I was curious about who will be required to get insurance under Obamacare in New York State. I was wondering if it would be mostly Upstaters or Downstaters, people from the cities or rural areas, or if it would primarily impact people from a certain region of state.
Fortunately, the Center for Medicare Services, puts that data on a website that can be relatively easily imported into your GIS program and linked against the 2000 PUMA TIGER/line.
First the uninsured. In general, people who live in suburbs and downstate, are most likely to be insured. In the suburbs, there are often 6-7% uninsured, versus some rural areas where the uninsured can be around 12-14%. Poor, urban areas often have pretty high rates of uninsured too.
This is not surprising, as these regions are wealthiest. If you have assets, your going to want to protect them should you get injured or sick, with insurance.
Roughly half of the uninsured will simply get Medicaid under Obamacare, varying a bit by region.
By expanding Medicaid, many of the working poor will be able to get quality healthcare, insuring a sizable portion of the uninsured in New York.
Then, 2-6% of the population, depending on region of state, will have to buy an insurance policy on the Marketplace, or pay an uninsured tax. Between employer-based insurance, Medicaid, and other social programs, the 94% to 98% of state won’t have to buy any additional insurance from what they are currently getting.
To assist the 2-6% of state which must by insurance on the market, a vast majority of uninsured will receive premium assistance, that will make the actual cost much lower.
When I was 21 years of age, I used to be a prolific blogger. I used to write all of the time, almost doing a post every day, about a different topic. For a while I had a theme for each day of week, later things kind of fell into reruns, with less frequent posts. Eventually, blog posts and essays became an occasional part of the blog – not something I wrote on every day.
When I was 21, I felt I had unique experiences and unique views that ought to be expressed. Indeed, many of them have been expressed on this blog. But now that I am 30, I am more interested in what other folks have to say, and sharing what they share. Sometimes it better to listen, and if somebody hits something right on the nose, to share their content, rather then right my own. Not all works have to be creative – and indeed, many know better then I know.
Many life stories I haven’t chosen to share. Sometimes, I am just not willing to share my mistakes, lest play up the embarrassment of the story. Other times, I can’t share on promise to others to keep what I know in the back of head, and not public knowledge. And in many cases, I plain lack the words to write them down.
Tomorrow is the official kick-off of the Obamacare Healthcare Marketplace, that will allow people who lack insurance but have disposable income or who are sick to buy insurance in a competitive fashion, without consideration of their current health status. The idea is no longer can people be denied insurance, because they are sick and do not get insurance through their employer – but of course, they must have money to buy that insurance – as it’s a commercial, only partially-taxpayer subsided benefit.
The problem with Obamacare is it basically continues the existing system, with some extra duck tape, to try to bridge in the problem of the uninsured sick, into the current health insurance system.
That’s a laudable goal, but if you only add the sick into the various insurance risk pools, you will only add to the price of insurance. Despite the Obamacare tax on those who are uninsured, it’s not clear if it will get many of them to buy insurance. The reality is most people who pay the uninsured Obamacare tax, won’t even really notice it – as it will come out as a slightly lower refund when they do their taxes in the following year. Few if any will actually pay the tax directly – because most poor and working folk either get an earned income tax credit or getting a tax refund for overpayment.
Obamacare is a boon for those looking for insurance. It will make insurance much more affordable for those who see a need in having an health insurance policy. Many responsible and informed people, who couldn’t afford insurance policy prior to Obamacare, will choose to get a insurance policy to protect their assets. Unfortunately, I suspect that is a minority of the uninsured. Most of the uninsured, are relatively healthy, and relatively poor and without assets. Expanding Medicaid will help the poorest of these individuals, especially those with families, but it won’t help the relatively healthy, and only slightly better off.
There are a lot uninsured Americans that make between $8-$15 hourly, but aren’t lucky enough to work for companies that provide regular healthcare insurance at an affordable rate. Many of those people work paycheck to paycheck, drive older cars, and rent. Their assets are very limited – if they got really sick – there isn’t much for hospitals and doctors to seize in collections. Those Americans also are unlikely to have even $80 monthly or so for the minimal insurance, offered through the Obamacare low-level plans, that only really cover you if you get seriously sick. Even if they could find the money by giving up their cellphone or cable television, do you think they will?
To protect the system, it makes sense for all Americans to health insurance – at least in incidents of catastrophic illness or hospital visits. For most individuals, health insurance only makes sense if you get it cheaply from your employer, you have assets, or are sick or feel you have a risk of getting sick. The solution is not a tax on the uninsured, who are largely struggling to get by.
The solution is to provide a basic insurance benefit to all who suffer catastrophic illness or injury paid through the broad tax collection powers of the federal government.
There are a few very wealthy in our society, who can afford to pay a lot into the system. Once you have a certain amount of money, any additional money declines in utility. Working folk, should also contribute a marginal amount into the health-case system. The reality is we could have a broad-based tax-supported health insurance system, that could cover the highest risk parts of the insurance, leaving individuals with the ability to buy insurance to cover routine doctor visits and other lower-cost services. Some would choose to go without any insurance, and simply pay in cash, for what is necessary, up to what is covered by government.
Any single-payer system should not restrict private insurance, above and beyond what the government covers in it’s system. It’s simply undemocratic to ban queue jumping, or paying for extra services, with private money, if people so choose. They’re should also be a cost burden put on private individuals – like co-pays or fees – to discourage excessive use of the health care system and keep it affordable for government. If government decides not to cover something, private individuals or their privately-purchased should be allowed to cover it.
I think the President made an honest attempt at reforming health-care insurance, but the net result was the same basically broken system, we’ve always had in America for those under Age 65. Adopting a Medicare-for-All system, would move our country forward, yet to still allow people to purchase private plans and purchase additional health-care, not covered by the basic Medicare system.
One of the problems I have with the individual mandate, is those who do not get healthcare insurance have to pay a tax, yet get nothing in return. That tax should go directly for paying for healthcare for those persons, by either using that revenue to add them to Medicaid or an assigned risk pool.
Option 1: Automatic Enrollment to Medicaid for Those Without Insurance.
Those who pay the individual mandate tax could automatically be enrolled in the government’s Medicaid program. The individual mandate tax could pay for the costs of enrolling these persons into medicaid. Medicaid would ensure these persons have access to basic healthcare, and because such an expansion would be paid directly out this tax, there would be no cost to government.
Option 2 Assigned Risk Pool for Those Without Insurance.
Alternatively, those who do not enroll in a private market insurance plan could be placed in the assigned risk pool, similiar to those who can’t buy insurance on the private market due to DWI or bad driving records. The individual mandate tax could pay for those individuals who don’t have insurance to be automatically assigned to an insurer, for it’s most basic plan.
Insurers would be forced to accept persons assigned to them, at random, by the government, who don’t currently have insurance. These individuals paying the individual mandate tax, would have their tax revenue handed over to the private company they are assigned to. Insurers would cover their healthcare costs, with very basic plans.
People Still Would Want to Get Insurance.
Being enrolled in Medicaid or a an Assigned Risk Pool insurance is far from an ideal solution for most people. People would be actively encouraged to buy insurance on the exchange, rather then taking whatever the government has randomly assigned to them, or government sponsored Medicaid.
Yet, the assigned risk pool is better then nothing.If for some reason a person didn’t sign up for insurance, they should be covered with basic healthcare insurance. Assigned risk is very market friendly, and is less government involved then expanding Medicaid, so it seems likely that would be the reform chosen for healthcare coverage for all.
If you ask many people today, the assumption would be almost everybody has a Bachelors Degree, if not more education then that. Yet, except in the most suburban (and wealthy) portions of state, Bachelors Degrees are relatively uncommon — often held by fewer then 1 in 10 people over 25 years of age.
It turns out there is a close connection between suburban lifestyles and having a bachelors degree. Zoomed into closer into a map of the Capital District, you will note how closely link suburbanization is to number of people with a bachelors degree.
That said, obtaining that Bachelors Degree might be worth your while — if you avoid college debts, and land a good job after college. Indeed, the wealthiest portions of state tend to have the highest percentage of those with Bachelors Degree, e.g. the suburbs.
It’s probably wrong to assume one is wealthy or well off with a Bachelors Degree, or that all rural folks are backwards hicks leaving in poverty. It’s more that the more affluent (in money terms) suburban life tends to require more schooling then more rural or urban occupations.
One thing that\’s always bothered me a bit is that no matter how hard one tries, we are always stuck in the present. The present is forever lasting, we can not travel back in time or into the future. We can see cause and effect, and realize there is something called time but never really experience it or control it, because there is no time but the present.
Driving home the other night, I realized how strange time really is. I was 5 minutes from home, and I was so tired. Yet, I felt I could be driving forever, as there was no escaping the present, no matter how hard I tried. I knew I would be home in 5 minutes, but that didn\’t mean I was home. I could have been driving forever.
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There is that funny thing called the future and the past. We remember the past, and can often forsee future events. Certainly if I had decided to doze off or take my hands off the steering wheel, I could perdict what would like happen. If I crashed, I probably could remember back to what happened on the sleepy night, but there would be no turning back the car from crashing.
The relationship of present to the past and future is often pretty clear in our minds. Yet, it seems strange when you really think about those other times, when you know there is nothing but the present, a time that will stretch on for enternity. We will never escape the present.
I sometimes get the biggest kick out of people who act like they have god on their side. They know you must be wrong, because you obviously must not have god your side.
As far as I know, God is not into partisan politics. He probably wouldn’t take any opinion on any of the human issues of day, except to encourage people to use their conscience and work to help their fellow man as they believe best.
Always try to challenge your own beliefs and the orthodoxy of those around you. Be the troublemaker who asks the hard questions. Be the Devil’s Advocate, because certainly God wants some people to advocate for the devil, in case god is wrong. It also wouldn’t be right not to give the Devil the defense he deserves.
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