We're not doing great
April 4, 2020 6:30 AM   Subscribe

Projections of the COVID-19 impact on health insurance, (PDF) This analysis by research and consulting firm Health Management Associates (HMA) projects three possible scenarios of the impact of COVID-19 on the US health insurance market. They estimate that the mildest outcome will leave 30 million people without health insurance. That rises to 40 million in the most severe scenario.

Some conclusions:
1. The number of people receiving coverage from an employer could decline by 12 to 35 million,
including both workers and family members.
2. Medicaid enrollment could increase from 71 million to 82-94 million.
3. Medicaid enrollment could grow by 5 million regardless of the number of people who lose their
jobs.
4. Uninsured numbers could increase to 40 million, with bigger impacts in non-expansion states.

Meanwhile, the Trump administration won't reopen Obamacare enrollment for the uninsured.
posted by Kirth Gerson (72 comments total) 28 users marked this as a favorite
 
Update: Trump's health secretary now says there will be a special enrollment period for Obamacare.
Azar added that people who have recently lost their jobs and thus their insurance would be eligible for a special enrollment period under health care exchanges created by the Affordable Care Act, passed under former president Barack Obama.
posted by Kirth Gerson at 6:44 AM on April 4 [14 favorites]


this is terrible. And thanks for the enrollment update.
posted by clavdivs at 6:51 AM on April 4


A lot of rural hospitals have been on the brink for a while now and some have been closing or reducing services. In Texas for instance, 156 counties out of 254 (60%) don't have a single ICU bed. The midwest is full of counties that have no ICU beds, no hospital, not even a physician.

Just think of the shock to the system when 12% of their client base literally disappears overnight. How many hospitals that were on the brink will close right in the middle of this pandemic? How many have credit to keep operating once the bank account runs dry? How many will want to go into debt, risking that they may not get a government bailout by states and a federal government that have no interest in providing citizen services beyond what is necessary to stop the fomenting of a violent revolution?

These things all compound on each other. Atrophy within the system has been building for a long time and we're about to see the full carnage of employer sponsored, for-profit medicine unleashed. It's not going to be pretty.
posted by Your Childhood Pet Rock at 7:07 AM on April 4 [19 favorites]


That rises to 40 million in the most severe scenario.

That's the effect of unemployment, when your health insurance is tied to your employer. However, one of my risk scenarios is, "Your health insurer goes bankrupt and can't pay any claims", when their reserves dry up. Which, if everyone uses the same model, is a systemic issue.
posted by mikelieman at 7:27 AM on April 4 [5 favorites]


The politics of this virus make me so angry, they jog me out of my fear. These vultures were slowly cutting Obamacare into ribbons before this happened, and suddenly it's a convenient save for the current " Oh shit, where's the bottom" disaster.

But these disasters happen all the time to families, just not en masse. It's almost like we all need health care to be independent of our jobs, OR SOMETHING. ::cough::socialize it::cough::
posted by erinfern at 7:38 AM on April 4 [35 favorites]


In Texas for instance, 156 counties out of 254 (60%) don't have a single ICU bed.

Oligarchs and low tax assholes like Grover Norquist ate all those beds. We could have them but decided yachts and NZ bunkers were more important.
posted by benzenedream at 7:40 AM on April 4 [19 favorites]


An acquaintance who posts updates from the US embassy in Tokyo recently posted one that in a weirdly, I don’t know, snide? tone, said that Americans should leave Japan and return to America as soon as possible, or be prepared to remain in Japan indefinitely. It went on to note that, in the case of a serious outbreak of corona in Japan, residents here might not receive the high level of care we’ve become accustomed to.

The reaction of nearly every American I know living here has been the same: laughter, profanity, and disbelief. No matter how bad things get here, and I don’t doubt they will, I know that, if I returned home with no employment prospects, I would be utterly without any sort of insurance, leaving me to go heavily into debt if I got sick, at best, or just die, at worst.

To everyone back home, goddamn, I wish you the best, because the system is built to take in profit, not to care for the sick.
posted by Ghidorah at 7:46 AM on April 4 [34 favorites]


I suppose it's too much to hope for that we'll come out of this with the political will to change our stupid for-profit system for something that actually works.
posted by The Underpants Monster at 8:18 AM on April 4 [18 favorites]


Update: Trump's health secretary now says there will be a special enrollment period for Obamacare.
Azar added that people who have recently lost their jobs and thus their insurance would be eligible for a special enrollment period under health care exchanges created by the Affordable Care Act, passed under former president Barack Obama.
Hate to burst the bubble, but this is just a regular SEP that's always been available to people losing coverage due to loss of other minimum essential coverage.

What people are asking for is basically a new mid-year open enrollment period that anyone could sign up for. This would allow currently uninsured people to sign up. All states with their own exchanges excepting Idaho, as of right now, have already done so. Typically insurance companies hate this because it fucks with their risk pool projections and such but in the middle of the pandemic, I think they'd prefer people to be insured maybe. Or maybe they just recognize that no one knows what the fuck will happen now so they might as well gain goodwill, fixing the insurance markets after the crisis is a huge unknown anyway.

The Medicare-reimbursement for self-pay (i.e., uninsured) people and ban on balance-billing is, on the other hand, basically a limited (COVID-19-related care only) version of Medicare-for-all-without-other-coverage, and with zero premiums and cost-sharing to boot.
posted by tivalasvegas at 8:41 AM on April 4 [12 favorites]


Typically insurance companies hate this because it fucks with their risk pool projections and such but in the middle of the pandemic, I think they'd prefer people to be insured maybe.

Probably a recruit to dilute situation. The highest uninsured rates are 19-34. The majority of expensive COVID-19 care is for the older types and thanks to Medicare Advantage, 3 in 10 Medicare enrollees over 65 are covered by private insurers. Getting any and all people under 65 is going to be critical to shoring up revenue.

I'm sure someone, somewhere is looking at actuarial tables and asymptomatic modeling and knows just how profitable people under 35, while not immune to COVID-19, are going to be compared to the older age groups that send 20-40% of people to the ER with this thing.
posted by Your Childhood Pet Rock at 9:34 AM on April 4


Tying health insurance to employment works great when...

...lol, sorry, couldn't finish that sentence with a straight face. It never works well.
posted by clawsoon at 9:47 AM on April 4 [12 favorites]


Your Childhood Pet Rock: The majority of expensive COVID-19 care is for the older types

It's not just older types, it's also people with other expensive health conditions of the sort that the healthcare exchange forms don't ask you about, like diabetes or liver disease (CDC link), so the insurance companies can't price those conditions into their premiums.

A special open enrollment period now seems really worst-case to me as far as insurance companies' bottom lines go. The people who want insurance now are either actively sick, plan on getting sick soon, or have these expensive other factors. The insurance companies are vultures but their profit margins aren't so big that they can just absorb the cost of a pandemic along with a huge influx of people with costly conditions. Really the only options I see are letting people die, or effectively nationalizing healthcare, either directly or via massive government subsidies to these companies. I think we're seeing that letting people die is, in the end, not acceptable to most people, no matter what the Tea Party supposed hardliner types want you to think, so it's going to be gobsmacking amounts of government money one way or another.
posted by bright flowers at 9:47 AM on April 4 [1 favorite]


You're still looking at tens if not hundreds of thousands of younger and middle-aged people signing up for insurance who will then be hospitalized with COVID-19 and especially given that insurers are waiving cost-sharing for related medical costs, that increase in income from premium is not going to make up for the cost to the insurers. They will almost certainly need a bailout unless the feds agree to reimburse them for the care (which is just another way of saying "bailout", I guess). Or else, if they manage to wrangle through until 2021, somehow, premiums will be absolutely ridiculous and once again the government will basically be underwriting premiums via the mechanisms for determining premium tax credits, as that is a function of the cost of the second-lowest-cost Silver plan.

I mean, there just won't be the money. The insurers will literally run out of money and what then? The people can't pay, the insurers can't pay, the hospitals can't eat the costs.

Now that I think about it a bit more, the government is going to have to pay for all of this care regardless of whether they open a universal SEP or not, or basically every hospital in the country is going to go bankrupt.
posted by tivalasvegas at 9:51 AM on April 4 [4 favorites]


And what happens when the insurers blow through whatever cash reserves and premium revenues are coming in with COVID care, and then by summer they again do not literally have the cash on hand to pay for all the other care, the medication and regular health care and such? Yeah, we're about to see a de facto single payer healthcare system and I imagine it'll be done at Medicare reimbursement rates. Huh.
posted by tivalasvegas at 9:56 AM on April 4 [2 favorites]


Yeah, we're about to see a de facto single payer healthcare system

Or. A bunch of hospitals collapse, a bunch of insurance companies go out of business, a few get bailouts, and our remaining healthcare system becomes even more expensive and only for those few that can afford it. Just like the market fetishists and GOP always planned all along.

Given our track record and who is in charge I’m inclined to believe scenario B.
posted by Everyone Expects The Spanish Influenza at 10:08 AM on April 4 [21 favorites]


the political will to change our stupid for-profit system for something that actually works.

Given that a significant chunk of the political spectrum believes that all problems are really the fault of black helicopters, the global elites, brown people everywhere, poor people everywhere (except me & mine! we're salt of the earth!) and a gigantic secret child-sex cult that resides onboard the USNS Mercy and on special Martian bases run by reptiloids and pizza shop owners ..... I'm gonna guess that no, you will not get something that works.

Instead, you'll get something that sucks more for everyone, except for people like me who have gold-plated insurance. For us, it's gonna rock, because investments will flow in at the high end to make everything more comfy and convenient for me.

Yay?
posted by aramaic at 10:08 AM on April 4 [5 favorites]


"Those few that can afford it" ends up being the very few that can literally afford to pay cash out of pocket -- we're not talking about higher costs just for working-class and lower-middle-class people, but for pretty much everyone outside the 1%, anyone who's covered by insurance regardless of how good it is. I don't think that's politically sustainable.

The question is whether people will accept the status quo ante once they've gotten a taste of single-payer through the end of 2020. I'm willing to accept that the brainwashing may be just enough, but it's not... a sure thing by any means.

We are in extremely weird times.
posted by tivalasvegas at 10:13 AM on April 4 [1 favorite]


> Given our track record and who is in charge I’m inclined to believe scenario B.

> Instead, you'll get something that sucks more for everyone, except for people like me who have gold-plated insurance. For us, it's gonna rock, because investments will flow in at the high end to make everything more comfy and convenient for me.

Right. For whatever reason, there's this belief out there among many people who should know better that Trump doesn't have any principles, therefore he might be tempted to simply fire a bazooka of cash at the problem, resulting in something resembling single payer. This is total nonsense! Nobody who goes through this is going to feel like they've gotten "a taste of single-payer". Money raining down from the sky and matriculating through our existing healthcare providers and insurers is going to go to reimbursing their up-front costs for emergency treatment, with anything left over going toward profit.

Individuals not receiving treatment for COVID-19, meanwhile, will basically be avoiding doctors and hospitals as much as possible, and therefore won't see any of this. Many are putting off important but not life-saving procedures and surgeries that will hurt them later when they do try to get care, increasing their out-of-pocket costs, for which no reimbursement is coming.

I don't know if this is Stockholm Syndrome or what, but please stop entertaining this ridiculous hypothetical that we are Shock Doctrine-ing ourselves into a better system.
posted by tonycpsu at 10:19 AM on April 4 [17 favorites]


Healthcare reserves are built at extremely high tolerances. Most try to keep well in front of statutory minimums and keep above the 500%ish range of risk-based capital ratio. Kaiser in California at one point had a monstrous 1600% of its risk-based capital ratio in reserves. That was so insane that California's AG issued a "WTF? Why do you keep increasing premiums if you have 20 billion fucking dollars in the bank?"

Compare it to a bank running on like 8%. Health insurance companies are regulated to hell and back to be bullet proof on capital requirements and they're one of the few people who amass as much reserves as possible because when shit hits the fan, they're the ones that are going to cop a good spraying.
posted by Your Childhood Pet Rock at 10:26 AM on April 4 [7 favorites]


I know quite a lot about health policy and how the insurance markets work. I'm trying to think through the plausible outcomes here, and while I'm aware that systems in general do tend toward homeostasis I can really see the current system falling apart under the weight of this crisis.

The government has already, just yesterday, told hospitals that they will cover unreimbursed COVID-related care at Medicare rates, without requiring that patients be enrolled in some special Medicaid-look-alike, nothing -- they're just going to write checks. And the shit has just barely started to hit the fan.

Maybe you're right, Your Childhood Pet Rock, and that certainly is the lynchpin of my argument. (I note, however, that the article you link says at the top that it's from 14 years ago, and I don't know about how much the regulatory landscape has changed since then.)
posted by tivalasvegas at 10:35 AM on April 4 [3 favorites]


For whatever reason, there's this belief out there among many people who should know better that Trump doesn't have any principles, therefore he might be tempted to simply fire a bazooka of cash at the problem, resulting in something resembling single payer.

There's also the pattern: 1. Trump blusters something about prescription drug prices that sounds strangely lefty 2. Big Pharma stock prices drop 3. Someone hurries to whisper something in Trump's ear 4. Trump comes out and reads a prepared statement that sounds like GOP orthodoxy 5. Everything returns to the way it was 2 to 3 days earlier.
posted by gimonca at 10:35 AM on April 4 [14 favorites]


The feds have always covered the costs of uncompensated emergency care. There's more of it out there now that providers are required to treat, so they're throwing more money, but that doesn't in any way resemble "a de facto single payer healthcare system".
posted by tonycpsu at 10:39 AM on April 4


Obviously I don't know what's going to happen, but I think business-as-usual-but-a-little-worse is unlikely given that this catastrophe is going to personally touch everybody. Similarly dumping tons of money into healthcare isn't a hypothetical, it'll have to happen in the next couple months or we'll see, putting it mildly, grim outcomes. This isn't to rule out that we could end up with extremely bad government, open fascism etc, in the wake of this. But, if we end up with whole communities out of work and sick with no hospital available, communities that were formerly doing okay if not prospering, the people in these communities will get together and talk about what to do about it, and I don't think stuff like Pizzagate will come into it. They might not come up with the space communism that MetaFilter prefers, but it'll be something besides the status quo.
posted by bright flowers at 10:41 AM on April 4 [4 favorites]


Sure, there's the safety net payments -- but my understanding is that hospitals know that number and are able to budget for it ahead of time; this is a different situation. And still, beside that issue what happens if insurers do blow through their reserves, particularly in smaller states and with smaller insurance companies that might not have the cushion of a Kaiser or a big-state BCBS? Does the money pass through from the government to the insurers and on to the providers? Does the promise to cover *all* COVID-related care fall under the existing ability to provide reimbursement for emergency care? Does HHS even have the statutory authority to make any of these payments or policy decisions?
posted by tivalasvegas at 10:50 AM on April 4


Basically, I guess, my argument is that we're going to have to (and in some cases already did) make huge changes to how medical expenses are compensated, a super-complex and creakily bandaged system at the best of times, and we're doing so pretty much on the fly. The potential for unforeseen consequences that cause either insurers or providers to run out of money seems pretty high to me, and I think at that point all bets are off.
posted by tivalasvegas at 11:01 AM on April 4


Medicaid covers ER emergency treatment, but for a limited amount of hours, often 23.
posted by kerf at 11:32 AM on April 4


but for a limited amount of hours, often 23.

Let me guess. Some asshole came up with the brilliant idea that homeless people would start drinking antifreeze to get a hospital bed for a few days and so added this ridiculous punitive measure?
posted by Your Childhood Pet Rock at 11:42 AM on April 4 [1 favorite]


The general idea is that even Ronald Reagan realized that it looks bad if we're letting people bleed out in the parking lot of the ER because they can't pay, so the hospitals have to provide emergency care until the person is "stabilized" (then back on the streets with them).
posted by tivalasvegas at 12:07 PM on April 4 [1 favorite]


Healthcare reserves are built at extremely high tolerances. Most try to keep well in front of statutory minimums and keep above the 500%ish range of risk-based capital ratio.

This is true, and Health Insurers tend to keep larger liquid cash reserves around than other insurance companies. BUT, the bulk of these reserves tend to be not-so-liquid investments in various markets. In good times, this is where the bulk of the companies profits come from - investment earnings, not premiums.

In bad times, they sometimes go bankrupt.
posted by Anoplura at 12:38 PM on April 4 [1 favorite]


There's also the pattern: 1. Trump blusters something about prescription drug prices that sounds strangely lefty 2. Big Pharma stock prices drop 3. Someone hurries to whisper something in Trump's ear 4. Trump comes out and reads a prepared statement that sounds like GOP orthodoxy 5. Everything returns to the way it was 2 to 3 days earlier.

I would not be at all surprised if it eventually came out that members of the Trump cabal sold pharma stocks just prior to [1.], then bought same after [2.], but before [4]. Or if it didn't come out, but happened.
posted by Kirth Gerson at 1:57 PM on April 4 [3 favorites]


All it takes to fix the insurance nightmare is a universal agreement among Democrats to socialize health insurance, and simple majorities in the House, Senate and the Presidency. It doesn’t matter how insane the other side is, if the Democrats can actually muster the will and the majorities they can force a wholesale reform through in a month. We don’t need Bernie, we don’t need Republicans, we don’t need the lunatics; we just need to get the entire party on board by spring of 2021. Hopefully compete economic and medical collapse over the next year will be enough.
posted by chortly at 2:31 PM on April 4 [1 favorite]


All it takes to fix the insurance nightmare is a universal agreement among Democrats to socialize health insurance, and simple majorities in the House, Senate and the Presidency.

Alas Democratic Party simple majorities are always undermined by 3-5 reps or senators who are actually moderate Republican entryists.
posted by srboisvert at 3:03 PM on April 4 [2 favorites]


"Always" may be a bit parochial at this point. The fundamental question is whether 2021 will be more like 2009, 1993, 1965, or 1935. There were certainly far more conservative Democrats in 1965 and 1935 than there are today.
posted by chortly at 3:56 PM on April 4 [1 favorite]


This might not be as dire as projected. The CARES Act is providing $350 billion as aid to small businesses under 500 employees to keep people on the payroll even if not employed. The payroll includes health insurance benefits.
So a lot of people shouldn't be laid off at all.

And for the unemployed, they will be receiving $2400 a month in addition to their state's regular unemployment insurance. For a household of two workers, that's an extra $4800 a month. That would go a long way to paying for health insurance.

For at least the next two months, the unemployed can avoid paying for COBRA coverage. They only need pay if they suddenly have expensive health needs, in which case they can enroll with retroactive coverage.

Loss of health insurance is only going to become a real issue if the shutdown goes beyond two or three months.
posted by JackFlash at 3:56 PM on April 4


I'm sorry where are you seeing everyone will get 2400 a month for unemployment?

"Married couples with no children earning $150,000 or less will receive a total of $2,400. "

This is not a monthly unemployment check this is a single, one time stimulus check. Unemployment will trod along.
posted by symbioid at 4:15 PM on April 4 [1 favorite]


Symboioid, there are two different programs in the CARES Act. The one most people have talked about is the one-time checks, as you noted. These are $1200 per person plus $500 for children under age 17. These are called Recovery Rebates for Individuals.

But there is a separate program that supplements unemployment benefits through the end of July. It is $600 per weekly check (about $2400 per month) in addition to regular unemployment benefits. This is called Federal Pandemic Unemployment Compensation.
posted by JackFlash at 4:23 PM on April 4 [3 favorites]


OK thanks - i tried to find that and didn't see, probably because I was looking for 2400 but they mention with 600. Appreciate the reply.
posted by symbioid at 4:32 PM on April 4 [1 favorite]


The firm I work for is still small-ish, maybe 250. They're not eligible for CARES at all.

You see, even a partial non-majority stake by private equity is disqualifying ( I actually think the attorney said non-zero ).

That was a sneaky bullshit thing to do.
posted by j_curiouser at 4:42 PM on April 4 [3 favorites]


The coronavirus’s unpredictable impact on next year’s health insurance rates, explained

Vox article. It says premiums could go up as little as four percent or as much as 40 percent depending on how long the pandemic lasts, whether insurers need to dip into financial reserves, the cost of postponed elective medical care in 2021, and whether congress provides financial to the health insurance companies (they are asking for it).
posted by eagles123 at 4:52 PM on April 4 [1 favorite]


You see, even a partial non-majority stake by private equity is disqualifying ( I actually think the attorney said non-zero ).

I do not think this is correct, but I could be wrong. My understanding is that it must be a "controlling ownership" to be considered a private equity portfolio company, which would imply a majority stake. But there is a lot uncertainly out there as the Small Business Administration races to implement the new laws.

As defined by the Small Business Administration, all private equity owned companies in a portfolio are considered one large company, which may have more than 500 employees. This disqualifies them from the Payroll Protection Plan. But they would be eligible for the low interest loans for corporations.

In any event, people are working on getting either a waiver or new legislation to change this. But I don't expect anything too quickly.
posted by JackFlash at 5:01 PM on April 4 [1 favorite]


An acquaintance who posts updates from the US embassy in Tokyo recently posted one that in a weirdly, I don’t know, snide? tone, said that Americans should leave Japan and return to America as soon as possible, or be prepared to remain in Japan indefinitely. It went on to note that, in the case of a serious outbreak of corona in Japan, residents here might not receive the high level of care we’ve become accustomed to.

Same message went out from the US embassy in Canada.
posted by eviemath at 7:37 PM on April 4 [1 favorite]


But then you have Joe Biden saying that he would personally veto medicare for all if he was president.

Like I dont see how it is going to get any better?
posted by Iax at 11:16 PM on April 4 [2 favorites]


I don't think that's politically sustainable.

What is politically sustainable is what ever those who own the Senate, the courts, and the executive say it is. That’s our reality.

We have already witnessed at least a dozen iterations of things that we were told were not politically sustainable get sustained. That is not changing.

The only thing that matters in this country is power. The left still doesn’t understand this. I don’t understand why. But they don’t. If the left doesn’t control the government and the power we’re not getting socialized healthcare by Some Weird Trick As the consequence of a pandemic.

Chaos really is a ladder and the right knows how to climb it. When the left actually wins a presidential election and takes back the Senate THEN I’ll have faith in what we can and cannot politically sustain.
posted by Everyone Expects The Spanish Influenza at 11:17 PM on April 4 [4 favorites]


even Ronald Reagan realized that it looks bad if we're letting people bleed out in the parking lot of the ER because they can't pay

Or more likely, someone realized that people dying in the parking lot will both scare away the paying patients and result in dead bodies that someone has to deal with.

OTOH, admitting them, patching up their immediate problem, and pushing them back into wherever they came from, means if they die a week later because they couldn't keep the wound clean/ get adequate drinking water/ safely walk around an apartment, well, it's not the hospital's problem.

There was absolutely no law that could be passed that would prevent emergency patients from showing up at hospitals. Telling them "if there's no proof you can pay, we won't check you in" results in emergency patients standing around (or sitting around, or lying around bleeding) in the emergency room lobby, or as close to it as they're not physically forced away from.

I do not for one second believe that treating them is a matter of altruism and compassion. (The doctors and nurses mostly have compassion. The laws were not written by doctors and nurses.) Treating them is a way to avoid stroke and gunshot patients from dying on top of the other patients, and scaring the hell out of the kids of rich people in the process.
posted by ErisLordFreedom at 11:23 PM on April 4


The government has already, just yesterday, told hospitals that they will cover unreimbursed COVID-related care at Medicare rates, without requiring that patients be enrolled in some special Medicaid-look-alike, nothing -- they're just going to write checks.

-Trump Says Hospitals Will Be Paid for Treating Uninsured Coronavirus Patients
-White House says it will use $100B to reimburse hospitals to treat uninsured Americans for coronavirus
-Trump administration will reimburse hospitals for treating uninsured coronavirus patients using stimulus funds

In any event, people are working on getting either a waiver or new legislation to change this.

fwiw...
Private equity groups seek US small business rescue loans
posted by kliuless at 1:49 AM on April 5 [2 favorites]


-Trump Says Hospitals Will Be Paid...

Trump says a lot of shit. About 10 days ago, he said MA would be getting a bunch of respirators from the Federal stash. Last I knew, zero have arrived. Governor Baker said something at the time that amounted to "I'll believe it when I see them." Trump has been saying a lot of shit about people getting cash relief, more unemployment benefits, etc. When the details are exposed, it looks like his henchpersons and the Republican legislators are working hard to narrow eligibility for the benefits as much as they can. Believe it when you see it.
posted by Kirth Gerson at 5:17 AM on April 5 [6 favorites]


Meanwhile,
Trump administration quietly guts COVID-19 paid leave provision that already excluded 75 percent of workers

The Trump administration has quietly issued new guidance that will exempt many small businesses from having to provide some workers with paid leave during the coronavirus pandemic.

The Department of Labor issued a temporary rule Wednesday that effectively exempted businesses with fewer than 50 workers from being required to provide 12 weeks of paid leave for workers whose children are suddenly at home from school or child care under the coronavirus stimulus package signed by President Donald Trump.
posted by Kirth Gerson at 5:45 AM on April 5 [2 favorites]


If health insurance premiums do spike towards the upper end of that 4% up to 40% range, we’re going to probably see millions drop their coverage. Health insurance costs are already a heavy burden on people. We aren’t rich, but we’re doing ok, but I can’t afford a 20-40% premium hike. Between premiums and an HSA contribution that’s about half of the premium (and still not enough to build up to the deductible in a year) a big chunk of our income is gone before anything else gets paid. And I know other people have it even worse.
posted by azpenguin at 6:08 AM on April 5 [2 favorites]


We're clearly in the territory past insurance into the question of who is going to pay for all this. Rather, there are two issues: one, who's going to pay, probably the various governments and insurance companies with providers eating a lot of the cost; two, separate and unrelated question, how much are we going to try to shake down people unlucky enough to get hit with massive bills while uninsured. They might as well introduce universal NHS-style coverage while simultaneously sending out $100k bills to 10% of the population picked by lottery weighted toward the less privileged. Or just take all their money in a "how much do you got?" sort of thing. Of course it was already like this, but the pandemic is accelerating the situation.

In other words on the micro level, yes people definitely should have insurance if possible to avoid falling under the baleful Eye of Doom, but on the macro level making this an issue of getting people insured is I feel missing the point. I'm not criticizing anyone in this thread, to be clear.
posted by bright flowers at 6:34 AM on April 5


exempted businesses with fewer than 50 workers from being required to provide 12 weeks of paid leave

Well that actually makes sense. Most small businesses do not have a war chest of three months salary for all their employees sitting around at once if they are shuttered and not making revenue during a pandemic. Unless this includes McDonalds franchises or something.

I own a small business. I employ six full timers. We already guarantee two weeks paid sick leave (plus maternity leave) in addition to two weeks paid vacation with the ability to accrue more. That is exceptionally generous in my industry. The lowest salaried person makes $72k a year. The highest, which isn’t me btw, makes over 160k. We’re still on the hook for 10k of rent per month. Plus equipment leases. We can afford to pay everyone a month maybe six weeks without revenue. After that it’s lights out and everyone is out of work. Now, we’re lucky in that we can generate revenue having nearly everyone working from home. As long as the clients can pay, that is. Which is looking iffy.

A small sole proprietor cafe or something? On the hook for three months wages for twenty thirty people? All at once? No way. There won’t be a small business (50 or fewer employees) left standing at the end of this.

The government has to step in at that point.
posted by Everyone Expects The Spanish Influenza at 9:43 AM on April 5


exempted businesses with fewer than 50 workers from being required to provide 12 weeks of paid leave
Well that actually makes sense.
The government has to step in at that point.


No it doesn't make sense. And yes the government has stepped in, big time.

First off, the Families First Act fully reimburses companies for providing paid leave -- 100%.

And then the CARES Act provides funding to keep all of small business employees on the payroll whether they are working or not -- 100%.

There's simply no excuse for not using these government funded mechanisms to keep people fully employed during this crisis.
posted by JackFlash at 10:22 AM on April 5 [4 favorites]


Sure, in principle; but as always, the devil's in the details.

What happens when there's more money requested than there are funds appropriated?

How many small business owners are going to know how to negotiate the process?

How many small group insurance plans are going to lapse while all this is happening?
posted by tivalasvegas at 11:52 AM on April 5 [1 favorite]


What happens when there's more money requested than there are funds appropriated?

Miracle of miracles, Trump and Pelosi agree! Both have publicly announced said they will appropriate more money if necessary.
posted by JackFlash at 12:25 PM on April 5 [3 favorites]


Yeah. All this "100%" bullshit is theoretical until you actually try it. People are trying to use the "government funded mechanisms." And the PPP goes through private banks. Our bank, like many, is simply not taking PPP applications unless you have a loan with them. Which we do not. We are currently awaiting hearing from another with no word yet.

The government is going to have to "100%" step up a bit more for small businesses.

Like I said we are okay for now since we are generating revenue. But other business are not quite so lucky. So tone down the strident certainty a wee bit unless you are a small business owner going through this right now.
posted by Everyone Expects The Spanish Influenza at 12:49 PM on April 5 [1 favorite]


In other words on the micro level, yes people definitely should have insurance if possible to avoid falling under the baleful Eye of Doom, but on the macro level making this an issue of getting people insured is I feel missing the point.

To me this is more like an illustration of the shortcomings of health insurance as a model for getting people care. It's just not sustainable, especially considering the profit motive of so many involved parties - insurance companies, hospitals, administrators, pharmaceutical companies, etc. I don't lump doctors in that list - there are some that can be pretty money hungry, but most of them have years of schooling, a shitload of med school debt, and they have a job that they want to do instead of thinking of ways to squeeze more money out of their patients. Getting people insured means trying to continue the same model that we know does not work.
posted by azpenguin at 12:58 PM on April 5


Actually I have done this. First off, you can get an emergency $10,000 EIDL loan in just three days, directly from the SBA. You don't have to go through a lender. You can follow this up with a larger loan all online, no lender. All 100%
free money if used for qualified expenses such as payroll.

And the PPP has only been live for two days. Complaining that you can't get service right now is a bit premature. Bank of American got 85,000 applications on the first day. Of course banks are going to prioritize their longest customers. If not BOA, then open a business account at another bank or credit union that is more friendly.

I mean, complaining about a little paperwork when you are shut down and have nothing better to do seems a bit much. It's free money for your business, yourself and your employees.
posted by JackFlash at 1:27 PM on April 5 [3 favorites]


It's not just "complaining about a little paperwork", JackFlash. It's about the fact that there are many, many small business owners that are not going to have the bureaucracy-navigating skills to get things done in the few weeks or days before they have to let employees go, before they run out of money, before their landlord starts coming at them for the rent that was due on April 1.

How many of them can fold without the economy collapsing?
posted by tivalasvegas at 2:22 PM on April 5 [2 favorites]


Actually I have done this.
Right. Well. I guess I have to take your word for that. So you're a small business? How many people do you employ?

You've made some bold statements made it all seem so trivial. And it is not. First YOUR personal experience is not universal. There are all sorts of hiccups and stalls. That for many businesses will be fatal. And right. We ARE only a week into these programs. Not many small businesses are getting the money yet, are they?

you can get an emergency $10,000 EIDL loan in just three days
Yup. Did that Thursday. Which is basically a small bridge loan. Haven't gotten any check yet. And 10K is not a full payroll for most businesses. Certainly not mine. Not sure why you think that would sustain business with 15-50 employees.

And nobody is complaining about a little paper work. I'm not "complaining" at all. And you know I'd really like to say something about how insulting your tone is that wouldn't be polite. I'm simply telling you facts and experiences.

And BTW, the Families First Act fully reimburses you in TAX CREDITS. Not cash in hand. Small businesses are not getting is cash — right now. A week is all it takes for many small businesses to go under without revenue. The fact we have to go through banks so they can get a cut and ensure that that the businesses that owe them money already can pay and will get the lion share of these funds first is god damned absurd.

I have been a vocal advocate for federal paid sick leave, well, for years. But just insisting that small business provide every single employee paid sick leave during a pandemic with no revenue is like coming up with money out of god damned thin air. It won't work until there is solid provable infrastructure in place to help them do so.

Right now all this is still in the theoretical phase. The CARE act is a start but it isn't proven to function on any scale that will be needed yet. Your say so isn't proof.
posted by Everyone Expects The Spanish Influenza at 2:32 PM on April 5


Of course banks are going to prioritize their longest customers.

Right. I have banked at my bank for 27 years. I just do not owe them any money. So. How much longer do I need to be a priority before I get PPP? Another thirty years?
posted by Everyone Expects The Spanish Influenza at 2:36 PM on April 5


How much longer do I need to be a priority before I get PPP?

It's been two days.

Look, if your business has 50 employees and it is so marginal that you can't even survive a couple of weeks and you have no line of credit, well you're right, maybe the best thing you can do is lay off your employees right now so that they can get unemployment insurance. And then afterwards, when this is all over, they can find a more secure job at a better business.
posted by JackFlash at 3:05 PM on April 5 [1 favorite]


[You two maybe just take up a brisk email correspondence if you really want to keep wrestling with each other about this and stop making everyone else listen.]
posted by cortex (staff) at 3:07 PM on April 5 [5 favorites]


There won’t be a small business (50 or fewer employees) left standing at the end of this.

The government has to step in at that point
.

They will. To make it easier for big business to fill the niche.
posted by j_curiouser at 3:09 PM on April 5 [5 favorites]


It's been two days.

Look, if your business has 50 employees and it is so marginal that you can't even survive a couple of weeks and you have no line of credit, well you're right, maybe the best thing you can do is lay off your employees right now so that they can get unemployment insurance. And then afterwards, when this is all over, they can find a more secure job at a better business.


Jesus fucking Christ. This is not the type of thing I want to read. Can we keep in mind that we are all human beings here? Is being right on the internet worth that much?
posted by eagles123 at 7:26 PM on April 5 [5 favorites]


To be fair to small business owners who don't have the ability to pay their employees for a month before getting the SBA process worked out, many of them in fact thought they had themselves covered through business interruption insurance, only to find out they didn't.

Vitriol and accusations of malice when a system isn't running perfectly from the moment it begins when there was less than two weeks of lead time to get it set up also seems a bit much. It's clear many banks are acting as if PPP loans are subject to the normal shit when the law is written specifically so that they shouldn't be except in the sense of where paperwork gets sent so that everything gets accounted for in the end.
posted by wierdo at 11:35 PM on April 5 [1 favorite]


Update: it’s been now 10 days. Application sent to three banks later and we’ve told PPP is running out of money. We were first in line. But like I said. Banks are prioritizing NOT long time customers, but people that owe them money. Though it’s likely we will, eventually, get some payroll money. No idea when.

The magical 10k EIDL check still hasn’t arrived. And it too is now limiting it’s grant totals to 15k until it gets more money.

As I suspected clients are having trouble paying our bills. Though luckily a big client paid off their invoices a week before the stay at home and our landlord has waived April rent. But I doubt May.

This is what small businesses with zero revenue that are expected to meet payroll are facing. And the fast majority cannot ride out more than two weeks paying out with nothing coming in. The vast majority.

So. All these mythical “better run businesses“ that survive, the few remaining, will certainly have the pick of the litter. Probably for much, much cheaper.
posted by Everyone Expects The Spanish Influenza at 10:31 AM on April 13 [4 favorites]


Further Update: Looks like the EIDL program has changed from $10k to $1k per employee. The EIDL is drastically under-delivering.
posted by Everyone Expects The Spanish Influenza at 2:27 PM on April 14


It's not the only one. Democratic Congressmen are saying that over 80% of the cost of the CARES Act is a massive tax break for the rich.
[Texas Congressman] Doggett tried to put the impact of the tax changes into context Tuesday by pointing out that “for those earning $1 million annually, a tax break buried in the recent coronavirus relief legislation is so generous that its total cost is more than total new funding for all hospitals in America and more than the total provided to all state and local governments.”
posted by Kirth Gerson at 2:40 PM on April 14 [5 favorites]


I told you so. This is what Trump and Republicans do. They announce some magic policy and then don’t deliver it and nobody checks back to see if it ever happened.

I can name about a eight small businesses that were going strong for a decade or more that have already gone under. Those jobs are gone.

I’ve been in business since 1996. We’ve got another month in us without getting revenue. We have some coming in but I can see it slowing. The PPP assistance is half of what we need and we’re likely not getting more because funds are gone. And that check still hasn’t come. Just like the stimulus checks haven’t come. And the EIDL has evaporated.

And. It’s not going to just go back to normal. All but my biggest corporate clients don’t have revenue. When we can get back to regular operations they’re not going to have money to pay for our services — services already rendered — for a while either. We’re planning it will go on for the rest of the year AT LEAST.

Will we make it? I see us laying off at least three people in July. And making them freelance. That’s three more people without health benefits or ANY paid sick leave. The rest by august if money hasn’t come in. And freelance rates will be down significantly. So we will pay them less. Because we’re in a city that will likely see 20% unemployment for a while. The idea of 12 weeks paid sick leave in that climate is idiotic.

The claims that a “well run” small business under 50 employees that has a war chest of ready cash (and no, a line of credit is just more debt — you don’t use that for payroll) to make payroll for any length of time with out incoming revenue is absurd and total fantasy. We knew the Trump government wasn’t going to step in with anything but words and handouts for banks and billionaires. And here it is.

And frankly I think an apology is owed from a couple commenters here whose strident judgments were based on absolutely zero experience running a business with employees. Especially one during a pandemic.

Next time listen to those of us going through this.
posted by Everyone Expects The Spanish Influenza at 9:08 AM on April 15 [4 favorites]


Small-business program intended for quick grants is running weeks behindApplicants are supposed to receive emergency cash within three days. Many have been waiting weeks.
“Sadly to say, we’re getting low on funds,” SBA lending specialist Roderick Johnson said in an April 9 webinar for D.C.-area realtors. The webinar was hosted by the National Association of Real Estate Brokers with participation from a Democratic Senate staffer. [...]

“Sadly, the disaster loan program is a complete disaster,” Holly Wade, director of research and policy analysis at NFIB, the industry group for small business, said of the EIDL program.

“We have not heard from any small business owner who has received the loan. We’ve heard from just a handful — I want to say less than five people — who have received the emergency grant,” Wade said. “There is no communication or very little at most between the SBA and applicants on the status of the loan. It’s just silence.”
posted by tonycpsu at 12:47 PM on April 15 [1 favorite]


Welp.

Government’s Small Business Loan Program Is Already Out Of Money

uncle_pennybags_broke.gif
posted by tonycpsu at 8:27 AM on April 16 [1 favorite]




In Florida, the problems are literally by design. It was openly stated at the time the system was implemented. Unlike NJ, it isn't even particularly old, though it certainly looks it. That is also by design. The more confusing, frustrating, and scary (with literally pages of fraud warnings, not screenfuls, but separate pages the server has to send and you have to click through) the process is, the fewer people will actually complete the process.

The true irony about all the fraud warnings? Rick Scott, our former governor and current US senator who commissioned Florida's new UI system made a large portion of his fortune with..wait for it..Medicare fraud. A man who literally defrauded the government insisted on admonishing the unemployed that benefits fraud is a crime. One that pays at most $275 a week, an entire lifetime of which would add up to less than Rick Scott's fraudulent gains..that we know about.
posted by wierdo at 8:47 PM on April 27 [2 favorites]


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