I Did Some Math to See if I Could Afford the American Health Care Act. Here’s What I Found.

Let’s say, just, you know, maybe, could be, hypothetically, I’m living under the Republican-proposed American Health Care Act.

And before I begin, I want to note that I did all of this without a preconceived notion of what the outcome would be. I chose pretty (really) conservative cost estimates to give the American Health Care Act the benefit of the doubt, and to see if, in a hypothetical situation, I would be able to afford the healthcare I need under the proposed system change.

Say I’m 30 (as I am) and, for this example, I’m still able to work. Let’s say I earn $30,000 per year. But it doesn’t matter what I make, because the “tax credit” is now based on age and not income (unless I make over a certain amount). So, as a 30 year old, I get a $2,500 per year tax credit to either A) put into an un-taxed health savings account, from where I can draw money to cover medical expenses, or B) go towards paying the premium of any plan I choose that is considered an “eligible individual health insurance policy” (for instance, I wouldn’t be able to use the tax credit for a plan that covered abortion). Let’s just go with option B for this experiment.

Let’s say I have ankylosing spondylitis (AS) and post-traumatic stress disorder (which I do). I need infusions of a specialized drug every 8 weeks. This drug costs thousands of dollars per treatment and there is no generic. I also take medications to help with nightmares and trauma-induced insomnia. I take anti-inflammatory and pain medications to further manage symptoms of my AS. I need regular lab-work and doctor visits every few months with different providers, which averages to at least one specialist appointment per month in addition to monthly psychiatry and therapy appointments.

Let’s say I find an insurance plan that covers the treatments I need, has a low deductible, fairly affordable copays, and my current doctors are in-network. Let’s say the monthly premium is $700. With my $2,500 tax credit, I would be able to knock off about $200/month on that premium, so my out of pocket cost would be $500/month or $6,000/year.

Let’s say my copays are $15 per prescription, specialist visits are $30, and labwork and primary care provider visits are $25. With an average of six prescription refills or changes per month (taking into consideration the constant juggling of medications for people with difficult-to-manage chronic diseases), that’s an additional $90 out of pocket per month, or $1,080/year. If I see one specialist per month ($30), have bloodwork done or a primary care visit once a month ($25), and see a therapist and psychiatrist once a month ($30 + $30 = $60), that’s an additional $115/month or $1380/year.

Added up, my out of pocket medical costs (aside from any additional out of pocket costs for anything like massage, acupuncture, or over the counter medications) would average $705/month ($500+$90+$115) or $8,460/year ($6,000+$1,080+$1,380).

Now let’s look at my living expenses, with conservative estimates based on current numbers:

Martin Vorel Stock Snapio


Rent + utilities (including phone + internet): $1,500/month

Food and groceries: $350/month

Let’s just throw in my two cats, too, since they’re family: $150/month for food, litter, and pet insurance

I haven’t included extras, like clothes, entertainment (including cable), or travel. I haven’t included student loan payments. I haven’t included a car, since it isn’t seen as a necessity in many major cities, and I haven’t taken into consideration the cost of other transportation (like Lyft or public transit). And I didn’t include any wiggle room to to build a cushion for emergencies (like a house fire or a death in the family requiring time off work and travel).

With these estimates, my total living expenses apart from medical care are around $2,000/month or $24,000/year.

With the cost of medical care added, my expenses grow to about $2,705/month or $32,460/year.

Let’s look back at my income – $2,500/month or $30,000/year.

Ok, now lets throw a kink in the plan. Suppose I lose my job – maybe I become disabled and can no longer work…maybe funding ran out for my position. I’m newly unemployed with no income. It’s 2020, so funding for Medicaid has been capped and I can’t be enrolled because enrollment into Medicaid has been frozen. Federal funding for Medicaid will steadily decrease, leaving more of the financial burden up to states. This means my state will have less money to spread over a larger population of people who qualify for the program.

I’m stuck somewhere in the gap, not able to afford the insurance I need to cover my healthcare needs, and not able to access services through Medicaid. My disability application is taking years and years to process (as is the custom), so I don’t qualify for Medicare either. All my healthcare comes from emergency rooms, which don’t have the capability of managing a chronic disease (remember my list from above?), and my visits cost the system a lot more, not to mention cause a strain on emergency rooms that are meant to treat actual traumatic events (rather than chronic diseases that can often be effectively managed with adequate access to treatment). My condition shouldn’t be an emergency, but what other choice do I have?

With these “choices,” my care costs more than it ever would have, both to me and to the system as a whole. Even if I become employed again and am able to purchase a private plan, if I lacked insurance for 63 consecutive days, my premiums would legally cost 30% more for 12 months after getting insured again.

Nope. Nope. Nope. NO.

This is the difference between affordable access to adequate care and “choice.” Don’t let the American Health Care Act fool you. Choice is a sexy word, but only if you have money.

But please…let’s repeal the Affordable Care Act and replace it with the GOP’s plan.

Also, pay attention to Republicans who say, “We need to save the economy” without saying a thing about how the healthcare system is supposed to save LIVES. Also…they openly have not figured out yet how to pay for these changes, so for them to claim this is fiscally responsible is absolute BULL.


Sources for further reading or exploration:

This Kaiser Family Foundation Summary of the American Health Care Act

This PBS News Hour video: How Would the American Health Care Act affect cost and access?

This CBS MoneyWatch article: The American Health Care Act: What’s in it for you?


 

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