What are your views on health insurance?

[barkhausen102]

As we all know health insurance has become super expensive in the last few years, especially for those raising a large family. I would like to hear your opinions on health insurance. Do you purchase it? What is your church's policy on it?

I have heard some people don't buy it and others make special trips to Mexico for healthcare where it is more affordable.

What is your view on it?

[JohnH]

In our church members can participate in a church mutual aid plan, state aid, private health insurance including the ACA, or nothing at all. People in Canada mostly use state aid, although sometimes they travel to other places to get certain procedures done. Very few of our businesses have over 50 employees, so very few employers have health-benefit plans, mostly due to the high cost of them. Some I am aware of over 50 simply risk paying the $2,500 per year per employee fine if an employee applies for a benefit plan under the ACA, which is a better deal than spending $18,000 or so per year per employee for a plan most employees won't even want. (Employers have to cover 85% of the cost of benefit plans.)

The church mutual aid struggles with paying out more in shared needs than it collects in member sharing responsibilities, yet the perception from most members is that the aid plan is stingy and not worth it.

Using state aid in states with Medicaid expansion has become very common.

In places where my own church's member make up a large fraction of the population, the mutual aid plan works a bit better and they have worked out deals with local health providers that make it more affordable. However, many of these providers are in turn struggling to stay in business.

My personal advice to most people is to try to qualify for Medicaid and to prayerfully consider if it's worth making the extra money to then have to spend it on exorbitant health insurance. For a family of 5 children, the cheapest plan is $17,000 a year; for a family with 1 child, it's $12,000 a year. The out of pocket amount with deductibles etc is another $18,000. So a family needs to earn at least $35,000 extra (after tax) to make it worth it. The tax credit subsidy is usually not very substantial; for example, for a family with 1 child earning $90,000 a year, the cheapest plan is still $5,000 a year, and the out of pocket amount remains $18,000.

For the family with 5 children earning $70,000 a year, the cheapest plan is "free" but the out of pocket amount is still $18,000. If they earn $65,000, they qualify for Medicaid and everything is free and does not require a complex tax credit, it does not require any deductibles or copays, and it fully covers vision and dental as well.

[Soloist]

My personal advice to most people is to try to qualify for Medicaid and to prayerfully consider if it's worth making the extra money to then have to spend it on exorbitant health insurance. For a family of 5 children, the cheapest plan is $17,000 a year; for a family with 1 child, it's $12,000 a year. The out of pocket amount with deductibles etc is another $18,000. So a family needs to earn at least $35,000 extra (after tax) to make it worth it. The tax credit subsidy is usually not very substantial; for example, for a family with 1 child earning $90,000 a year, the cheapest plan is still $5,000 a year, and the out of pocket amount remains $18,000.

For the family with 5 children earning $70,000 a year, the cheapest plan is "free" but the out of pocket amount is still $18,000. If they earn $65,000, they qualify for Medicaid and everything is free and does not require a complex tax credit, it does not require any deductibles or copays, and it fully covers vision and dental as well.

That might work in a state which expanded medicaid but from what I'm seeing, your numbers don't work.

[Szdfan]

My personal advice to most people is to try to qualify for Medicaid and to prayerfully consider if it's worth making the extra money to then have to spend it on exorbitant health insurance. For a family of 5 children, the cheapest plan is $17,000 a year; for a family with 1 child, it's $12,000 a year. The out of pocket amount with deductibles etc is another $18,000. So a family needs to earn at least $35,000 extra (after tax) to make it worth it. The tax credit subsidy is usually not very substantial; for example, for a family with 1 child earning $90,000 a year, the cheapest plan is still $5,000 a year, and the out of pocket amount remains $18,000.

For the family with 5 children earning $70,000 a year, the cheapest plan is "free" but the out of pocket amount is still $18,000. If they earn $65,000, they qualify for Medicaid and everything is free and does not require a complex tax credit, it does not require any deductibles or copays, and it fully covers vision and dental as well.

That might work in a state which expanded medicaid but from what I'm seeing, your numbers don't work.

If the numbers are correct, a bunch of conservative Anabaptists are about to get seriously hurt with the upcoming cuts to Medicaid.

[JohnH]

If the numbers are correct, a bunch of conservative Anabaptists are about to get seriously hurt with the upcoming cuts to Medicaid.

What upcoming cuts?

The requirement to work 20 hours a week isn't a problem.

[JohnH]

That might work in a state which expanded medicaid but from what I'm seeing, your numbers don't work.

Sorry; I forgot to mention that was for expansion states. Most conservative Anabaptists live in expansion states.

[Szdfan]

If the numbers are correct, a bunch of conservative Anabaptists are about to get seriously hurt with the upcoming cuts to Medicaid.

What upcoming cuts?

The requirement to work 20 hours a week isn't a problem.

Ironically, it’s the people least equipped to handle these changes, like large, rural, self-employed Anabaptist families that are exactly the ones most likely to lose coverage with Medicaid cuts and work requirements.

1) A lot of self-employed farming and ranching families don’t have verifiable wage documentation (like W-2s or pay stubs) to prove they’re working the required twenty hours. When people work for themselves, they rarely pay themselves a formal, documented wage. (I’m chaperoning my school’s FFA chapter to their fall conference — I just confirmed this with the group sponsor whose family owns a ranch).

2) Farming is also highly seasonal work. With more frequent eligibility checks, farm families may cycle in and out of Medicaid when their seasonal income spikes, even though their annual income remains too low to afford private insurance.

3) Conservative Anabaptists often rely on rural medical providers that depend heavily on Medicaid reimbursements. With these cuts, many of those providers won’t survive. I’ve already heard of three clinics closing in the Shenandoah Valley this September and my local hospital has been cutting services. There are questions over whether it will close. That not only means lost local jobs but also that people here would have to travel an hour or more for medical care.

[JohnH]

Ironically, it’s the people least equipped to handle these changes, like large, rural, self-employed Anabaptist families that are exactly the ones most likely to lose coverage with Medicaid cuts and work requirements.

1) A lot of self-employed farming and ranching families don’t have verifiable wage documentation (like W-2s or pay stubs) to prove they’re working the required twenty hours. When people work for themselves, they rarely pay themselves a formal, documented wage. (I’m chaperoning my school’s FFA chapter to their fall conference — I just confirmed this with the group sponsor whose family owns a ranch).

Have you ever actually applied for Medicaid when self employed?

You have to fill out quite a bit of paperwork to verify/document income - if you don't have a reasonable tax return. If you do, you can just turn in last year's tax return. That's required already and has nothing to do with 20 hours. As far as confirming the 20 hour work requirement... the law has a provision that any self employed person is assumed to be meeting the 20 hour requirement. (I don't know how they will handle "negative income" or "zero income" self employed people. I was negative income one year without a tax return filed for the prior year yet which was even more paperwork to fill out, but it wasn't impossible. The benefits you get when in negative-income are very generous.)

When people work for themselves, they rarely pay themselves a formal, documented wage.

I'm not sure where you get ideas like this. When people work for themselves, they often get a 1099, which is formal documentation. Otherwise, they file income tax returns, which are another form of documentation of what they pay themselves.

It's true that if someone plans to cheat on their taxes and not document or report accurately what they pay themselves, it will be more challenging to qualify for Medicaid. Medicaid offices generally are stricter than the IRS when it comes to documenting income. But that doesn't mean it's impossible. For example, in my state, if you don't file tax returns and aren't sure what your business expenses are, you can simply report your gross income (from 1099s or a bank statement or PayPal account, etc showing deposits) and you are allowed to compute 50% of that as expenses. This is a very common situation for people like someone who drives for DoorDash.

2) Farming is also highly seasonal work. With more frequent eligibility checks, farm families may cycle in and out of Medicaid when their seasonal income spikes, even though their annual income remains too low to afford private insurance.

No, they won't, because Medicaid is based on annual income, including seasonal income. If your income is variable, you document that and turn it in. For self employed people including farmers, a tax return is enough to show annual income. You do have a legal obligation to report if you think you're going to make more money this year. For many people that's just not a problem!

There are not "more frequent eligibility checks". You requalify once per year, and then halfway through the year do a redetermination. On the redetermination, you simply sign something saying "nothing's changed", or if it has changed, you say what the change is.

Food stamps already had a 20 hour per week work requirement so all the infrastructure already existed for this. People really want their food stamps and are willing to do the extra paperwork needed to qualify. It's not burdensome or onerous.

3) Conservative Anabaptists often rely on rural medical providers that depend heavily on Medicaid reimbursements. With these cuts, many of those providers won’t survive. I’ve already heard of three clinics closing in the Shenandoah Valley this September and my local hospital has been cutting services. There are questions over whether it will close. That not only means lost local jobs but also that people here would have to travel an hour or more for medical care.

Szdfan, you're basically full of nonsense - sorry to put it that way, but I'm not sure how else to say it. Most conservative Anabaptists don't use Medicaid or state aid at all. I am in one of the very few conferences that does do so.

Holmes County (the largest Anabaptist concentration there is) is very well served by many different providers, some of which are cash pay only (and work with mutual aid plans), and some of which take Medicaid and insurance. There really isn't much of a problem at all with "rural" medical providers in Ohio where Anabaptists live; if anything, it's one of the best places in the country due to the diverse range of options. I don't think I could honestly get better medical care anywhere else.

In PA, a group of Amish are busy building their own health center which will have their own providers. That's another option conservative Anabaptists can do, particularly ones who don't want to participate in state aid plans.

[barkhausen102]

Most conservative Anabaptists don't use Medicaid or state aid at all. I am in one of the very few conferences that does do so.

For those that do not use medicaid, what do they do if they have a large family? Do they buy health insurance on the open market or just hope nobody in the family has to go to the hospital? Probably majority of the times the children will not require much health care, but if somebody in the family has to be hospitalized and there is no health insurance it could be a big problem and a large bill.

[R7ehr]

Most conservative Anabaptists don't use Medicaid or state aid at all. I am in one of the very few conferences that does do so.

For those that do not use medicaid, what do they do if they have a large family? Do they buy health insurance on the open market or just hope nobody in the family has to go to the hospital? Probably majority of the times the children will not require much health care, but if somebody in the family has to be hospitalized and there is no health insurance it could be a big problem and a large bill.

They join a church and the church helps pay the medical bills. And if the church can’t pay it, then the church reaches out to other churches to help. And if the church is an independent, and can’t cover it, I don’t know what they do.