Do You Have a Choice in Health Insurance?

A number of religious institute members have expressed concern and disappointment in recent months over the way that the Affordable Care Act has structured health insurance on the exchanges. Because those members who work within the institute or for another Catholic employer have no reportable income, the only option available to them when they go to the state marketplace is Medicaid. Even if they wanted to pay something toward their health care, they are not allowed to apply for a non-Medicaid plan on the exchange and qualify for a subsidy.

An article yesterday by Nicole Hopkins in the Wall Street Journal expressed similar dismay over this dilemma. Hopkins' mother is age 52 and has minimal income due to circumstances in recent years. However, despite her low income, for years she has chosen to pay for her own health insurance. Under the new law, however, the policy she has been happy to pay for for years will no longer be available. Indeed, her cost would increase by 50%, and her deductible would skyrocket, if she chose to continue to pay for her own insurance. Hopkins writes:

The Sept. 26 letter from my mother's insurer promised that the more expensive plan "conforms with the new health care law"—by covering maternity needs, newborn wellness and pediatric dental care. My mother asked: "Do I need maternity care at 52?" In addition to requiring her to pay an extra $1,677 annually, the plan would have increased her deductible by $1,500.

Thinking that her mother had made a mistake and that she must be able to bypass Medicaid and opt to pay something for her coverage, Hopkins walked her mother (in the state of Washington) through the online application process from across the country (in New York). Of the application process she writes:

The situation sounded absurd, so I asked her to walk me through her application on Washington Healthplanfinder to make sure she wasn't missing anything. Sitting in New York with my computer, I logged onto the site under her name and entered the information my mother provided over the phone. I fully expected her to realize that she had forgotten some crucial piece of information, like a decimal point in her annual income. We checked and double-checked the information, but the only option still appeared to be Medicaid. She suggested clicking on "Apply for Coverage," thinking that other options might appear.

Instead, almost mockingly, her "Eligibility Results" came back: "Congratulations, we received and reviewed your application and determined [you] will receive the health care coverage listed below: Washington Apple Health. You will receive a letter telling you which managed care plan you are enrolled with." Washington Apple Health is the mawkish rebranding of Medicaid in Washington state.

The page lacked a cancel button or any way to opt out of Medicaid. It was done; she was enrolled, and there was nothing to do but click "Next" and then to sign out.

Hopkins listened as her mother explained to her why she was so averse to being forced to go on Medicaid.

"I just don't expect anything positive out of getting free health care," she said. "I don't see why other people should have to pay for my care, whether it be through taxes or otherwise." In paying for health insurance herself—she won't accept help from her family, either—she was safeguarding her dignity and independence and her sense of being a fully functioning member of society.

Before ObamaCare, Medicaid was one option. Not the option. Before this, she had never been, in effect, ordered to take a handout. Now she has been forced to join the government-reliant poor, though she would prefer to contribute her two mites. The authorities behind "affordable care" had erased her right to calculate what she was willing to spend to preserve her dignity—to determine what she thinks is affordable.

That little contribution can mean the difference between dignity and despair.

For the truly poor, being institutionally forced to take welfare is demoralizing. The Affordable Care Act is at risk of systematizing learned helplessness by telling individuals like my mother that they cannot afford to care for themselves in the way they could before the law was enacted. "This makes me feel poorer than ever," she said.

Naturally not everyone feels the same way as Hopkins' mother. Many see Medicaid as an "entitlement" that is available to anyone who qualifies. It has been, and continues to be, for many a life-saving program. And that is a good thing.

But when someone is willing and able to pay something toward her upkeep, when it matters to her that she maintain some modicum of internal pride and dignity, being forced to depend on the government is a humiliating experience. Ms. Hopkins' mother's dilemma is indeed sad.

In a country that has grown and thrived for centuries due to an indefatigable belief in hard work, unfettered  human ingenuity, and  indomitable courage, are we indeed facing a government that can tell us "we know what's best for you" (comprehensive coverage that you do not need) and "you must settle for what we give you" (Medicaid)? Sadly, it is looking that way more and more.

To read Ms. Hopkins' entire article, go to http://online.wsj.com/news/articles/SB10001424052702303531204579207724152219590.