Medi-Cal: The $0 Copay Plan

February 7, 2012 - By admin

Katy Grimes: If you didn’t already believe that there is a concerted effort underway to force socialized health care on all Americans, perhaps it is time to change your mind.

California sought permission recently from the federal Centers for Medicare & Medicaid Services to collect co-pays from Medi-Cal recipients – the class of people in California who pay no income tax, but receive free health care. The Obama Administration rejected the state’s request.

Medicare recipients were lumped into the request, but are different because they paid into the system for decades with Social Security taxes – California’s eight million Medi-Cal recipients did not, do not, and apparently will not.

Federal officials told California that the request violates the Social Security Act, proving that we have several generations of government employees and welfare recipients who believe they are entitled to government care at no personal cost.

But the state only requested permission to charge for co-pays of $5 for a doctor’s visit, $50 for an emergency room visit, $3-$5 for medications, and $100 per day for hospitalization, up to a maximum of $200. What I wouldn’t give for a health plan with those co-pays.

ObamaCare

It looks as if we all may get the same health plan soon, but with a reduction in care and services, unless ObamaCare can be stopped. The centerpiece of ObamaCare is the individual mandate, the provision that makes it mandatory for every citizen to purchase private health insurance. The mandate is currently under review by the U.S. Supreme Court.

While private sector, employed Americans pay exorbitant health insurance premiums for less and less medical coverage, public employees and welfare recipients receive comprehensive gold plans, with very low contributions, and low or no co-pays.

The argument from the Obama administration is, that for welfare recipients and the retired, people “struggling to make ends meet,” a $50 copay for an emergency room visit, or $5 for a doctor visit, could prevent people from seeking necessary care.

Middle class and working class people have lived with the same dilemma for years. Ironically, in private sector, we assume that actuaries plan on higher co-pays making people think twice about seeking medical care. But with most welfare mothers running to the doctor for every runny nose and cough, Medi-Cal should have a co-pay.

The people in government making up this drivel must not share doctors with Medi-Cal patients the way the rest of us do. Even with my private health insurance, every time I go to the doctor, for which I am charged a $40 co-pay, the waiting room is filled with Medi-Cal patients, who appear to use trips to the doctor as a social outlet.

They brag about how they  don’t have to pay for anything when they go to the doctor. They compare medications, illnesses and conditions, and talk about medical issues with the confidence of a nurse practitioner, while sick people taking time off of work, come and go.

After four back surgeries and rehabilitation therapies, I’ve seen the inside of too many doctor’s offices, and been around too many fakers with time on their hands.

This will only get worse, and is where we are headed. According to the people who brought you ObamaCare, asking welfare recipients to pay $5 is considered “a much bigger chunk out of their budget” than it is for working people.

I’d like to know what “budget” they are talking about. I have a budget because I work and earn an income. Those who receive government assistance as a vocation, don’t have “budgets.” Apparently asking them to pony-up money for a visit to the doctor doesn’t fit into the big social plan for liberals.

The Public Vs. Private Divide

For 20 years, I was responsible for purchasing health insurance plans for a large, private sector manufacturing company. I have seen the erosion in private sector benefits first hand, while watching premiums increase every year. And every year insurance brokers talked about the expanding “Cadillac” medical and dental plans the state, city and county employees were enjoying, while Cadillac health plans weren’t even being offered anymore to small group private sector employers. According to many brokers, insurance companies couldn’t make as much money from the private sector plans as they could from selling insurance to governments.

While government regulators hammered away for years at insurance companies, they’ve driven health insurers right into the outstretched arms of ObamaCare – and they are dragging us with them, kicking and screaming.

A new report commissioned by America’s Health Insurance Plans, examines the impact of the health reform law’s premium tax on the cost of health insurance coverage. (Beware the phrase “health reform” – it is a plan to expand coverage to more people, and charge insurance companies a hefty excise tax to accomplish this)

The report shows that the premium tax:

Will increase premiums by an average of 1.9 – 2.3 percent in 2014.

Will increase premiums by an average of 2.8 – 3.7 percent by 2023.

In the small group market, of which most private sector health insurance is, this translates into an average increase of $2,800 for individuals and $6,800 for families over a 10-year period.

The premium tax also applies to Medicare Advantage, Medicare Part D and Medicaid managed care plans.

While the middle and working class are being disproportionately squeezed with higher taxes, higher utility costs, higher food bills, higher education bills, and getting regulated, taxed and fee’d to death in small business, the only class of people that government seems to care to protect anymore is the welfare class. If only the same care was shown to the people who create jobs and work…

FEB. 7, 2012

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Comments(12)
  1. Beelzebub says:

    The government spent $53B on medicare and medicaid (cal) in 1980. Last year it spent over $800B. That’s an increase of about 9% a year. There’s no indication that rate of increase will slow. By 2020 the outlay will increase to $1.6T or more. That’s roughly half of the nation’s current total Federal budget. That’s can’t happen. It’s mathematically impossible without massive cuts in care and services.

    Obamacare’s mandated coverage does nothing more than reward the insurance companies that game the system for profit. Mandated insurance will produce additional windfall annual revenues of $80B or more for the big health care insurance companies. These are companies that can currently blackball you from health care insurance for something as common as high blood pressure. These are companies that require prior authorization for routine procedures and prescription that are oftentimes denied.

    We currently spend 18% of our GDP on healthcare in America while euro nations spend 9%-11%. And the euro nations show better medical outcomes across the board. The french, germans, austrians, dutch, swedes, canadians, etc… are overall very happy with their HC systems. Americans are being gouged for their healthcare and receive shoddy care in return. We subsidize the entire world for their prescription drug care. You could buy an american made pharmaceutical (generic or branded) in most any developed country for about half the price that you would pay at any given american pharmacy. That’s because the laws passed by congress are bought and paid for by big american pharma companies.

    Much of the problem in America is the cost shifting. When illegal Juanita crosses our borders in her 7th month and drops her package in one of our American hospitals you are forced to pay for it. Chances are she had poor prenatal care and has a special needs baby – which will cost you $millions$. And of course illegal Juanita is provided with taxpayer funded housing, food and medical care when she leaves the hospital. Due to this ‘cost shifting’ when a regular citizen who fell on hard-times and lacks insurance goes to the ER he’s charged $25 for an aspirin. Break your arm or leg without insurance and it’s going to cost you $15,000 for ER treatment. If you don’t pay it they’ll slap a lien on your home or seize your bank account. One half of all bankrupcies in the United States are due to unpaid medical costs. But somebody has to pay for Juanita and her newborn.

  2. Rex The Wonder Dog! says:

    Break your arm or leg without insurance and it’s going to cost you $15,000 for ER treatment. If you don’t pay it they’ll slap a lien on your home or seize your bank account. One half of all bankrupcies in the United States are due to unpaid medical costs. But somebody has to pay for Juanita and her newborn.

    You nailed it, $25 for an asprin if you’re uninsured.

    BTW-80% of ALL BK’s are due to two factors,1) health problems (aka no insurance under insured) and job loss, not over spending as many yahoo’s will claim.

  3. Rex The Wonder Dog! says:

    But the state only requested permission to charge for co-pays of $5 for a doctor’s visit, $50 for an emergency room visit, $3-$5 for medications, and $100 per day for hospitalization, up to a maximum of $200. What I wouldn’t give for a health plan with those co-pays.

    Actually this WAS the law up until 12-31-2011. Visits were $5 co pays, meds were $2 co pays, no they are free.

  4. CalWatchdog says:

    Beezlebub, the “french, germans, austrians, dutch, swedes, canadians, etc… are overall very happy with their HC systems,” is an incorrect statement. Those governments are happy with the HC systems. The french, germans, austrians, dutch, swedes, and canadian people come to America, and travel to India and Mexico for the surgeries that they need and cannot get in a socialized healthcare system.

    How do you think that insurance companies game the system for profit? Because of government regulations and interference. If you’d only allow business to thrive or fail without government interference, the free market would support the good ones, and the bad businesses would fail, as decided by the consumer.

    - Katy

  5. Beelzebub says:

    “The french, germans, austrians, dutch, swedes, and canadian people come to America, and travel to India and Mexico for the surgeries that they need and cannot get in a socialized healthcare system”

    There are over a million american ‘medical tourists’ who are forced to travel abroad each year because they can’t afford medical treatment in the US. Many must go to India, Singapore, Thailand, etc… otherwise they would either die or live the rest of their lives being chased by a bill collector. None of the euro citizens are denied a life saving surgery, nor do they face bankrupcy as a punishment for getting sick. You should talk with a few of them like I have. Most are very satisfied with their HC system. Polls show that the large majoriyt of Canadians much prefer their HC system to ours. Research it.

    You’re not understanding how the corporate-government swindle works. The corporations bribe the politicians to pass laws that favor thier respective industries. Why do you think there are laws against the reimportation of American made pharmaceuticals once they are sold to our global neighbors??? To benefit the consumer. We pay 2x-3x the amount here for american made pharmaceuticals than foreigners pay throughout the world. American big pharma wants US citizens to subsidize the rest of the world.

    Here in America our per capita HC costs FAR OUTDISTANCE europe or any other developed global economy. Don’t believe me? Read this:

    http://www.kff.org/insurance/snapshot/OECD042111.cfm

    Since our medical care in America and outcomes suck compared to the other nations, according to the World Healthcare Organization – where do you think all the excess money we spend goes??? To the middlemen – the healthcare insurance companies.

    And please don’t claim that the europeans get rationed healthcare.

    For God sakes. We have 40 million people without healthcare insurance and folks with high blood pressure who get blackballed by the cherry picking insurance companies. That’s not rationing???

    Your continuous finger pointing at the government without placing equal blame on the corporations for the mess we’re in is totally misinformed.

  6. Beelzebub says:

    Oh, and for all those misinformed naysayers who claim the canadians hate their health care system and all come to America for treatment need to read this and get in touch with reality:

    http://blogs.chicagotribune.com/news_columnists_ezorn/2009/08/never-mind-the-anecdotes-do-canadians-like-their-health-care-system.html

    All the polls say the same thing. Canadians much prefer the healthcare system they have to what we have here in America.

    So let’s put all the myths to bed once and for all.

  7. queeg says:

    Socialized medicine is bad..

    What about asking payment for saving lives.

    Copys and premiums before fast food….hmmmm!

  8. Beelzebub says:

    “Socialized medicine is bad..”

    I guess that’s why the canadians overwhelmingly prefer their HC system over ours.

    The problem with our HC system is that it was designed to benefit the corporations and not the citizens.

    That’s why we spend 18% of our GDP on HC while all the socialized nations spend 9%-11% on HC and produce better outcomes.

    Please don’t ignore the raw data when formulating your opinions.

  9. daisygirl says:

    It is interesting how biased you are against all Medi-Cal recipients. It is not a good idea to lump everyone into one stereotype. I was married for 12 years and worked from home the last 6 years. Shortly after my separation, the job I had laid off most of us because the insurance company had begun to hire in-house. I found myself jobless and the single mother of two children. I first hunted the want ads for a job with which I could feed my children, pay rent, make my small car payment, etc. etc. Even though I’d worked regularly for approximately 18 years, I discovered that there were no jobs that matched my work history nor was there a job which would cover my expenses. What I had to do was apply for Medi-Cal because once my divorce was final, I no longer had health benefits. I also began to go to school more than full-time and I started working part-time. I take more than a full course load because I’m anxious to get to a point where I can work full-time in a job that will help me take care of my kids. I was told that it would take me three years to get through the junior college, but I got through in two and earned two AA degrees. I have just finished my first year at the university and I have one year to go until I earn my BA. Again, I am taking more than a full course load and am attending summer school so I can get through quickly. After my BA I will earn my teaching credentials and hopefully I will be able to find a job soon after that (this may be a struggle as well). However, the difference will be that I will have an education behind me which I did not have before so I will be qualified for jobs which will help me provide for my kids even if they aren’t teaching jobs.

    Your statement, “Medicare recipients were lumped into the request, but are different because they paid into the system for decades with Social Security taxes – California’s eight million Medi-Cal recipients did not, do not, and apparently will not,” is very asinine and shows just how uninformed you are about people like me.

    I worked for 18 years and put into the system; I am working now; I will be working in the very near future. I am working hard to get through school quickly while dealing with a two-hour round trip commute, keeping a house, taking care of my kids, and working two jobs. When you figure the hours that I put in for just school, work, and my commute, my work week totals 69 hours. This doesn’t even include extra things that are required for my classes such as internships and having to go do other outside assignments which take up my “extra” time nor does this include maintaining the house and yard and everything else that we all need to do in our daily lives. While doing all of this, I am also maintaining a 3.855 GPA and have been invited into an honor society, two of them actually.

    I am not complaining about my situation. I could have easily sat on my rear end collecting cash aid and whatever else I could, but that is not in my character. I know I’m not the only person on Medi-Cal with this mindset. I know this because there are many like me on the college campuses. We want to work, we just need help for a little while until we can get ourselves there.

    So, please, next time you want to make a blanket statement like that, think twice and consider that you may not know everything you need to know in order to say such a thing. Try doing a little more research on the demographics and maybe even interview some Medi-Cal recipients.

  10. nikki says:

    Most children receive medical aid. In my state you can make up to 60,000 dollars a year and may be only pay 24 dollars a month and have a $5 copay. A 5 dollar Co pay for some one making $5,000 a month is nothing but for some one only receiving $490 for them self and child can not even pay rent. Also when you started that people bring their kids to the doctor for every runny nose. I say that is a good parent because they want to know what is wrong with their child. If they didn’t take their child I would wonder more.

  11. Nimue says:

    I enjoyed reading this and grew in my understanding of the many aspects of health and care and disease and insurance.

    Health is a real wealth. And far preferable to disease and injury. We’re all better off with health. We all need access to care when we need it. It’s about being a human, not whether you can afford it. This country and society live in a lot of disease, and the insurance protocol for going to the doctor makes a lot of sense. Just not a lot of health.

    And as far as immigrants using medical services, many pay for them, also. Many work and pay for them. If the system were less abusive, discrimination would end.

    Just think about it, maybe increasing numbers of people wouldn’t be getting whooping cough now if everyone could just go to the doctor right away if they developed a persistent cough. Especially whoever brought it into the locality in the first place. Whether they could afford it or not.

    Thanks for your consideration, and thought provoking blog.

  12. Rachael Towne says:

    All medi-cal recipients pay no income tax? Wrong. I’m self-employed and make around $5,000 per month. My husband lost his job, so we have been living on my income. We sure as hell are paying income tax.

    My children qualify for medi-cal under the new ACA guidelines and I’m so grateful! If this ever happened to you and you or your children ever needed medi-cal, I would be happy that my tax dollars would help. It’s called not being a sociopath.

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