When we first wrote about Devor, a commenter on the CJR site asked why he did not enroll his kids in the Illinois state insurance program for children. Devor followed up and after a few tries got them enrolled in All Kids. He dropped his family coverage, leaving only his wife without insurance. That brought up another problem—doctors in Salem don’t want to see children who are insured under the state program, and Devor’s children are unable to get back-to-school appointments with their pediatrician. It seems, Devor said, they don’t get paid enough from All Kids. “We had a doctor for nine years, and he won’t see us,” Devor told me. Three weeks ago his ten-year-old daughter needed an emergency appendectomy and was taken by ambulance to St. Louis Children’s Hospital. All Kids covered the bills, and everything was fine until she needed a follow-up appointment and couldn’t get one in Salem. The one doctor who would treat All Kids patients was too busy. So Devor’s wife drove their daughter two hours to St. Louis to a doctor who would do the check-up, an expensive proposition considering the high gasoline prices and a paycheck stretched thin.
When Campaign Desk chatted with Devor before the health reform law passed, it was unlikely reform would help him much, because he had coverage from an employer. Now it’s clear health reform won’t help at all. “Health reform made an effort to preserve the status quo for employer coverage,” explained Larry Levitt, a senior vice president at the Kaiser Family Foundation. “The upside is that people didn’t have to change their coverage. The downside is that families who can’t afford employer coverage or the coverage is inadequate will not be helped by the new law. They will be people in the lower-to-middle income range who will be affected.”
Devor will be barred from buying insurance in the new state shopping services, called exchanges, and from receiving a government subsidy to pay the cost, because the premium from his employer for him is less than 9.5 percent of his gross income. A recent proposed Treasury Department ruling also means that his wife and children will not be able to buy a policy either. Their eligibility for a subsidy is based on the premium that Devor would pay from his employer. “Even if they gave me a subsidy to buy insurance,” Devor said, “it would have such big deductibles and coinsurance, I couldn’t even use it. That’s what happened before when I had insurance. Theoretically, Devor is better off than most in this predicament because his employer pays the full cost for him.
Nevertheless, Levitt says Devor’s assessment is correct. He works for a firm employing fewer than fifty workers. Policies sold to workers in these small groups can carry deductibles as large as $4000 for a family and as large as $2000 for an individual. Small businesses can offer a policy that—while providing the essential benefits the law calls for—will, on average, cover only sixty percent of someone’s medical expenses. These so-called bronze policies will likely be popular because they are cheaper than those covering more of a worker’s expenses.
Devor hopes his kids can stay on the state program, but that depends on his income. The more he makes, the more likely it is his children will no longer qualify, and he will once again have to pay for family coverage, and cope with the ever-increasing out-of-pocket expenses that overwhelm his budget. He may be one of thousands or perhaps one of millions of Americans who will still be uninsured—those in a no-man’s land forgotten about in the sales job for reform.