Uncovered California: Why Millions Have Fallen Into Health Care Gaps

Yves here. This post on Covered California gives an update of sorts on Obamacare. Recall that Covered California is as good as Obamacare gets. Yet this article details how it has fallen short, particularly for low income people,

By Sasha Abramsky, who writes regularly for The Nation, and the author of several books, including Inside “Obama’s Brain,” “Breadline USA” and “American Furies.” His latest book, “The American Way of Poverty: How the Other Half Still Lives,” was published by Nation Books in September. Originally published at Capital and Main

“Right now, I have a medicine sitting at Wal-Mart pharmacy that I can’t purchase till payday,” Jacqueline, a 55-year-old San Diegan told me during a telephone interview in mid-April. She asked that her last name not be used for this story. “I’ll go without, eight or nine days till payday. It’s for my high cholesterol.”

Five years after the Affordable Care Act became law, and more than three years after California began moving aggressively to implement its provisions, upwards of three million Californians remain without health care coverage; and millions more, like Jacqueline, have basic coverage but continue to be grievously under-insured.This is the story of how so many Californians continue to fall through the ACA’s cracks.

Until a few years ago, Jacqueline worked a hospital security job, which paid fairly decently. Then she lost it and ended up with another security job, this one paying only $11 an hour. It didn’t come with health insurance, and so Jacqueline went online to buy insurance through California’s health insurance exchange, set up in the wake of passage of the Affordable Care Act. Because her earnings left her well below 400 percent of the federal poverty line – the upper limit for insurance assistance under ACA — she qualified for subsidies.

These subsidies are calculated on a sliding scale according to a recipient’s income, so that people pay anywhere from two to 9.5 percent of their income. But, Jacqueline dis covered, buying into a gold or silver plan would still cost more than she could afford. And so, despite the fact that she suffered from diabetes, high cholesterol, neuropathy and other ailments that required frequent doctors visits and a steady array of medications, she bought into a bronze plan.

Such plans essentially shift the financial burden from now, when the monthly payment is due, to later – when the bills come in from doctors; prescriptions have to be paid for out of pocket. They cap out-of-pocket expenses at $6,850 for an individual and $13,700 for a family – which, for the working poor, represents a prohibitive outlay of cash. (A Cost Sharing Reduction Subsidies program can significantly reduce out-of-pocket maximums.) Take, for example, the story of Maria Can de Tec, a laundry worker at an Orange County convalescent hospital, who managed to buy subsidized Anthem-Blue Cross insurance for $151 per month but, following an emergency room visit for internal pains and bleeding, ended up with nearly a thousand dollars in bills that she is now having to pay off in $76.92 monthly installments.

The bronze plan that Jacqueline chose still cost her $50 per month — the upper limit of what she could afford — and, as she found out once she began using its medical services, it came with hefty copays and deductibles. It was, in many ways, barely more than catastrophic coverage. Near the end of each month, with no money in the bank and days to go until her next paycheck, she would run out of medicines.

“I can tell the difference when I have my medicine and when I don’t,” she said. “I have more stress and worry. I wanted to see the doctor about issues of mental health. Stress and tension. And once I found out how much it was going to cost, I didn’t go. I came to a decision that I really need this, but I couldn’t afford to go. And I’m having really bad issues with my neck, back and legs – and I can’t afford to go to the specialists.”

When the Affordable Care Act was passed, California embraced its principles more assertively than did most other states. It set up the nation’s biggest insurance exchange and invested heavily in Covered California, the organization responsible for bringing the uninsured into the insurance system; it added state dollars to provide additional subsidies to anyone whose earnings placed them at less than 250 percent of the federal poverty line; it expanded its Medi-Cal roles dramatically – the ACA allowed states to cover anyone whose income was no more than 138 percent of the poverty line. And it has spent heavily, for each of the last five years, on outreach to bring children and other particularly vulnerable groups into primary care settings – since studies indicate that previous expansions of the health care safety net, from the State Children’s Health Insurance Program, to Medicare for the elderly, have taken four to five years to bring in all the people they can, and to reach a state of steady enrollment.

The ACA, says Anthony Wright, executive director of the Sacramento-based advocacy organization Health Access California, which campaigns for policies that would bring more Californians into the health care system, “allowed us huge progress. We’ve cut the number of uninsured by half. We had seven million uninsured prior to ACA. The modeling suggested we would land at around three million – and that three or four million would [eventually] be covered.” So far, California has already outperformed these goals, with close to four million newly covered Medi-Cal patients, and upwards of 1.5 million buying into subsidized insurance.

And yet, because of the way the federal law was worded, as well as some of the unique demographic and economic characteristics of the state, six years after the ACA’s passage many millions of Californians remain uninsured; data from the 2014 California Health Interview Survey, the most comprehensive study to date, estimates five million. They are, as researchers from the University of California, Berkeley’s Center for Labor Research and Education, and the University of California, Los Angeles Center for Health Policy Research calculate, disproportionately Latino and male, and most of them work at least 30 hours per week. In addition to the uninsured, however, hundreds of thousands more, like Jacqueline, bought into bronze plans that essentially provide financial disincentives to seek medical attention and thus leave them significantly underinsured.

There are the spouses and children of workers whose employers provide them with health insurance but either don’t offer coverage to family members or offer it only at a price that renders it unaffordable. Because of an accidental miswording in the ACA, these families, even if they are less than 400 percent of the poverty line, aren’t eligible for subsidies. It’s a trap that advocates refer to as the “family glitch” and it ought to be relatively easy to fix. But because the Republican majority in Congress is more interested in defunding ACA than in filling in holes in its coverage, the glitch remains in place. In 2011 UC Berkeley Labor Center researchers calculated that 144,000 Californians were caught in this trap.

“If my husband, daughter and I all purchased insurance through his employer,” wrote Brenda, a 57-year-old woman from the town of North Hills, to Bethany Snyder, who until last May was director of communications at Health Access California, “that amount would be half of his monthly take-home pay, leaving very little for food, housing and other essentials.” While her husband was covered through his employer, and their daughter was on another insurance plan, which cost them $161 per month, Brenda herself was unable, because of this, to afford insurance. Instead, she was relying on a cost-sharing plan for her medical bills run through Christian Healthcare Ministries. It was better than nothing, but she still wanted, one day, to be able to access proper health insurance.

In high-cost-of-living areas of the state, there is another problem: families at just over 400 percent of the poverty line, who on paper ought to have plenty of disposable income to buy nonsubsidized insurance, but who spend so much on housing that they end up not having enough to buy insurance.

While there are tax penalties in place for those who go uninsured, those penalties are not imposed on people who can show that to access nonsubsidized insurance they would have to spend more than eight percent of their income on health care policies. In some parts of the Bay Area, for example, health care analysts have found clusters of middle-aged people who are foregoing coverage because of extremely high housing costs, and who are not subject to tax penalties because the cost of insurance, which rises the older one gets, would be more than eight percent of their income.

The last, and largest, remaining group excluded from health care coverage consists of California’s millions of undocumented residents. When ACA was passed, Congress explicitly excluded them from access to Medicaid and to federally subsidized insurance policies. As a result, even as most of the legally resident poor in California have accessed some form of coverage in the years following the ACA’s passage, the undocumented remain intensely vulnerable. Wright estimates that whereas, before ACA, only one in five of the uninsured lacked legal residency status, today upwards of half of the state’s uninsured are undocumented.

“They have to rely on the emergency room for all their health care needs,” explains Don Nielsen, director of government relations at the California Nurses Association. (Disclosure: CNA is a Capital & Main financial supporter.) We’ve met opposite the Capitol building in a café frequented by the political classes. Nielsen is wearing Ray-Ban sunglasses and a black suit with a “Bernie” pin on a lapel. The CNA had, months earlier, endorsed Bernie Sanders’ presidential campaign in large part because of his commitment to single-payer health care. “That’s a big roll of the dice,” Nielsen says. “They [ERs] have to accept everyone, but they are only required to ‘stabilize’ them. They don’t have to do anything beyond that. It’s real hit and miss.” CNA’s slogan on health care reform was simple: “Everybody in, nobody out.” Under single-payer, Nielsen states, no one, regardless of their immigration status, could be denied access to health care.

Says one Sacramento resident, who was undocumented for 16 years and asks to remain anonymous, “My Dad has needed a surgery for a hernia operation for years.” Her parents, who live in the southern part of the state, remain undocumented. “He’s just been waiting, hanging on, hoping there will be a time he can afford surgery and time to recover. It’s a struggle. There’s no safety net.” The woman’s father had worked for years in a factory that made RVs. But then he became injured and could no longer do the heavy lifting required in the factory, and he was out of work.

“It’s kind of a sad tune we are all familiar with,” his daughter explains. “We know we’re forgoing care. It’s too expensive. It’s too bad, you know?”

Many California counties, no longer having to provide indigent care for poor, able-bodied adults now covered under Medi-Cal, have used some of their savings to expand basic clinic coverage for undocumented residents – realizing that it is actually cheaper to provide more comprehensive primary care coverage than to have to pick up the emergency room bills accrued when the undocumented finally seek treatment in hospital settings. Forty-seven counties are now providing more than just emergency care to these residents, up from only nine just last year. But while that change has been welcomed by advocates, in the long run it is only a scattershot solution to a vast problem – and one that leaves the undocumented vulnerable to changing financial and political winds at the county level.

A more systematic approach has, in the past year, emerged at the state legislative level: In October of last year, Governor Jerry Brown signed a bill that would allow California to use state dollars to provide Medi-Cal to undocumented children. The provisions of this law, which follows passage of similar state measures and city ordinances in Massachusetts, New York, Chicago and Washington State, went into effect in early May of this year, meaning that with good outreach in the coming months almost all of California’s children could end up with health coverage. Wright and other advocates believe that upwards of 175,000 of the estimated 250,000 undocumented children in the state will soon be enrolled in Medi-Cal. The state is also using its own dollars to cover refugees who don’t have their green cards, as well as DACA (Deferred Action for Childhood Arrivals) students. If the U.S. Supreme Court allows DAPA (Deferred Action for Parents of Americans) to proceed, California will stand ready to expand health care access to this group, too.

For the past year, Sacramento has also discussed legislation that would allow undocumented adults to buy nonsubsidized insurance plans on the Covered California exchange. The legislation would require a federal waiver, but since the exchanges are no longer federally funded, such a waiver is likely to be granted. And this year state Senator Ricardo Lara (D-Bell Gardens) has pushed Senate Bill 10, a proposal that would expand Medi-Cal access, again paid for with state rather than federal dollars, to undocumented adults too. Polling from 2015 indicates 58 percent of Californians support this move.

Slowly, California is plugging the ACA’s gaps. It has taken five years to halve the number of uninsured in the state. It will likely take several more years to make a serious dent in the remaining numbers. And some of the problems, such as the family glitch, will likely still remain even at the back-end of years of effort.

But, unlike on the federal level, statewide there is at least now the political will to tackle this problem. And that’s a huge accomplishment in and of itself.

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  1. ambrit

    I’m in the 55 to 65 demographic and borderline poor. My state, Mississippi has not expanded Medicaid. Even if it did, I would be facing the dreaded ‘estate recovery’ option. Despite the State of Californias’ efforts, that state has millions of uninsured and more millions of effectively uninsured. This state by state disparity clearly violates the spirit of the Equal Protection clause of the Fourteenth Amendment. The fix for the ACA must be a national one. Putting a stake through the heart of the ACA might be a basic prerequisite to any progress. This is an issue where ‘incrementalism’ is a net negative.

      1. ambrit

        I would rather have the ‘assets’ go to my wife if she outlives me.
        The other side to this coin is that today, basic medical care can easily bankrupt an individual or family; not only catastrophic care is now onerous. Plus, unless one is convinced of imminent death, voluntarily entering into the inferior position in a relationship of rent extraction is so irrational as to counterbalance the irrationality of forgoing medical “care.” I might add that the medical ‘profession’ as now formulated is not so much a science based inquiry after the truth of ones’ physical and mental well being as an exercise in the financialization of survival itself.
        So, to answer your question, yes, I do choose to pass what few ‘assets’ I have on to family rather than fritter away my funds on the Medical Industrial Complex.
        This is also a case of an obviously discriminatory law. The age bracket 55 to 65 is singled out for special treatment. One does not see income tax rates adjusted for age, do we? Inheritance taxes do not adjust for age either. The only logical reason for this age related carve out is the fact that, statistically, older people have more assets and are thus easier targets for ‘revenue enhancement’ policies.

      2. ambrit

        My first try at a response was eaten by hungry internet monsters.
        The short answer to your question is, yes, I would rather pass on what few ‘assets’ I have to family, especially my wife, rather than fritter away my funds on the Medical Industrial Complex.
        Medicine has become an exercise in unrestrained rent extraction. My old doctor recently retired. “I’m tired of wasting so much of my time and effort on pleasing insurance companies and greedy medical holding companies,” is the way he put it to me. I could argue necessary versus unnecessary treatment options with this good man. The newer younger doctors I have dealt with do not, as a general rule, hew to the Hippocratic Oath. The authoritarian mindset is strong in this cohort. The other issue in play is the proliferation of needless medical interventions, I suspect, prompted by financial considerations.
        Frankly, I espouse the full Nationalization of medicine. If one wants a hybrid system, make all medical schools free if the student agrees to a set period of service in the public health sector in exchange. Almost anything short of Witch Doctors will be superior for the society as a whole than what America has now.
        If you disagree, then Galts’ Gulch Medical Center is that way -> Good luck fulfilling their entrance requirements.

        1. Malcolm MacLeod, MD

          ambrit: You are right on target with your comment. I retired in 1996 (general pediatrics),
          just when practice was becoming less enjoyable and more constrained, and I worked for
          the Northern California Kaiser-Permanente Medical Group, which was as good as it gets.
          For years I’ve been preaching that the US needs single payer Medicare for all folks, which
          would solve our healthcare problems. The government subsidized my medical education
          (GI Bill, UVA.), at a time when a bank would laugh if you asked for a loan. Owing a huge
          debt can make new physicians a bit more money grubbing than is healthy, so that helping
          them a bit over a period of years pays off for everyone. This is the wise European way.
          Done correctly, medical practice is loads of fun and some laughs.

          1. ambrit

            Thank you for that first hand information. My old doctor also had a sly sense of humour. Once he figured you out and you checked out as humour friendly, watch out! I used to hear the receptionist laughing sometimes from behind that opaque barrier in his waiting room. Try and find a smile, let alone laughter in a large medical office today.
            One of my Moms’ good friends on Miami Beach was the Head Night Nurse at a local hospital. Some of the stories she told! All true she swore.

    1. pretzelattack

      that’s what i’m thinking, the aca is such a mess. one reason to vote for trump, at least we might get rid of this boondoggle.

      1. jackiebass

        You apparently haven’t done any serious research on the snake oil salesman named Donald Trump. He isn’t what he tells you he is.

        1. ambrit

          Well, as we’ve found out from prior study, the Democratic candidate is not much better than a Minion of the Dark Forces. Given the paucity of “good” candidates on offer, the mystery of Trump is far preferable to the proven evil of H Clinton. Sometimes one has to buy the snake oil in preference to the Jimson Weed and Arsenic mix.

  2. Pat K California

    Very well done article, I would say … as a self-employed Californian who has had her own difficulties with Covered California. However, I noticed that the article says nothing about the fact that many medical groups in the state refuse to accept insurance from Covered Cal … and that every year is different regarding who accepts what. That means that every year becomes a crapshoot. Will my doctors of long standing accept my insurance this year or not? I cannot tell you how often I have been sitting in a doctor’s waiting room and have overheard the receptionist tell some poor soul that, “Oh, we don’t accept Covered Cal.”

    The first time I signed up with them … that poor soul was me! Anthem Blue Cross led a whole lot of us to believe that our doctors accepted their Covered Cal policy. They are now in the midst of a class action law suit over that little lapse. Fortunately, I was able to bail at the last minute and thankfully found a decent policy in the private market, not the ACA. (In California, the private market has to offer you policies similar to the ones in the ACA … even though you will pay more for them.) What I found was that the only way I could keep all 8 of my doctors, plus my local hospital, year after year, was simply to pay more.

    Ha! Listen to me. “Simply” pay more!! “Simple” it is NOT, even though I make fairly decent money. The ability to have stability in my health care is costing me $1200.00 per month … plus a copay of $70 every time I see a specialist … $35 every time I get an EKG. The only thing that is saving me is the fact that I am only 9 months away from qualifying for Medicare, which looks like it will cut my cost down to $500 per month. Just have to grit my teeth and hold out till then …

    I’m glad California is stepping up to help the folks who don’t have my means. If health insurance costs are painful for people like me who can ostensibly afford them, I can’t imagine how much pain the poor must be in. This whole situation just sucks.

    1. inode_buddha

      In between CalPers and CoveredCal, I have to wonder just where the hell all that money disappeared to? Time for some citizen clawback… I never in my life thought I would be glad to be in the most business unfriendly state in the country — NY.

    2. TimH

      Oh yes, for Bay Area. I pay $750 fo Blue Cross, direct, because Palo Alto Medical Foundation doesn’t take Covered California. The dental part is worthless – only pays $50 for a cleaning, which costs $120. My company plan didn’t bat an eyelid. The copays are high, and the deductible is $5,000. Essentially the insurance is only useful under major incident circumstances, useless for preventative health care.

  3. Jim Haygood

    ‘The “family glitch” and it ought to be relatively easy to fix. But because the Republican majority in Congress is more interested in defunding ACA than in filling in holes in its coverage, the glitch remains in place.’

    This article makes a strong case that, even were the “family glitch” to be fixed, ACA still would be a dysfunctional program that imposes excessive copays and deductibles on subsidized participants.

    So let’s not omit giving credit to California’s great Nancy Pelosi, who advocated passing the 2,000-page Senate bill to “find out what’s in it,” after Senator Max Baucus engaged a health industry lobbyist to write it.

  4. Arizona Slim

    And tell me how single payer would be worse than this situation. Or, for that matter, a public option.

    1. NotTimothyGeithner

      HMO profits…duh. Although in the case of ACA, the insurers were going under because the HMOs are the real villain, and Obama and company wanted to save the insurance industry with a few bones to the voters. Obama and company expected the economy to roar to life because freedom or some nonsense. Does anyone remember the Democrats who kept saying, “maybe they should have focused on the economy before Healthcare”? It’s completely non sensical to separate the economy from the Healthcare industry, but Democrats are only smarter than Republicans, not exactly a high bar.

      Bernie Sanders as an independent only has his position as the ranking member of the Senate budget committee because the other 45 Senators (sans Reid who is still leader despite being grossly incompetent) are simply lazy and not interested in hard work. They’ll do sexy stuff such as mugging for basic cable which makes them feel good and working on campaign commercials, but the ranking member on the budget committee is THE plum job. And Sanders was the Veterans’ Affairs chair, another plum assignment that a non-party member should never have.

    2. Pat K California

      There is no question in my mind that a public option would be a vast improvement over the ACA. In fact, when the ACA was first signed into law in 2010, there actually was a public option … a little known temporary plan called the Pre-Existing Condition Insurance Program. It was meant to tide over people like me with pre-existing conditions who had no way to get health insurance before the exchanges opened in 2014. Best health insurance I’d ever had. All of my doctors and hospitals were covered. The premiums were eminently affordable. There was no hassle about what was covered (almost everything was covered except eyes and dental and cosmetic surgery).

      For nearly four years I was in fat city. In fact, at least in the beginning, the ACA was supposed to include a public option in 2014. Well, that was fine by me! I planned to sign up for that. No way was I going to go back to dealing with health insurance companies.

      Sigh. Of course, the public option vaporized sometime before 2014. What a huge disappointment. Getting thrown back on the tender mercies of private health insurers was not fun after four years of the government-run PCIP program, let me tell you.

      1. Code Name D

        Skeptical flag on the field! Being familiar with how the ACA came into being, I am going to need to see some sources regarding the public option being part of older versions of the plan.

        And I am skeptical that the public option would be much of an improvement. It’s rational works only in the neo-liberal free market, so there is good reason to believe it would only further complicate the system, or possibly even be a dumping ground for poor and expensive consumers, leaving the healthier and more lucrative consumers for the privet insurance to plunder.

        In practice, the public option seems to be used more as a tool to suppress talk of single payer plans or even nationalization.

  5. Jim Haygood

    Trash talk from the health coverage giants against the short-timer 0bama admin:

    (Marketwatch) Aetna and Humana said Thursday they would “vigorously” defend a planned merger against a Department of Justice lawsuit.

    The companies said that the merger has “tremendous value” to customers and thus “the facts do not support the basis for DOJ action.”

    They gave generously to the Clinton Foundation, and damned well expect their money’s worth.

  6. patrick

    Its strangely ironic that the woman mentioned in the first paragraph can’t afford her statin drug. These drugs should never be taken by women and they are virtually worthless for males. Statins are a remnant of the demonetization of dietary lipids. Start your research here: http://www.thincs.org

    1. Yves Smith Post author

      That is not true. Statins are beneficial IF you have heart disease. You are correct that they are widely overprescribed and that no one has (or will) look into the consequences of messing with the liver function over long periods of time. However, the article didn’t go into her medical history to indicate whether she has heart disease or not (as in they could be monitoring her cholesterol for that reason and not just the bias of modern practice). Moreover, heart disease is very much underdiagnosed in women:



      1. Arizona Slim

        I’ve read that half the people with heart disease don’t have high cholesterol. And that half the people with high cholesterol don’t have heart disease.

  7. diptherio

    Good article, but still frames the problem as lack of access to health insurance, not lack of access to health care. Might it be that insurance companies are themselves a hindrance to the delivery of health care, which is what I think we are all actually concerned with?

    1. Pat


      Unless and until we can make it understood that insurance does not equal health care and that the primary discussion should be about health care NOT insurance I believe that the discussion will largely go in circles. Somehow universal health care morphed into universal insurance coverage without accounting for the fact that the whole point of the health insurance business is to provide as little healthcare as possible, legally and otherwise.

    2. ambrit

      Right. What’s called the Health Insurance Marketplace is actually a Neoliberal triage operation.

    3. Michael

      People in the U.S. still regard and accept their health as a for-profit business. Until that changes, the businessmen (insurance companies) get to run “the market” (i.e., people’s well-being).

    4. Badtux

      It’s a two-part problem. The first part of the problem is that there is no market for health care, and cannot be, because health care is literally “your money or your life.” There is a market for car repair because if a car repair shop manages to destroy your car via incompetence, you can buy another car with the proceeds of suing them. But if a doctor manages to kill you via incompetence, you can’t buy another life. Reality just doesn’t work that way. As a result, people will pay literally any amount up to total destitution in order to get the best doctor they can get, the doctor who has the greatest chance of keeping them alive. Your money, or your life. That’s the choice people are given. That’s not a market, that’s a Central Park mugging! (Note that this applies primarily to specialists in life-threatening diseases, which is why I as an engineer make more than family doctors, but way, WAY less than a heart surgeon).

      The second part is that the insurers, the people who are supposed to be stopping the mugging (via limiting payouts to doctors so that doctors cannot profit exorbitantly from their market power), have settled on a variety of negative mechanisms to do this, the primary ones being narrow provider networks (i.e. only the cheaper / less competent providers in their networks) and arbitrary denial of payment for services (same as arbitrarily denying services because providers are refusing to do procedures unless they know the insurer will pay). A lot of this is because the only way to actually stop highway robbery would be if insurers colluded to limit provider income as is done in other countries (for example, at the beginning of each year the French Ministry of Health gets together all the individual Medicare providers and health care provider representatives in the country and sets for the year what their payments and incomes will be — note that France has *multiple* Medicare funds, it’s effectively universal single payer but wasn’t originally), and such collusion is illegal under the current health care system in the US. So insurers resort to evil instead.

      Single payer would fix a lot of this, *if* allowed to cap disbursements to individual providers such that providers can’t make more than a certain amount of profit per year. Good luck on that one….

  8. anonymous123

    I have been planning for awhile to quit my job to start an entrepreneurial venture, but the sole reason I haven’t is because of health insurance. My husband has been out of work for a year and a half, so I’m our sole supporter and my employer-sponsored insurance is VERY good and reasonably priced. When I looked on Covered CA, it was nearly $700/mo for the two of us (we’re in our 30’s), with a ridiculous $4,500 family deductible for a Silver plan. No way in hell can we afford that if neither of us are bringing in an income, particularly with both of us seeing several specialists recently. So my venture waits…

    1. Arizona Slim

      Which is why universal health care, combined with single payer insurance coverage, will spark an entrepreneurial explosion in this country.

      1. jrs

        of course most people in a one income family where they are supporting another person (and kids?) in addition to themselves would not quit a steady gig to become an entrepreneur even with healthcare. Because it is crazy risky – upside may be riches but the downside is homelessness. I guess some would.

        1. anonymous123

          Thanks for the hefty dose of judgement, but in our situation our downside is not homelessness. And we don’t have kids. And who said my current gig was steady or stable? I should also mention, the “upside” of entrepreneurship is not always riches (most people will fail, so you can’t do it for money). For me, it’s about freedom.

          There were a lot of incorrect assumptions in your statement.

  9. mkexplorer

    I’m a self-employed Californian living in the Bay Area and must get my health insurance through Covered California. On paper, the coverage is quite good, but my otherwise excellent medical group will only accept one plan through the exchange. In other words, there’s no effective competition on an exchange that has dozens of plans. Consequently, the premium is sky high. Furthermore, if I need to go to the hospital, the nearest good medical center that accepts my plan is 50 miles away! Stanford Hospital is less than 15 miles from here, but my insurer dropped them from the plan this year.

    Initially, I believed the ACA was incrementally better than the awful system we had before, in that at least it covered more people here in California. However, the new system has been steadily crapifying (to use a common NC term) ever since it was introduced. If California is one of the better ACA states, God help us!

    I’ve long been a strong supporter of single payer. Despite the hopes and claims of the ACA’s advocates, seeing the law in practice has only strengthened my conviction that we need single payer now.

  10. Wade Riddick

    “diabetes, high cholesterol, neuropathy” – Each one of Jacqueline’s mentioned conditions is avoidable for most patients. They are caused by the rationing (or confiscation, if you will) of healthy nutrition and medical care.

    For instance, stripping fiber out of the food supply creates little sugar bombs that then 1) raise the consumer’s bad cholesterol, 2) cause insulin resistance leading to 3) diabetes and 4) neuropathy. Antibiotics aggravate the risk by killing the healthy bacteria in the gut that limit inflammation and maintain insulin sensitivity.

    We don’t subsidize the health care to deal with sugar but we do helpfully subsidize the sugar industry and the FDA is hard at work obscuring the damage caused by broad-spectrum antibiotics and fiber-free fraudulent foods.

    The privatization of public goods leads to their confiscation and ultimately extortion. The cost of the damage is far greater than any “profit” that results to the privatizer.

  11. ger

    Get over it! The ACA is welfare program that few can afford to use. The millions of enrollers, that are bragged about by the Obama Admin, do not have health care. They have “insurance” that is essentially useless and making the insurance policy holder even poorer.

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