Even the upper middle class would have difficulty financing a 200K medical bill. And 200K, or higher, is quite common these days. A 20% co-pay on 200K is 20K. Most middle class families could finance that. I don't know what percent of middle class families are fully covered by insurance, but i imagine that data is available. It's the young not covered under their parents' policies and that make too little to qualify for premium subsidies under Obamacare and too much, or lack dependents, to qualify for medicaid in the States that did not expand Medicaid that have a problem if they become seriously ill or have a bad accident. They only have access to medical care through the emergency room or charity clinics, unless they have atypical financial means of course. If anyone thinks this is adequate care they should re-think that. From Mississippi, where I live, here is a true anecdote. It is by no means an isolated incident. And although anecdotes usually do not help us learn what is true in general, this particular anecdote is an exception and will be very helpful in understanding how irrational our U.S. medical care system can be in conjunction with the qualifying rules for medicaid in the States that did not expand medicaid. I know quite well, I've known him since he was 20, a young man now in his early thirties that is HIV Positive. He makes too little to qualify for insurance premium supplements, and he has no dependents. Mississippi did not expand medicaid. To prevent his HIV infection from progressing to AIDS, he needed to be on antiviral protease inhibitors, but he was told by his physician at the State run Clinic that there was no funding for antivirals in Mississippi that would cover him, and the cost would be approximately $3000 per month*. Eventually he developed AIDS and his health rapidly deteriorated. The same clinic told him he had only a few months to live and asked him if he would rather remain at home or go to a Hospice. They still did not offer any path for him to obtain protease inhibitors.** A friend, not associated with the State run clinic, told him that now that he had AIDS and only months to live he could qualify for disability, and once he was declared disabled he would then qualify for medicaid and have access to protease inhibitors. The friend knew how to go about this and was instrumental in helping him rush through his disability application. He finally got on protease inhibitors just in the nick of time, as in another month he very likely would have been dead. His T-cell count bounced back. He is now undetectable and relatively healthy. He wants to work full time, but if he works a regular job he will lose his disability status and with it his Medicaid which is what is keeping him alive and well. He can work for a limited number of hours and not lose his disability status. The question remains, why didn't the State health clinic advise him on how to qualify for disability once he had AIDS, and even assist him in doing that! What a System!!! And why are we preventing people who want to work full time from doing so! In Mississippi, there is no reason to think this is an isolated incident. There is just no way to know how many young men and women with AIDS the State may have succeeded in murdering (there is no other appropriate word) by this same route. ____________________ *This is the approximate cost for an individual. Who knows what the actual cost to an insurance company or the State clinic might be. Probably a lot less. **What's rather bizarre here, is that I would guess his hospice care would be paid via State medicaid? But then, while in the hospice, he would have had access, wouldn't he?, to protease inhibitors via medicaid. But If he had access to protease inhibitors his T-Cell count would have recovered and he would than no longer qualify for Hospice care or medicaid. It's a catch -22 situation with the only real path to a solution for this situation in Mississippi being through full blown AIDS and then via Social Security disability. So why did the State health department fail to council him on this. Are we Mississippians intentionally trying to kill our HIV positive citizens? I just checked on this via google and apparently medicaid pays for hospice care only if you qualify for medicaid, the Mississippi hospice plan is apparently a separate deal in that even if you don't have private insurance or medicare, or medicaid, the state will still 'generously' offer to let you die in a hospice. How nice of them.
Have only read the first few lines and am already confused. Question: what keeps someone who does not qualify for either govt program to get privately insured? Can't be more than 500 dollars a month for a young person you described and 500 should amount to a very good coveragte with low deductibles and hardly any copay, no? Will keep on reading... Thanks in advance for your lengthy post.
I can't say for sure but my guess would be that while he was healthy he barely made enough to get by and 500 per month would have made it almost impossible to pay his basic bills. In retrospect it would have been wise to take out that $500 policy even if he had to live in his mother's back yard in a tent! (I understand insurers have to accept you regardless of pre-existing conditions, but is the premium the same regardless?) He probably just foolishly kept putting off buying insurance until he had AIDS and then his health deteriorated so rapidly he wouldn't have made it to the next enrollment period. He lives with his mother now and gets $500/mo disability payment. He gives most of that to her to help with expenses. She works as a waitress in a casino, and she has his identical twin brother, who is paralyzed from the mid waist down and wheelchair confined, living with her as well. This is one of those situations that makes the rest of us very thankful indeed.