• Why I said that in the NYT

    A number of you are asking me why I said the following (emphasis mine):

    In 2014, however, the choice for McDonald’s workers will no longer be between a bad policy and no policy. Through the exchanges, they will be able to buy a real health insurance plan — one that covers cancer, heart attacks, surgeries, M.R.I.’s and hospital stays. Dr. Carroll notes that many families will end up paying less than they are now paying out of pocket and will get more access to care, too.

    Fair question.

    Right now a worker at McDonalds is paying $32 a week, or $1664 a year, for a plan that caps out at $10,000 a year.  Let’s assume we’re considering a single male worker, age 27, who lives in a state where non-pregnant adults are not eligible for Medicaid (like most states).  Let’s also consider a range of salaries that this person might be making, from minimum wage up to $12 an hour (which is high for McDonalds).  Here’s what things might look like for him in 2014 compared to now, if he took his free choice voucher and went to the exchange (2014 dollars):

    Per hour salary Annual premium
    $       7.25 $               -
    $       9.00 $     858.00
    $     10.00 $  1,030.00
    $     11.00 $  1,429.00
    $     12.00 $  1,720.00

    A minimum wage worker would qualify for Medicaid under PPACA in 2014.  So his premium would be nothing.  Total win for him there.

    People making $9-$11 an hour would pay less each year than they are for their McDonalds mini-med plan right now.  Less.   If the worker is paid $12 an hour, they will wind up paying $56 dollars more per year, or just over a dollar more per week.

    But they will have real insurance.  Their yearly cap won’t be $10,000; yearly caps will be gone.  So will lifetime caps.  And the coverage will be much more robust.

    Moreover, workers under 27 can get on their family’s plans.

    I’ll let David Leonhartd say it again:

    The health care overhaul that passed Congress is far from ideal, as I have written many times in this space. But it does represent progress.

    The fact that it is beginning to disrupt the status quo — that some insurance policies will eventually be eliminated and some inefficient insurers will have to leave the market altogether — is all the proof we need.

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    • I understand that “many” individuals and families will end up paying less for better coverage as your example illustrates. I’m interested in whether you’ve seen a more comprehensive public analysis that sheds light on how many individuals and families are net ahead and how many are net behind on spending on health care as a proportion of their income. I’m looking for an analysis of subsidies in the health exchange, similar to the CBO letter to Senator Bayh in 2009, by income, combined with the number of individuals/households in each of the income categories. What’s the most detailed analysis that you’ve seen so far?

      Thank you.