Based on Federal Poverty Limit Guidelines if you are single with no dependents and if you earn $16,242/yr gross, then you qualify for Medicaid/Medical. But if you earn $16,243/yr gross, then you will need to go to Covered California and pay anywhere from $1 a month up to $63 a month for your health plan AND you will have to pay out of pocket for all of your monthly CPAP supplies, plus pay out of pocket for each and every doctor trip, AND pay for any medications you take. Did you get the difference?
That is one dollar more between $16,242 and $16,243 yearly gross income. And being just one dollar over could make it to where you don’t have Medical anymore and now you need to pay $?? for your prescriptions if you take any and if you are older than 50 – more than likely you will be taking some form of medication each month. CPAP supplies anyone? There is no guarantee that your new insurance will cover the cost of CPAP supplies each month ( and you will need to get nasal cushions each and every month). What, you think you will be able to afford paying anywhere from $14 to 40 every single month for your nasal cushions? That means paying $$ each and every since month you pay out of pocket for your medications too since if you get the $1 co-pay plan, you will pay MORE out of pocket! Nice huh? Nasal cushions, and every 6 months paying for headgear. It depends on the insurance you get if what you need is covered.
You see what the Affortable Care Act did do, was it expanded Medicaid for all of the people that were – unemployed non-disabled males, and underemployed non-disabled males working part-time PLUS, it expanded it to unemployed non-disabled AND non-pregnant women/no children, and underemployed non-disabled women. So before Obama came around, if you were a low income woman that was not pregnant/no children and not disabled, you didn’t have any healthcare – unless it was through out own choice or through your employer. Now of course that made some sense since employers didn’t really offer healthcare to their part-time employees AND people understood that if you are low income, you will not be able to AFFORD healthcare. Plus, it is common sense to know that if you are low-income, you are probably going to be eating poorly since all of the crap that we shouldn’t eat (things with sugar in them etc) are very cheap. So the very people that need healthcare – don’t have access to it.
So what Obama did was TRY To remedy that issue by expanding Medicaid/Medi Cal to all of the poor single people and poor married people with no children (that were not disabled). But what he didn’t know was that this Affordable Care Act would hurt the people that are just making above 138% of the FPL. So if you are making just over 138% of the federal poverty limit (for your family size), according to the Affordable Care Act, you should be able to afford the payment options that the government has set for you. It was the ACA that set limits or caps on the payments. So you either pay $1 a month with a high amount of co-pay whenever you see your doctor. Or you may pay $83 a month every month even when you only go to see your doctor once every 10 months. It also FORCED ALL PEOPLE to have medical insurance and I think it is wrong. You don’t force people to have medical insurance. I now have a new doctor and by choice I am seeing him since he is a naturopathic doctor. By choice I am still using BiPAP for my sleep apnea and yes, for now – Medi Cal is covering the cost of my BiPAP supplies. However, should I be forced to pick a doctor from Medi Cal? I don’t think so. If I didn’t have sleep apnea, I’m not sure I’d want to see any doctor that practices general western medicine. I think I’d rather have catastrophic medical insurance. And if you are like me with much more income than me, you would be able to afford to see a naturopathic doctor more often than me and you may be even going to get acupuncture at your own expense since IT IS YOUR CHOICE whom you see. Let’s say you are at 300% of the federal poverty limit. for a family of four you and your wife together earn $72.750 a year. If you don’t have insurance through your job then you need to enroll you and your three other family members in through the marketplace which NOT Affordable. You don’t want to pay for A Bronze Molina 60 HMO $396 per month. If you believe in Chinese medicine and the government is telling you that you and your wife both are required to enroll into a government sponsored health plan, then why would you enroll in it if you are not given other options? If you enroll all four of your, then you’d be paying almost $400 a month for something that you and your wife will never use! Who does that? So now you only enroll your two children at the tune of $196 per month. Better, but you believe that you should allow your children age 10 and 14 – the choice that you give to yourself. Do you think you should have to enroll your children into a government sponsored health plan, if your entire family wants to practice chinese medicine and doesn’t want the general western medicine that only treats crap after you get it? I don’t think you should have to.
And not to mention changing doctors is a hassle in and of itself since you have no clue if the doctor you chose – is uh – a good doctor with good bedside manners. You got some book in front of you and now you do “eeny, meeny, miny, moe” and pick whatever doctor is close to your job or your home. You get to your doctor after about 4-8 weeks of signing up and after being told from someone else “He is not seeing new patience” and bring in old documents that you need “such and such ” and that you were diagnosed with this and that and sleep apnea and you had a prescription good for a year from Feb 2016 to Feb 2017 and now it’s August 2016 and what do you need? A new prescription from your doctor to inform your new DME supplier that you need this stuff. PLUS you HOPE that your stupid doctor puts in all 12 (or 24) CPAP nasal cushions so you don’t need to return in 3 months to say “Oh, you only filled that out for 3 months, I need enough for a YEAR” (Most insurances cover up to 12 or 24 nasal cushions a year or 1-2 nasal cushions a month).
Before all of this happens you need to call your new insurance company to find out if they even COVER the cost for CPAP supplies and before they will check, I’m sure that you will need to see your new doctor script to prove to him that you need CPAP! You may even be told “I need to do a sleep study on you” even if you last sleep study was done in a sleep lab just 15 months – even if you show the evidence of that sleep study with papers.
Now for anyone that has never been in any situation like this where you earn 138% or 139%of the FPL – and you’ve always earned 400% of the Federal Poverty Limit – God bless you. You know people that an get you that wonderful career in accounting and you are gifted and blessed with an income of $80K a year for you and your wife. If you have 4 blessed children and you have a white picket fence, then you and your wife together earn $150K a year and you are living in the sweet spot. You have no need for fuss. You got money and you don’t need to worry about anything. You got Whole Life Insurance on yourself, your wife, and all your children are on the 20 year fully-paid up plan that way when they turn 21, they will have a fully paid up plan and will have a nice amount of cash built up in their life insurance plan. You have that 401(k), you got the house and the two cars and a boat. You were born to wealthy parents that taught you how to take $1 and how to invest that to make it $100. Your parents taught you how to lie and how to sell and swindle. Invest, Invest, Invest you say. You never knew what it is like to live on less than $2K a month. You never knew what it was like to live Pay Check to Pay Check and say “I can’t pay for ABC now. I need to wait until two weeks from now to pay for it since I don’t get paid again until two Fridays from now”.
And I’m SURE Mr. Senator and Mrs. State Senator doesn’t know what it is like to live pay check to pay check. I’m sure you are paid $80K up front just for showing up to Washington 6 times a year to discuss matters – that matters to the American citizens. You work all of about 28 weeks out of the year if that. Congress takes so many breaks I wonder if you even know what it is like to work 40 hours a week and come home tired after working 9 hour days.
I must say that the people that WROTE the Federal Poverty Limit Guidelines working for the Department of Health and Human Services are the people that I’m talking about right now (above). Policy makers. You don’t know what it is like to be at the income of only 139% of the federal poverty limit or $16,243 a year for a single person. But you are reading this and you are saying “Single? I’m married. I have a wife!” Okay, you don’t know what it is like to earn 138% of the FPL for an income of two – which is only $21.983 a year. And that is just minimum wage if you work 40 hours a week. I get it. You make $5K a month salary and you have two little initials following your name. Those are “JD” since you went to LAW SCHOOL and you passed the state bar exam. So you don’t have ANY IDEA what it is like to live on poverty wages, but you wrote the law for everyone ELSE living paycheck to paycheck. You make sure your own family is covered, but everyone else? Who cares. You don’t know them.
I’m guessing you wouldn’t be able to afford that BMW if your income was 150% of the FPL. Let’s try it if you were making only 138% of the FPL. But you say “No, I’m the State Senator that wrote the numbers on that FPL and I’m not only married, I have three beautiful children.” Alright sir, I’d like to see you try to live at 139% of the FPL with only $39,205 a month for a family of 5. Hey, YOU WROTE THE NUMBERS Mr. State Senator! Not me. You are the one that said “If you earn over 138% of the Federal Poverty Guidelines, you don’t qualify for Medicaid anymore. You need to go to Covered California or go to Healthcare.gov and apply there” where you find out you need to pay anywhere from $1 a month up to $80 a month. How answer me this. How will you afford to pay that insurance (mind you, that $80 is only for YOU, the working man)? If you want health insurance for all 5 of you, you may just need to pay $300 a month. How will YOU do that if you only make just over 138% of the federal poverty limit? You got a home mortgage at 1,500K a month (adding up to $18K a year), you got your kids (all under 5) childcare at $350 a week (17,500 a year for 50 weeks a year since you only work 50 weeks a year). Oh did I make a mistake in my calculations somewhere? Did I not say that you only earn $39,205 a year for a family of 5? I’m sorry, I just calculated $35,500 a year in expenses and I haven’t even covered food for your children, gas in your car for work, and I didn’t add up any money for your health care insurance. But with this very realistic view of life, I just left you only $3,705 a year to cover food for your family, your entire families health insurance and – opps! Gas in your car. How will you pay for all of this with only $39,205 a year? I don’t know. But YOU Mr. Senator, wrote these laws on what should be 138% of the Federal Poverty Limit and ONLY you can fix it. May be you should take a look at these numbers again and see if 150% of the federal poverty limit would be a more appropriate level of income to tell someone that they make enough money to get on Covered California. At least with 150% of the FPL, You’ d be at $42,641, which would give you an additional $3,436 per YEAR. Which would give you $286 a month “extra” if 150% of the FPL was the “set number” for meeting the requirements for Medicaid and EBT benefits. What would you be able to do with just $286 more per month? I’m sure you’d be able to put that into your car for gasoline. OR may be you want that to go to health insurance. Oh, but you can’t do that, since in reality, you only earn $39,205 a year and you don’t even have enough for food! But you can’t get EBT either. Why? The income requirement for EBT are LOWER than 138% of the FPL. You need to earn less than 133% for EBT benefits so you got to pay out of pocket for food for you and your family.
You are an idiot to think that anyone can make it on 138% of the FPL or live on 150% of the FPL. You need to make the Federal Poverty Limit around 200% ($23,540 for a single person with no dependents/$48,500 for a family of four) to qualify for anything, since earning less than that is living in poverty. What I mean is, instead of starting the chart at 100% which is only $11,770 for a family of one/$24,250 for a family of four – you need to make the first column 200%. Do some minimum wage studies and calculate inflation with how minimum wage has rose of the last 30 years.
Let me copy and past something from a link I will post. http://billmoyers.com/2013/09/18/why-is-the-federal-poverty-line-so-low/
“In 1999, a single mother struggling with this question sent an email to the Health and Human Services employee whose job it was to calculate the federal poverty line. She wrote:
I am a single Mother and work two jobs which equal about $18,000 per year. We barely afford rent, electric, cable, phone, water, food, taxes and vehicle expenses. [But] the federal poverty level is $11,060. My daughter and I have zero, no, zilch money left after paying the bills for medical or clothing. How on earth does the Federal Government expect us to pay for cars….There just is NOT enough money left at the end of the month for a car payment….Please tell me…how they expect people to live on under $20,000 per year.”
Well, Mr. Gordon Fisher, that about sums it up and that was back in 1999. If you take a simple calculator on the BLS website that is inflation calculator and put in some numbers, you will find out what you need to earn today. So I’m putting in $10,800 with a starting year of 1980. If you make only $10,800 a year in 1980, you’d need to earn a total of $301,211.48 a year in 2016 dollars to keep up with INFLATION. That means inflation has rose about 300% since 1980. What about the Federal Minimum Wages? Wages have not kept up with inflation. Let’s take what I used to earn in 1996 and see what it is in 2016 dollars. In 1996 I earned about $12,000 per year. I was working full-time and for part of the year, I worked 66 hours a week and I only earned about $7.16 an hour and I had raises every 4 months since I worked with a union that made sure we got .15 cent raises every 4 months. In today’s dollars, that is only $18,212. 77 per year. So if I was working a minimum wage (CA is $10 an hour) job and working a full 40 hours a week, I’d be making about $20K a year and just over that $18,212.77 and guess what? My income/hour wage increased, but I didn’t GET anywhere Mr. Gordon! I’m just about making the same buying power now! I didn’t gain anything. My step day was making about $27,000 per year in 1999. The same buying power today? It takes all of $38,592.82 to buy the same stuff from 1999. If you make less than $38,592 today, then you make LESS (since you have less buying power in 2016 dollars) today than you did in 1999.
Mr. Gordon, I’m trying to replace my step-dads income . And I can’t do it on $10 of minimum wage. I’m in student loan debt and working part-time with this income is not cutting it at a non-profit. With my MBA and skill level, I should be making at least $40K a year and there are no corporate jobs in Riverside County. And for the high school graduate, minimum wage must be at least $12.50 an hour. Right now in 2016, not by 2020. By 2020, inflation would erode that $12.50 away to nothing by 2020.
So my question is why in the hell are Federal Poverty Guidelines still based on a woman named Mollie Orshansky, a civil servant working for the Social Security Administration back in the 1960s? Do we need to live in the 1960s? Do we all need to go around with no car? A car payment is just out of the question for MY FAMILY. We can’t afford a car note at the tune of $250 a month. We can’t do it on our income and believe me when I say that making $26K for a family of two is NOT a lot in 2016 dollars. I need to be making about 3K a month in order to afford all bill and yes, I’m including a car payment and Whole Life Insurance or Long Term Care policy for my mom so she will be able to pay for Long Term Care if she needs it when she in her 80s. If I want to take care of her, then I will need to pay for it.
“In 1965, the Office of Economic Opportunity adopted Orshansky’s thresholds as their poverty cut-off, and in 1969, her thresholds were made the government’s official definition of poverty. Also in 1969, a review committee made up of representatives from many government agencies decided the thresholds would be indexed to the Consumer Price Index, not to changes in the cost of food or the share of a family’s income spent on food. Since that time, the method for calculating the poverty thresholds has changed little”. So my question is. WHY HAVEN”T THINGS CHANGED in 1969? Pray tell me this! I pay out of pocket for food now and I didn’t know that earning less than $1,300 a month gross was “A lot of money each month”. I spend about 20% of my NET INCOME on food each month. I can’t afford to pay more than $211 a month for food. If I did, everything else wouldn’t get paid! However, other expenses are just not paid. For instance, I can’t pay each month for all of my mom’s bills or all of her credit cards. I wouldn’t be able to pay all of the utilities. I pay two utilities and that is INTERNET and that is a NEW utility of today. The other I pay is a basic cell (flip) phone which I don’t use to text. I talk and that’s it.
Let’s take a look at the non-profit group called Wider Opportunities for Women. “Their Basic Economic Security Tables, or BEST index, takes into account expenses that the federal poverty line doesn’t, including housing, utilities, child care, transportation, health care, household goods, emergency and retirement savings and taxes”.
So for my family, we don’t spend money on retirement savings since I don’t make enough income for that, nor does my mom. We have 0% going toward retirement. We have no childcare since I don’t have a child (not that I don’t want one). Healthcare we spend less than 5% of our income on that since we are on Medi-cal and if I earn over $16,243 next year I will be spending about 10% of my income on healthcare, may be more. I know I spend over 20% of my NET income for my own transportation. When I wasn’t working regularly, I earned about $90 a month and about 80% of that went to gas in the car each month.Household goods could include so many things. We can afford tissue for the bathroom and paper towel. We had to use the plastic bags from the grocery store as our trash bags for over a year since we didn’t have an extra $10 a month to purchase those 13 gallon trash bags at the store. It wasn’t until I was working a steady part-time job that I could afford to pay $7 for a box of 24 13 gallon bags. We don’t have an emergency fund. If we had to fix our cars, we’d be up shit creek without a paddle. We have carpet that may have possible mold on it and we can’t afford to get new carpet. So we let it sit there under plastic. It’s been there since Mia peed on the carpet back in 2011 or so. I’ve tried to clean it up back in those days, and nothing happens. How much will it cost to fix that? I don’t know. Vacuum it up and the black spot is still there. A steamer? That costs more money which we don’t have. When you have possible mold, I’d call that an emergency and what do you think it is doing to our health?
I think it is time for me to write to my Congressman woman and see what kind of response I will get if any.