Posted on 04/22/2022 4:19:14 PM PDT by nickcarraway
Leaving people uninsured winds up costing society a lot more by
A photo of a cowboy sitting on a horse and talking on a cell phone. His dog lies in the shadow beneath the horse. It is hardly a surprise that television cowboys bear little resemblance to the real thing, as the writer Maddy Butcher recently explained in the Washington Post. Unlike the modern-day characters in the series Yellowstone, Butcher informed us, today's ranch hands are not all tall and brusque, or even male, and they certainly don't engage in frequent gunplay. The intransigent cattle barons and the "simpletons kicking gravel in the road" are equally fictional, but some of the literary stereotypes do seem to have counterparts among today's 600,000 or so working cowboys, as counted by the Working Ranch Cowboys Association. According to Butcher, cowboys often have leathered hands, and sometimes broken bodies, from years of hard living and dangerous work. They also tend to be solitary and independent, with an average income of under $30,000, and "few have health insurance," which is the subject of our essay.
Most cowboys without medical insurance have opted to forgo it for some reason, despite the availability of nearly universal coverage under the Affordable Care Act (ACA). That choice fits the familiar image of rugged, government-disdaining individuals, suspicious of social welfare programs, especially in the deep Red western states. But even the toughest, most go-it-alone cowboy can still end up needing a doctor.
Butcher tells the story of a cowboy named Pete who works on the Crow Reservation in Montana. He suffered an accident while riding alone on the range, "but he managed to get to an emergency room, where he was treated for a broken nose, broken eye socket and broken cheekbone," and had his eyelid "stitched back together." Advised to take 12 weeks off, Pete was back riding the next day. "It could have been way worse," he told Butcher.
Assuming that Pete matches Butcher's profile of an uninsured loner, somebody still had to pay for all that repair work. The only emergency department on Montana's Crow Reservation is at the Crow/Northern Cheyenne Hospital, which is operated by the federal government's Indian Health Service. Like every hospital receiving government funds, the emergency department at Crow/Northern Cheyenne is required to treat everyone who presents with an injury, with or without insurance; it is even forbidden to ask about insurance during intake. So unless Pete had the money to cover the expenses himself -- highly unlikely on a typical annual income of $30,000 -- the chronically underfunded Indian Health Service was left eating the costs.
It didn't have to be that way. A 33-year-old male in Montana (Pete's actual age, as revealed in a Google search), with an income around $30,000, is eligible for a monthly ACA subsidy of $374. Although Montana does not have its own ACA exchange, policies from multiple companies are available for Montana residents at the federally operated Healthcare.gov, with monthly premiums of $83 or less (after the subsidy). If Pete had purchased such a policy, a private insurer could have picked up most of his hospital bill. Depending on the coverage and deductible, his nominal share could have been far less than the total tab, for which he is theoretically responsible without insurance. Most importantly, the Indian Health Service could have gotten substantial reimbursement from the insurance company, even without pursuing Pete for any of the balance.
The focus of the Post story was on the realities of cowboy lives rather than the gaping flaws of the country's healthcare system. But it nonetheless highlights how the ACA has fallen short in ensuring that everyone has coverage for basic medical care, including emergency services. Because of compromises needed to ensure passage of health insurance reform legislation, the ACA's requirement that everyone obtain a coverage plan was never expected to lead to a fully insured population. It was always clear some or many people would decline to participate -- the tax penalty for violating the ACA's individual mandate was relatively modest, and Congress effectively eliminated it during the Trump administration.
There were then, and there still are, policy options that could prevent this situation from happening. Single-payer systems -- as enacted in various forms in other industrialized countries across the globe -- generally seek to cover everyone in the treatment pool. While they differ greatly in how they function, the systems share the understanding that leaving people outside the insurance structure ends up costing society a lot more in the end. It is unfortunate that U.S. policy-makers and the public still do not accept this self-evident fact.
If Pete is one of the few ranch hands with health insurance, well, good for him. If not, he has learned by now that even the most self-reliant cowboy sometimes needs help from the federal government, at least when it comes to fixing broken bones. Fortunately for the uninsured, whether intentionally or not, Congress has decided that nobody should ever be turned away from emergency care, no matter what that does to the hospital's budget. Individual responsibility, as it turns out, does not mean taking care of only yourself. It also means taking reasonable steps -- including the purchase of medical insurance -- that protect everyone, taxpayers included.
David Tuller, DrPH, is a public health researcher and journalist in the School of Public Health at the University of California, Berkeley. Steven Lubet, JD, is Williams Memorial Professor at the Northwestern University Pritzker School of Law.
Cut out the middle man and just send the bill to Tuller.
This is outrageous! Jerry Jones can spring for medical insurance if workmans comp doesn’t pay. No need for the Cowboys to get overwhelmed by medical bills.
despite the availability of nearly universal coverage under the Affordable Care Act (ACA).
Prior to the ACÁ, I priced a plan through, ehealthinsurance.com. I picked the high deductible plan. If I remember correctly, it was about $140-150 a month.
Was it pelosi that banned individuals from deducting premiums like this from their taxes but kept it for corporations?
If I’m not mistaken, the Cowboys might be getting $30k a year, but they also get room and board
Assuming he had Obamacare, he would’ve had to meet his deductible first, so he might have been on the hook for $1500 to $6000, depending on his plan.
Let the Indian Healthcare service cover it. They lost to the Cowboys, anyway.
Governor Greg Abbott today issued a statement after the Centers for Medicare & Medicaid Services (CMS) announced their decision to withdraw their April 16, 2021 letter rescinding the previously approved 1115 Medicaid waiver extension. Last April, the Biden administration rescinded the extension that was granted by the prior administration. This extension, which was scheduled to run through 2030, provides critical healthcare funding, including funds for uncompensated care.
“CMS’ decision to withdraw the rescission of the 1115 Medicaid waiver extension allows Texas’ 1115 Waiver, originally approved in January 2021, to continue for the next 10 years and ensures that Texans will have access to crucial healthcare funding, including funds for uncompensated care. I applaud CMS for their reversal and thank Texas Attorney General Ken Paxton for fighting this decision over the past year in court. I also thank the Texas Health and Human Services Commission for their tireless work to secure this waiver extension. The original rescission by the Biden administration last April obstructed healthcare access for vulnerable Texans and took away crucial resources for rural hospitals in Texas, and I am grateful that Texans will now continue to have access to the health care resources they need.”
Did Biden do this only to red States?
This article assumes that Doctors and Hospitals are entitled to whatever price they wish to charge, the only question is who is to pay that cost. They erected the barriers to competition that comprise our medical system.
“despite the availability of nearly universal coverage under the Affordable Care Act”
Considering Obamacare jacked up deductibles in to the 8-10k range is it a wonder? “It’s free after you pay 10s of thousands.” But in reality American ranch hand need to just declare they are illegal immigrants.
“Considering Obamacare jacked up deductibles in to the 8-10k range is it a wonder? “
Montana here. My Wife’s deductible was raised from $6,000 per year to $7,000 per year this year. Add to that her monthly insurance cost of $525.00 and her out of pocket medical payments — before any insurance reimbursement — was $12,300.
We paid that and more for items not covered...We will pay an additional $1,000 for deductibles this year.
Being a ranch hand is a tough job and the farmers/ranchers universally treat them well — like family. They don’t make a lot of money, however.
Independent, solitary, hard headed, thinks for themselves. In other words, American patriots.
My county has a whopping one provider. I use to have a catastrophic plan with 5k deductible with low premium. Now... There is nothing lower than 800 per month with 8000 deductible. The ONLY clinic in the plan is about 40 miles away. I just pay cash at the local walk in doctor clinic. Luckily I have no medical issues and only visit to get stitched up for something. What are the odds of using 17,000 of medical care to break even? YAY Obamacare.
“My county has a whopping one provider. I use to have a catastrophic plan with 5k deductible with low premium. Now... There is nothing lower than 800 per month with 8000 deductible. The ONLY clinic in the plan is about 40 miles away. I just pay cash at the local walk in doctor clinic....”
Obamacare sucks for sure.
We do have Christian Health Share and it’s very good - it fills in the deductible hole so the deductible is only $500.00. In other words my Wife pays more for insurance - $525 + $210 = $735 and the deductible is in effect $500.
“What are the odds of using 17,000 of medical care to break even? YAY Obamacare.”
It happens. We spent $400,000 last year. Friday the 29th is another $28,000 visit.
YOU stay healthy and happy FRiend!
Peace and God Bless!
I had to bring one of my kids to the ER not so long ago. I have good insurance through my employer. The hospital initially charged over $10k. The insurance company said “screw you”, knocked their bill down to $1I, with me having a $250 co pay.
This is the real value of insurance, their leverage over ridiculous hospital charges. With a high-deductible plan like Obamacare, there is no incentive for the insurance company to question charges until your deductible is met.
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