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Healthcare is a looming question mark in the United States. Unlike many similar countries, such as the United Kingdom, Canada, and Australia, the US has a for-profit healthcare system, where citizens have to pay in order to receive health insurance coverage. On top of insurance, also have to pay for co-pays, deductibles, medications (which can still cost thousands of dollars every year even with insurance) and services that insurance refuses to cover, like certain preventative screenings.
Most people, if they were insured at all, got health insurance through their employers. This helped to keep their costs down because it functioned as a kind of “group insurance.” An employer with many employees who were interested in buying insurance could command less expensive rates from private health insurers. If you were unlucky enough to not have employer-provided insurance options, you could end up paying significantly more — by the hundreds of dollars — for coverage. Many people just couldn’t swing it, and in 2010, the year that the Affordable Care Act (ACA) was signed into law, 48 million were uninsured. In 2016, 28 million were uninsured.
This is not to say that the United States doesn’t have state-sponsored health insurance. It does. On a federal level, government employees are given heavily subsidized health insurance, and Medicare provides health insurance for citizens over age 65. In addition, the poorest US citizens may also be eligible for health insurance in the form of Medicaid, which is handled by the states.
In Arizona, that system is called the Arizona Health Care Cost Containment System. As of December 2017, nearly two million Arizona residents are part of the program. It is similar to every other Medicaid program in the country: it uses a combination of federal, state and county money to fund the program. The program uses these funds to negotiate insurance prices with private insurers and then, with few charges for medications or copays, the program completely covers “medically necessary” services for participants.
“We're going to have to get back next year at entitlement reform, which is how you tackle the debt and the deficit,” House Speaker, Paul D. Ryan said in early December, affirming his intention to make cuts to Medicaid and Medicare in 2018. He’s one of many people who argue against state-funded medical care. They argue that it’s part of a “nanny state” and that people are taking advantage of the services.
Will Humble, Executive Director for the Arizona Public Health Association, says that isn’t the case. “The truth is the majority actually have jobs, or a family member has a job, it’s just that it’s so low paying that they still qualify, or it’s part time.” A study by the Kaiser Family Foundation found that in 80% of households receiving AHCCCS benefits, at least one member was working full time.
A significant part of the population covered by AHCCCS is children, who get full medical and dental services, including coverage of medications. Adults get medical coverage but only $1,000 toward emergency dental services. Humble’s team, along with the dental associations and children’s advocacy groups, are working to get pregnant women access to full dental services as well. He argues that cleanings and periodontal work, the non-emergency services that aren’t currently covered, make sense. “[They] are helpful during pregnancy to improve the preconception health of mom and also to help the kid from getting cavities because of the vertical transmission of the bacteria when the mom has cavities.”
In order to qualify for AHCCCS as an adult without children, you must be a US citizen (or qualified noncitizen), under the age of 65, and be 133% of the Federal Poverty Line or below for single adults, which is $1,337 a month, or $16,044 a year.
Before the ACA, Arizona residents who didn’t meet these requirements and didn’t have affordable health insurance through work were essentially out of luck. An estimated 669,912 more residents are insured because of the ACA, in large part because of the included Medicaid expansion. For residents who make too much to qualify for AHCCS, they are often eligible for the ACA, though they may be nervous when they first see the price tag. Many don’t understand the advanced premium tax credit, which applies a tax credit to their insurance premium immediately, not on tax day. “Especially at that lower level, say 166% of poverty… when you include that in the premium, the premium comes down to next to nothing,” Humble said.
Eleven percent of Arizonans still remain uninsured, and it looks as though the Arizona government wants to make it more tedious to be on ACCCHS. There is currently a bill that would put a five-year lifetime limit on people’s ability to be on the program, a work requirement for able-bodied participants, and make it mandatory for people to report their income on a monthly basis. While the lifetime limit would be a problem down the line — it’s not retroactive — the income reporting is of particular concern. “To me that’s the biggie because if you forget a month, you’re locked out for a whole year,” Humble said. The bill hasn’t been passed yet, but with the new administration, they’re expecting it to be allowed through in early 2018. It’s too early to tell what effect that would have on the insured rate in the state.
Humble has an interesting proposition for Arizona to get more people insured, based on a Nevada that didn’t pass: Let people who are left behind by both AHCCCS and the ACA buy-in to the Medicaid program. “They make too much money for the advanced premium tax credit, so that’s more than 400% of poverty, and so they have to pay full freight for the premiums, and if they don’t have group health insurance through their employer or something, they’re kind of stuck with really expensive health insurance.”
“They’d be able to take advantage of the economy of scale that AHCCCS has when it goes out for RFPs to the managed care plans and the medicaid program,” he said. “It’s not that we’re asking the government to subsidize anybody’s health insurance, but provide another option for those people that really got the short end of the stick from the ACA.”
It’s also wise for Arizonans, and Americans generally, to keep health insurance at the top of their minds. With ongoing proposed cuts for Medicaid and proposed repeal of the ACA, many people may need to fight to keep their health coverage. In the meantime, those who aren’t insured should be exploring their options. While the window for 2018 coverage under the ACA has closed, AHCCCS does not have an enrollment window.
“One of the things that is surprising to me is the number of people who would qualify for medicaid but just aren’t signed up,” Humble told me. “They qualify for medicaid but they don’t know it or never thought about applying… or work for an employer that might offer health insurance but they get paid so little that they still qualify for Medicaid.” If there’s a chance that’s you, you can see if you’re eligible by going to the application form at AZAHCCCS.gov.
Healthcare is a looming question mark in the United States. Unlike many similar countries, such as the United Kingdom, Canada, and Australia, the US has a for-profit healthcare system, where citizens have to pay in order to receive health insurance coverage. On top of insurance, also have to pay for co-pays, deductibles, medications (which can still cost thousands of dollars every year even with insurance) and services that insurance refuses to cover, like certain preventative screenings. The cost of medication is so high in the U.S. that both Democrats and Republicans have proposed Personal Prescription Importation legislation that would allow Americans to import drugs from approved countries like Canada.
Colleen Stinchcombe is a writer living in Phoenix, AZ. She writes for publishers, brands and individuals. Her work can be found on SheKnows.com, Green Living AZ, the Brandless blog, Canadian Pharmacy Blog and elsewhere.
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