As Christmas approaches again and people wrestle with the pros and cons of the Affordable Care Act, I find myself asking, “Would Joseph, Mary and the baby Jesus qualify for healthcare under the ACA?”
The good news is, I can say with certainty, Jesus would not have to be born in a manger in Tennessee. Mary and Jesus would qualify for either TennCare or CoverKids. They would receive quality prenatal and obstetrical care, and Jesus would be eligible for pediatric care until he was 18 years old.
As for Joseph, I’m not so sure. As a self-employed carpenter, he would be subject to the individual mandate of the Affordable Care Act to obtain government-approved health insurance or pay a fine.
If Joseph lives in one of the many states that chose to expand Medicaid, and if his income is below $26,658 (138 percent of the poverty guidelines for a family of three), Joseph could be eligible. Otherwise he would have to purchase insurance through the federal exchange (think American insurance company).
But could he afford it? Not likely, even with a federal subsidy. He certainly could not afford to insure his family. It’s tough to make a living as an independent carpenter. Joseph might choose to go uninsured because he’s more worried about paying for a place to live and food to eat than having insurance.
If Joseph’s business booms and he does buy insurance, Jesus could stay on his policy until he turns 26. It has, however, always been a mystery what happened to Joseph, since we don’t hear anything about him after Jesus was 12. Could he have been a migrant worker? Did he get sick and die without health care?
Jesus would likely be on his own to find insurance after he turned 18. As a single man, he would have to make less than $15,598 to qualify for expanded Medicaid, if it is available. That is less than minimum wage. Even if he started out as a carpenter himself, around age 30 Jesus became an itinerant preacher and healer. His income probably plummeted, but can you really see Jesus standing in line to sign up for Medicaid, or picking from the list of exchange options?
What about leaders of other faiths? Since Moses was adopted by Pharaoh’s daughter, he would have been covered until he was an adult, but once he was wandering in the wilderness, I suspect he would be without coverage. Buddha was wealthy as a child but, like Jesus, was a poor itinerant preacher. So, no coverage. And Mohammed never stayed put in one place long enough to be enrolled.
Here’s my point: Jesus said, “The poor will always be with you.” So far he has been right. Many people will benefit from the Affordable Care Act, but we’re fooling ourselves if we don’t recognize that millions of people will remain uninsured. The poor will lack access to many needed services no matter what. For instance, in 2,500 pages of law, the words “adult dentistry” do not appear. Yet it is impossible to go from a $7-an-hour job to a $10-an-hour job if your teeth are a disaster. You just don’t get hired.
The exchange system may offer various levels of service—silver, gold and platinum—but obviously the prices will vary. Most poor people will choose the least expensive option. Technically they will have insurance and satisfy the law, but their policies will leave a lot of services uncovered—services they need but still cannot afford. Frequent job changes, which are a reality among low-income workers always looking for another twenty-five cents an hour or an easier bus ride, will lead to people bouncing in and out of healthcare plans without consistent care. These issues, along with many practical and economic reasons, are why the governors of many states chose not to create their own exchanges.
Governors have good reasons for their decisions based on sound business principles for the state. They make the kinds of decisions they elected to make. Nevertheless, we have work to do.
Memphis, where I live, continues to be one of the poorest cities in America. In any city, if we want our citizens to be healthier, we must roll up our sleeves and work together to make it happen.
The Church Health Center plans to dramatically expand our services in the coming years. We will consolidate under one roof as part of the redevelopment of Sears Crosstown, an iconic Memphis building and neighborhood, and continue to work tirelessly for the health of all citizens of Memphis. The Affordable Care Act does not close all the gaps in health care for low-wage workers, and the Church Health Center will still stand in those gaps. Every day we open our doors, we help people who need us the most.
Since we will not know when God will send a prophet into our midst, I want to make sure being poor and uninsured will not prevent that prophet from growing up strong and healthy. Every community in America needs to be strategic and efficient with its resources if all of our citizens are to receive quality healthcare.