COBRA-Buy and more healthcare news

(Sorry, I'm so sorry)

First, I must address an unforgivable error in last week’s news-newsletter. When I started Sick Note, I outlined one of the benefits of signing up as receiving weekly pictures of my cat, Digby, that would appear in these Friday news roundups. Last week, I forgot to do that. I am so sorry. Here are two to make up for it.

First, one from this week:

And a Classic Dig from the archives:

Thank you for your patience. It won’t happen again.

Coronavirus news

Joe Biden has released details of his proposed Covid-19 relief package. Much attention has obviously been paid to the hilariously Democratic weaselism of telling us we’re only owed $1400 in additional stimulus, not $2000, because we already got $600. You can’t get that one past me, Joe—you said $2,000 checks. I haven’t even gotten my $600 yet! Give me $2600, and actually I would like an Edible Arrangement too, now.

Here’s the section on healthcare:

Preserving and expanding health coverage. Roughly two to three million people lost employer sponsored health insurance between March and September, and even families who have maintained coverage may struggle to pay premiums and afford care. Further, going into this crisis, 30 million people were without coverage, limiting their access to the health care system in the middle of a pandemic. To ensure access to health coverage, President-elect Biden is calling on Congress to subsidize continuation health coverage (COBRA) through the end of September. He is also asking Congress to expand and increase the value of the Premium Tax Credit to lower or eliminate health insurance premiums and ensure enrollees - including those who never had coverage through their jobs - will not pay more than 8.5 percent of their income for coverage. Together, these policies would reduce premiums for more than ten million people and reduce the ranks of the uninsured by millions more.

So we have two big things here: Extending COBRA subsidies, and an expansion of ACA premium subsidies.

COBRA extension is a big missed opportunity, though it feels completely inevitable. When you lose your job and are offered COBRA, the premium is obviously unaffordable, because now you’re on the hook for the part your employer paid when you were employed. When I left my last job, it would have been $900 a month. Haha, thanks though! It’s much more for people with family coverage. (This is how much health insurance actually costs, but most people who are employed don’t even know what their boss is spending.) Subsidizing COBRA means subsidizing health insurance companies, just like we do on the ACA exchanges. It means giving health insurance companies thousands of dollars per person to provide what we all know is a pretty shit product—people would still be on the hook for their deductibles and co-pays, for example—a percentage of which is always dedicated to insurance company profits and CEO Boats. A private solution is always going to involve more money going to CEO Boats than a public one.

Even putting aside single-payer (though Bernie Sanders still wants Congress to create an “emergency universal health care program”), there are things Congress could do to extent health coverage to people without handing millions of dollars to insurance companies. It could create a public option alternative, which is something Joe Biden promised to do anyway, so why not now? It could expand and federalize Medicaid, which Jon Walker noted is also already part of Biden’s promised public option—and it’s a good way to get around Republican states doing things like the block grants we talked about last week.

If you’re a laid-off worker, you’ll surely be grateful to keep your plan, regardless of whether your employer or the government is paying for it—and it’s true that keeping people on their plans is broadly good, because they can keep their doctors. But it’s a missed opportunity to make the case for expanding government-provided health insurance, and to not throw millions of dollars at fucking Aetna.

The other part of Biden’s plan is just funny to me. I mean, it’s not “funny,” but it is. There is a non-specific commitment to asking Congress to lower ACA premiums, and then there’s this 8.5 percent thing. All along, part of Biden’s healthcare plan has been to lower the percentage of income that you can be expected to pay in premiums from 9.83 percent of household income to 8.5 percent. This plan was written long before the pandemic happened. If I were Joe Biden, I might revise that percentage given the advent of an economic catastrophe, knock it down to a neat 8 percent. Alas, no; it’s the same idea they had before the world-historic crisis. 8.5 percent. That’s the magic number. If you can’t afford a plan that’s 8.6 percent of your income, Joe Biden gets it, mack, he feels your pain. If you can’t afford a plan that’s 8.4 percent of your income, well, that’s your fault, isn’t it? Stop buying sneakers!

Anyway, friend of Sick Note Tim Faust said it best:

In other coronavirus news: Make sure you don’t miss this Kaiser Health News story on a dialysis patient and single parent who went to the ER when she was “having difficulty breathing because she’d had to miss a kidney dialysis treatment a few days earlier for lack of child care.” She was transported to a hospital 65 miles away because the one she went to was too full of Covid-19 patients. This is a person who already should not have had to go to the ER; she should not have had to miss dialysis because of a lack of childcare. Our decision to ignore the needs and costs of this vital part of having a fucking society simply creates more stress and illness down the line, plus more healthcare costs—and it’s all so much worse during a pandemic.

NPR reports that the pandemic is fueling renewed interest in unions among healthcare workers. I’d love to hear from any healthcare workers who are in the middle of unionizing, so please, get in touch. I’m happy to keep you anonymous in anything I write.

Virginia’s Spanish-language website for coronavirus vaccine information used Google Translate, which resulted in the site telling users the vaccine was “not necessary” instead of “not required.” Whoops!

The Guardian reports on those who are struggling with chronic illnesses and lost health insurance during the pandemic. Again, if you have a similar story, please get in touch.

An estimate by Los Angeles County shows that one in three people in the county have been infected with coronavirus—“more than triple the cumulative number of coronavirus cases that have been confirmed by testing.” LA continues to see horrible nightmares unfold in its hospitals, as The Guardian reported on this week, too.

Nursing homes that partnered with CVS and Walgreens to administer coronavirus vaccines are seeing problems, reports KHN. Mississippi, for example, “committed 90,000 vaccine doses to the effort, but the pharmacies had administered only 5% of those shots as of Thursday.”

Non-Coronavirus news

A quick break from “news” here first, actually. My friend’s partner started a new job recently, and was horrified to discover that his new employer wouldn’t be activating his health benefits until 90 days into his job. This is legal, though it is the maximum period allowed by law. But my friend also found this website for some millennial-ass payroll company, and look at what they’re telling employers about this waiting period (emphasis mine):

The period is also a meaningful way to reinforce your company culture — the same one that attracted your employee to your company in the first place. Whether it’s feeling more relaxed on that first daunting day or not having to worry about all the splintery details that go into enrolling in benefits, you want people to feel like they’re being taken care of whenever they interact with you. A warm welcome also helps people feel more in control at a time when things are already so new and tumultuous.

And finally, you can wield it as a tool. If you have a company that has high turnover, you may consider lengthening the waiting period closer to the 90-day upper limit. But if the opposite situation is true, it may be wise to begin benefits right after your new team member starts.

Gross! This is what they’re saying about you behind C-suite doors, workers: Don’t let them have their health insurance too soon or they might… quit? So they can then lose that insurance? What a deranged mindset. Hate them. Go wedgie your boss, he deserves it.


Back to news. In the spirit of the story I brought you last week from a DC public housing resident, whose moldy apartment made her sick, read this detailed investigation from APM and The Intercept into the thousands of public housing units that sit within a mile of a polluted “Superfund” site. We’re paying the government to poison poor children.

The Trump administration just finalized a rule that will allow states to essentially privatize their ACA exchanges, which could “steer low-income consumers toward private, substandard plans without explaining they were eligible for Medicaid.” If you think your state’s ACA exchange is bad already, wait until it’s run by some corrupt broker with a hankering for a second boat and a direct line to his state’s cheap-ass regulators and legislators.

In other privatization news, the Illinois House of Representatives will consider a bill to end Medicaid managed care in the state, which has been a disaster. The managed care model lets insurers make money off Medicaid patients by denying their claims. I would like to kick it into the sun. (Look out for more Sick Note coverage of managed care in the coming weeks.)

That’s all this week. Thanks for reading, and once again, my sincere apologies for the missed Digby photo.