According to a report prepared by three independent Wall Street analysts up to seven million people could qualify for federal subsidies that will pay the entire premium cost of some health plans being offered in the online marketplaces set up under Obamacare. The bulk of these policies are so-called "Bronze" plans offered in the Obamacare exchanges, which are divided into platinum, gold, silver and bronze "metal" categories, each of which offer a different mix of premiums, co-pays and deductibles.
The no premium plans were designed to encourage young and healthy people to enter (some) exchanges easily, enroll, and not worry about paying a penalty. Even low premium Bronze plans may be effectively premium-free if income is between 138 percent and 400 percent of the federal poverty levels, which entitles millions of workers to subsidies often greater than the premium. (Workers with incomes under 138 percent of the federal poverty levels (varies with family size) are eligible for expanded Medicaid and do not have to choose any plan from the exchanges.)
However -- just because a plan is "premium-free" does NOT mean its free. It's free UNTIL you get sick! Once you get sick, very high deductibles and co-payments for medical services and drugs will be billed to the "Bronze" patient. We are talking between $6,000 and $12,000 approximate maximum out of pocket expenses per family per year, varying with income. But its worse. Even these generous (to insurance companies) caps have been quietly postponed until 2015. So if you get sick in 2014 on a Bronze plan, there may be NO CAP on what doctors and hospitals may charge you. A $6000 bill on a $14-per hour distribution center worker can easily put him or her in bankruptcy country even with a CAP - never mind if there is NO CAP!
Subsidies for individual, as well as employer, plans are available, on basically the same terms. There has been a lot of phony hoorah from enemies of health care as a human right, and some backboneless Democrats as well, over cancellation of substandard individual plans. These are inferior plans that provide largely fictitious coverage: the deductibles, exceptions and co-pays are so egregious they will bankrupt most any worker who has to use the so-called covered services and medicines. Obamacare subsidies will make many of those with inferior, individual plans able to switch to better, standard and guaranteed plans free of premium charge as well! And those with premiums to pay are finding $50 a month premiums instead of the inferior plan's $250 a month premium.
In West Virginia, the intense struggle over Obamacare implementation is fully engaged. The Attorney General, Patrick Morrissey, is a tea party fanatic in the mold of Virginia's Ken Cuccinelli (just defeated in race for governor). He has waged bureaucratic and legal war against the release of funds to assist and educate people in enrolling in the exchange - part of the ongoing war by the ultra-right that has contributed to the very wobbly national roll out. But, at the same time, the state's health and human Services organization launched a very aggressive drive to enroll eligible workers and families into expanded Medicaid. To date, over 65,000 have already been enrolled - 25 percent of the West Virginia uninsured population! The governor estimates over 100,000 more will be eligible for this life-saving program.
The true bonanza in the Affordable Care Act for the millions of uninsured and under-insured workers below about 25,000 in annual income is expanded Medicaid. Compensation for doctors and hospitals under expanded Medicaid have been raised to Medicare levels - long a demand of physicians serving Medicaid patients. That the Supreme Court and arrogant, plutocratic, mostly southern governors and legislatures have denied this fully funded right to their working citizens are acts frankly beyond contempt. African American, Latino, and Asian American workers, youth everywhere, plus the millions of Walmart, fast-food style service workers will be punished disproportionately for no reason other than service to neo-Confederate, the-people-are-entitled-to-nothing", master/servant ideologies.
If recent zig zags and conflict over implementation of the health care law have proven anything it is this: The labor movement - and its allies - should consider a national patients rights organizing drive. Workers not in unions, independent contractors and others will need representation at many levels to resolve conflicts, and contradictions in the emerging health care system.
They are the guarantors of quality care, of establishing beyond challenge health care as a human right. They deserve a seat at the table of every health care institution and delivery system.
Photo: Charles Dharapak/AP