There are a few inequities in health care coverage in America today. Here’s the top 10 on my list that illustrates the inequities.
1. Congress/Federal employees
The Federal Employees Health Benefits Program (FEHB) is great. You are a member of a very large risk pool and you get to pick a health care plan from competing insurers. What’s even better, if you’re a member of Congress, you can keep your coverage when you leave at the same low price! What’s not to like?
Tricare provides civilian coverage for military personnel, retired military and their dependents. Great coverage at great prices.
3. Veterans Administration
Health care coverage for veterans. No reasonable person would deny this for those who have defended our freedoms. Unfortunately it’s only practicably available to vets who live in proximity to a VA facility.
Heard at town hall meetings on the public option: “Keep your hands off my Medicare!” Says it all.
You really need to be down on your luck to qualify. And you need to be in a state that has enough money and will to fund it.
6. ASO plan
You work for a large enough company that they self-insure. They use insurance companies for Administrative Services Only (ASO). They generally cover all employees equally. Good deal. But you still sacrifice a lot of your potential earnings for health insurance.
7. Large/Medium/Small company
For those companies that can’t fit an ASO, you shop for plans from insurance companies. The larger your employee base, the better your premiums as you expand your risk pool. Smaller companies pay more.
8. Self employed
The bad news is that you have a risk pool of one, so the insurance companies can gouge you. The good news is that you can take the cost of your premiums off of your adjusted gross income on your taxes.
9. Unemployed or employed without health insurance benefits
You’re screwed. Unlike the self employed, you pay for your premiums with after tax dollars. And like the self employed, you pay much more than if you were employed by a large company.
10. No health insurance
You’re really screwed. Not only are you paying for all of your health care with after tax dollars, you have no position to negotiate with your provider for health care costs.
There are a number of permutations on the above. For example, your health care plan may provide a Health Savings Account (HSA) which will allow for some of your health care costs to be paid with pre-tax dollars. Note your health insurance premiums do not qualify. Another issue is for companies that require employees that to pay part of their premiums. You can’t deduct this from your taxes unless it exceeds the 7% of your AGI when you itemize deductions.
This inequity puts an interesting face on the current health care reform debate.