Candidate Andrea Kelly Garrison for State Representative is starting a series of guest blogs that take a hard look at her District's top issues and problems. Andrea's view is that knowing and admitting the hard truths is the best way to create and fight for the policies that will actually help her community and future constituents. Today's guest blog is looking at the healthcare truths in the district.
Guest post by Patricia VanLuven
In Shiawassee County, over 25% of employees work in healthcare, education, or social services. Due to the pandemic, these employees have had to face rapidly changing work demands in settings that can pose high risks for COVID-19 exposure. 1,2
Additionally, about 25% of employees in Shiawassee County work in job sectors that are at risk for high pandemic unemployment rates. This includes employees in restaurants, bars, arts, recreation, hotels, personal services, retail and wholesale trade.1,3
Combined, more than half of the employees in Shiawassee County work in jobs that have a higher risk of pandemic unemployment, or a higher risk of COVID-19 exposure, or both.
These employees face difficult decisions about how to protect both their physical and their financial well-being during the pandemic. Many people in Shiawassee County are feeling this one-two pandemic punch.
To add to the stress, many of the employees in these at-risk sectors are among the lowest-paid workers. 4 This includes people such as cashiers, waitstaff, childcare workers, hospital janitors, and home health aides.
A living wage in Shiawassee County is about $14.90 for a two-income family of four. Even in periods with low unemployment, 1 out of 3 Shiawassee County families did not earn enough to afford basic living expenses. (See preceding blog). This perilous situation becomes even more difficult when people’s full-time work is disrupted by unemployment.
The pandemic is shining a spotlight on serious structural economic problems in America. Low-income households experience this acutely, and many middle-income people are also financially stressed.
The combination of health and financial worries illuminated by the pandemic elevates one of the primary concerns of Americans: health insurance.
In Shiawassee County, 63% of adults depend on their employer for their health insurance, or on the employer of a family member. 5
Losing a job often means losing health insurance. Without health insurance, preventative or necessary medical care is often unaffordable. 6 This risk is a serious concern at any time, but is frankly frightening during a pandemic.
The high level of dependence on employer coverage increases the risk that many people will lose health insurance right at the time when limiting the spread of illness in the community is essential to physical and economic recovery.
The second most common (18%) type of health insurance in Shiawassee County is Medicare, which is provided through the government, not employers. 5 Among people who have Medicare, a 2019 study found that 75% are either satisfied or very satisfied with their Medicare coverage. Only 6% of people said they were dissatisfied or very dissatisfied (1%) with Medicare. 7
However, Medicare is currently only an option for people who are age 65 or older (or have certain severe conditions). Due to the pandemic, many older working people will leave the workforce because of layoffs or COVID-19 risk. Medicare provides an essential, sustainable safety net for them.
There are multiple policy proposals that would make Medicare available to more people. In some proposals, Medicare would cover everyone. Other proposals add Medicare as a public option so anyone who wants Medicare can choose it.
Most people who aren’t currently eligible for Medicare can purchase private health insurance policies on- or off- the Marketplace. These policies are also independent of employment. In Shiawassee County, about 5% of people are insured this way (plus people who have multiple policies). 5
Many people who purchase a policy on the Marketplace are eligible for federal cost reductions, based on their income. If their income is too low they will qualify for very low-cost Medicaid insurance instead. 9% of people in Shiawassee County have Medicaid. 5
In Shiawassee County, the income levels for Medicaid eligibility and Marketplace cost reductions are approximately: 8, 9
There are policy proposals to raise the Marketplace income levels so more people qualify for cost reductions. There are also policy proposals to increase the size of the cost reductions so premiums and other costs are cheaper. Additionally, there are proposals to increase cost transparency and accountability in health care.
These changes, along with making Medicare available to more people, will help make health insurance more accessible and affordable for people. Having affordable, independent options will free people from being overly dependent on employer-sponsored health insurance. This will give people peace of mind during difficult times, increased financial and health stability, and more freedom to pursue dreams like training in a new field or starting a business.
Here is an overview of the most common types of health insurance in Shiawassee County, plus two “gap” options (COBRA and short-term) that people sometimes use when they are losing their employer-based insurance:
The bottom option on the chart – short term insurance – comes with significant warnings. Potential buyers must read the fine print before signing a contract. These short term policies lack most of the critical consumer protections of the Affordable Care Act (ACA) that other types of insurance are required to have.10
ACA protections include not allowing denials, exclusions, or higher costs for people with pre-existing conditions, requiring coverage for preventative care and mental health services, more coverage options for young adults, not charging women more than men, prohibiting annual and lifetime caps on coverage, and more. 11
Keep an eye on politicians who are attempting to weaken these critical protections. Instead, choose leaders who seriously safeguard consumer health and financial protections. We need leaders who will take action to increase health insurance affordability and consumer power, such as expanding Marketplace cost reductions and Medicare options. These strategies allow people to have independent, sustainable health insurance rather than being at the mercy of an employer or economic disruptions.
Details on data and sources are at http://justnumbers.vanluven.info/
1. Proportions of Shiawassee County population in selected jobs. https://data.census.gov/cedsci/table?t=Income%20and%20Poverty&g=0500000US26155&y=2018&d=ACS%201- Year%20Estimates%20Data%20Profiles&tid=ACSDP1Y2018.DP03&hidePreview=false
2. Covid risk by job sector: https://www.brookings.edu/research/essential-but-undervalued-millions-of-health-care-workers-arent-getting-the-p ay-or-respect-they-deserve-in-the-covid-19-pandemic/
3. Unemployment risk by job sector: https://www.bls.gov/news.release/empsit.t14.htm https://www.pewresearch.org/fact-tank/2020/03/27/young-workers-likely-to-be-hard-hit-as-covid-19-strikes-a-blow- to-restaurants-and-other-service-sector-jobs/
4. Michigan median wages by job sector. https://milmi.org/datasearch/wage-by-occ
5. Shiawassee County Community Health Assessment, 2020 http://health.shiawassee.net/docs/2019%20Community%20Health%20Assessment.pdf
6. Pandemic related insurance loss https://familiesusa.org/wp-content/uploads/2020/07/COV-254_Coverage-Loss_Report_7-17-20.pdf
7. Medicare satisfaction https://news.ehealthinsurance.com/_ir/68/20191/eHealth%20Medicare%20Consumer%20Survey%20February%2 02019.pdf
8 Income thresholds for Medicaid: https://www.healthinsurance.org/michigan-medicaid/
9 Income thresholds for the Marketplace: https://www.healthcare.gov/lower-costs/
10 Lack of consumer protections for short term policies. https://www.cbpp.org/research/health/key-flaws-of-short-term-health-plans-pose-risks-to-consumers
11 ACA Protections https://www.healthcare.gov/health-care-law-protections/rights-and-protections/
Poll/Sidebar: Unemployment rate, Shiawassee County. https://tradingeconomics.com/united-states/unemployment-rate-in-shiawassee-county-mi-percent-m-nsa-fed-data. html
Medicaid https://www.michigan.gov/mdhhs/0,5885,7-339-71547_4860_78446_78447_78454-407318--,00.html https://www.healthinsurance.org/michigan-medicaid/
Short term: https://www.kff.org/health-reform/issue-brief/understanding-short-term-limited-duration-health-insurance/