medical care. I would think a hospital would automatically help any patient who is eligible enroll in Medicaid, as it is in their financial interest to do so.
So, an able-bodied 30 year old who prefers to watch TV and play video games (and smoke cigarettes and drink beer), can either get Medicaid or show up at an ER and get free medical services.
i know that we can’t force able-bodied people to work, but I’m starting to think that a gas, cigarette and booze tax should be added to “capture” some of these folks. Then, maybe some sort of small tax credit for those who do work and pay taxes and have health insurance to get “reimbursed”. That may not be the answer…
When he does occasionally work, it’s “under the table” painting and other small construction jobs.
I know that this guy is not unique. That’s why I’m wondering if a tax on gas, cigs, and booze would capture these people, who do tend to use their “under the table” income for those purchases.
The rest of us could then get a small tax credit so that we’re not badly stung by those tax increases. Those added taxes would capture those.
He probably doesn’t qualify for medicaid in your state (iirc Texas?) since they didn’t expand Medicaid, and he is likely not in the income range to qualify for subsidized ACA plan. His only choice is free clinic or ER.
What would increasing taxes on the items you suggested do to change that situation? Texas and the other states which refused to expand Medicaid gave up federal dollars to fund an expansion 100%, so I highly doubt they will tax the citizens of their state more to cover those in the donut hole by the state’s own doing.
What you should do is lobby your elected officials to accept the federal dollars to expand medicaid in your state.
There is a tax penalty for people who don’t sign up for any coverage. That’s the incentive to get someone like this fellow to enroll in Medicaid. Of course there are people who don’t even fille taxes, but let’s assume it will catch up to him at some point.
My S1 and his GF are both students living on student loans, and they are both enrolled in Medicaid. The coverage isn’t at all bad. S1 got eyeglasses completely paid for.
Some states (I believe Texas is one), have their own methods for covering people like him. I believe Texas, for example, provides “charity care” funded via property tax assessments.
No, if he lives in a non expansion state he cannot get Medicaid or a subsidized ACA plan. I assume he is an adult with no children.
“As of March 2015, 22 states were not expanding their programs. Medicaid eligibility for adults in states not expanding their programs is quite limited: the median income limit for parents in 2015 is just 44% of poverty, or an annual income of $8,840 a year for a family of three, and in nearly all states not expanding, childless adults will remain ineligible.2 Further, because the ACA envisioned low-income people receiving coverage through Medicaid, it does not provide financial assistance to people below poverty for other coverage options. As a result, in states that do not expand Medicaid, many adults will fall into a “coverage gap” of having incomes above Medicaid eligibility limits but below the lower limit for Marketplace premium tax credits (Figure 1)”.
“There is a tax penalty for people who don’t sign up for any coverage.”
Not for him there wouldn’t be. He is too poor to get qualify for ACA coverage and likely doesn’t qualify for medicaid in his state, so there would be no penalty.
There are already taxes on gasoline, booze, and cigarettes (beyond general sales taxes that apply to everything). But many of them (as well as general sales taxes) are state taxes, which is why they vary so much by state.
Just wanted to point out that he can’t get “free” medical services at an ER.
While every emergency room is required by law to treat any patient with an emergent medical need or who is in active labor, privately owned hospital ERs can turn away patients who cannot pay for services. Public hospitals are required by law to treat everyone who presents themselves to the ER. (Even those in the US illegally.)
Public hospitals are also required by law to make a “good faith” effort to collect the cost of treatment from the patient. Undoubtedly the young man’s account has been sent to collection agencies multiple times.
As for the liquor and cigarette taxes–a portion of county/municipality, state and federal taxes on those items already goes toward paying for public health costs–both as direct payments to public hospitals and as health education/awareness programs. The exact percentage going to healthcare is going to depend on the state.
I"ll just point out a detail about those who get ‘free’ care at the ER - it’s only short term care. If that (uninsured) person has a chronic health problem, they are going to have real trouble getting the care they need.
I know an ER nurse and this situation drives her crazy because it has been her experience that the ‘free care’ patients tend to have a real entitlement mentality so they are often not pleasant patients to care for.
Not all medical care is emergency care. One can’t get preventive care at the ER, for example, including birth control if the patient is a woman. One can’t get labwork or tests at the ER, unless related to the emergent problem. One can’t get follow-up care for the emergent problem, for example, physical therapy related to the accident which landed them in ER. One can’t get care for any problems discovered during the ER visit; for example if the x-ray for your back pain reveals a tumor, the ER probably isn’t going to do a biopsy and certainly isn’t going to provide chemo.
There is a tax penalty for people who don't sign up for any coverage
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Right, but only if they FILE taxes and have a declared income. This doesn’t capture the large number that work under the table and never file taxes.
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I know an ER nurse and this situation drives her crazy because it has been her experience that the ‘free care’ patients tend to have a real entitlement mentality so they are often not pleasant patients to care for.
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I can see that happening. My housekeeper was angry that the ER prescribed her son a “name brand” Rx, instead of a “free generic”. I reminded her that her son is a “big boy” and he should have specified that he needed a generic, hopefully one on the “free list” at a number of pharmacies.
I remember after I had recovered from the flu, a person who did use the ER for “free care,” said to me, “did you go to the hospital.” I responded, “I didn’t going to the hospital for the flu, why would I?” She said, “well, they’ll hook you up to an IV and give you fluids, and likely give you a shot so that you’ll feel better.” Well, if I had done that, I would have been hit up with a 10% bill, which likely would have been a few hundred dollars (with my insurance having to pay a sad sum for just the flu!). I just “suffered” at home for a few days. Obviously if my life was endangered at some point, I would have sought medical treatment (first my doc, then hospital if thought needed). This lady really thought nothing of the whole thing. Gave no thought about who was really paying for her unneeded “free care” at the ER for the flu. It was like, “why don’t you go to the library”.
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There are already taxes on gasoline, booze, and cigarettes (beyond general sales taxes that apply to everything). But many of them (as well as general sales taxes) are state taxes, which is why they vary so much by state.
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Oh, I know that there are. But I wouldn’t care if they raised the cig tax a $1 a pack and have that go to provide these people’s healthcare…because at least many of them would be “paying” for it. Same with a booze tax.
As for the gas tax, since using gas is a necessity in many regions, giving a small tax credit to tax payers would “reimburse” them alone for this added tax that they shouldn’t have had to suffer.
@mom2collegekids Or we could just have universal insurance, like the rest of the world (and like our own senior citizens). Seems to me that’s considerably simpler, cheaper, and more efficient than trying to devise all these Rube Goldberg schemes.
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Just wanted to point out that he can’t get “free” medical services at an ER.
While every emergency room is required by law to treat any patient with an emergent medical need or who is in active labor, privately owned hospital ERs can turn away patients who cannot pay for services. Public hospitals are required by law to treat everyone who presents themselves to the ER. (Even those in the US illegally.)
Public hospitals are also required by law to make a “good faith” effort to collect the cost of treatment from the patient. Undoubtedly the young man’s account has been sent to collection agencies multiple times.
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I don’t know. I’ll ask his mom. She just used the word, “free”. I don’t know if when he tells him that he’s been unemployed for years (since any work is under the table), then maybe no one bothers to collect? I don’t know. I will ask.
Or maybe he does qualify for medicaid because it appears that he has no income. But what system allows an able-bodied person to “forever” claim that they’re not working and then be provided virtually unlimited care. I do know someone on medicaid, she’s about my age, she’s been on medicaid for decades (mildly-disabled) and medicaid has paid for a number of surgeries (hysterectomy, knee surgery, hernia surgery, 3 C-sections, etc), she regularly gets “pain shots” in her back, she has private care doctors all being paid by medicaid. So, I know that she doesn’t have limited options.
I don’t think the answer in the case of the 30 year old is expanding medicaid (alone), because it just perpetuates bad behavior. If expanding it by including some taxes that target the items that these people often consume, at least they’ll have some “skin in the game.”