In states with Medicaid expansion the ultra poor are covered, and I can’t see an incrementalist change toward universal health care changing this system.
Low to middle income workers who don’t get good insurance from their employers are facing barriers to care, because of high deductibles and high prescription costs. When I was in that position I gladly took on a higher premium if I could, in order to avoid a high deductible that would lock me out of care.
People who don’t need chronic care or who don’t have expensive injuries see the premium as their main expense and resent it. But they probably do not understand how a high deductible would block many of them from getting care, or ruin them with debt. Nobody in the working class should get a high deductible plan unless they have a bit of wealth, like home equity, that they are willing to gamble.
Compared to being blocked from care, I preferred a higher premium for as long as I could still afford it. Then when my income fell and my new employer didn’t offer real insurance (a situation common to most temps and gig workers) I was locked out of care because of the high ACA deductible and didn’t get care again until I had gotten so sick (from lack of care) that I fell into the Medicaid range. In other words, the only plan I could afford, Bronze, was useless because of the high deductible.
I’m convinced there are probably many people now on Medicaid who wouldn’t have landed there if we had a system that actually gave the working poor access to care.
A decently designed Medicare for all system should subsidize the working poor with a premium discount right up front. Blocking access to care with deductibles and high prescription costs is how the Right defanged the ACA and turned the poorer workers against it.
