The flat tax credit would favor younger people, enabling them to buy more coverage; policies in the individual market cost less if you are young. Using the credit, Bell might be able to spend less on premiums for an Arkansas Blue Cross Blue Shield policy with a $1000 deductible and 20 percent coinsurance—if the carrier would insure him at all and if it didn’t tack on a 50 percent surcharge for having high blood pressure and being overweight (as measured by the insurer). Under McCain’s scheme, insurers would not have to cover people who are already sick.
Bell the younger would have the same problem. Even with the $2500 tax credit and additional federal subsidies, most likely he would still be uninsured. His diabetes makes him uninsurable. McCain proposes putting people like him in a special high risk pool for the sickest of the sick, where premiums would be sky-high and benefits may be limited. Without an income to pay the premiums required by the high risk pool, or very generous subsidies, it’s hard to see how this would be much of an option. Bottom line: James Bell IV would still have troubled getting needed care.
How they would fare under Obama.
Neither father nor son would be required to buy insurance. The elder Bell could keep his coverage, which will probably get more expensive. Although Obama has promised that he would lower the cost of premiums by $2500 for the typical family, health analysts dispute whether this is achievable. Obama talks of a public plan option: Medicare-like coverage that people could choose instead of buying from commercial carriers. Whether this option will be cheaper depends on who provides the coverage.
If the government offers the benefits, as it does for Medicare, it’s possible that Bell’s premiums and other out-of-pocket expenses could be lower. There would also be a uniform comprehensive benefit package. If private insurers, with their high marketing and administrative costs, offer the benefits, then it’s not clear which option would be preferable. Too much is unknown, and, as the Democratic Party’s platform notes, all this will be thrashed out in the legislative process anyway.
Bell the younger has a shot at getting the consistent, ongoing care so necessary for diabetics. Under an Obama plan, he might be able to choose coverage in the public plan, assuming subsidies that are high enough to cover the premiums. If by some chance the legislative sausage grinder turns out a provision for automatic enrollment in existing public plans, like Medicaid or the State Children’s Health Insurance Program (SCHIP), he would qualify, giving him fairly comprehensive benefits and a way to pay for care. All this assumes, of course, he can still pay the modest copayments that would likely be required, and that the federal government offers the states enough funding to provide additional coverage for currently ineligible people like Bell the younger.
If a public program doesn’t come out of the legislative give and take, or if insurers are successful at maintaining their ability to turn away bad risks like Bell, he might remain uninsured, relying on his dad to pay the doctors and Abbott Laboratories to give him the test strips.