I’m old enough to remember the 1984 Summer Olympics and how gymnast Mary Lou Retton showed the world what a girl from West Virginia and trained in Houston could do. Ta. Her incredible talent and her million dollar smile were on full display. After Retton retired from her competitive gymnastics career, I started watching her on TV from time to time. I didn’t even think about her until a few weeks ago. However, this time the image was very different.
I read on the news what Retton’s daughter posted on Instagram. Retton was hospitalized in Houston with a rare type of pneumonia, fighting for his life, and was uninsured. Her daughter asked people to pray for Retton and donate money through her crowdfunding website to help pay for her hospital bills.
I felt immense sadness at Mr. Retton’s plight, both health-wise and financially. I was relieved that she was better on both fronts and was discharged from the hospital based on her report. raise over $400,000 For her hospital bills.
However, since I am interested in health policy, I also wondered, “Is it possible that America’s sweetheart doesn’t have insurance?”
The United States has an unusually and extraordinarily complex health care delivery and financing system. most americansThe highest medical costs are paid by insurance plans sponsored by employers (49%), the government (37%), or purchased on their own (6%). in texas, the numbers vary slightly: employers (47%), government (30%), and individuals (7%). Including Retton, 8% of Americans and 17% of Texans are uninsured.
Retton may not have been eligible for insurance provided by her employer. According to public sources I consulted, there is no opportunity for her to qualify through her spouse’s employer because she is not currently employed and is not currently married.
It is also unlikely that Mr. Retton would have been eligible for government-sponsored insurance. This category includes Medicare, Medicaid, and military. Since she is not a military member and is 55 years old, she is not yet eligible for Medicare. Currently, Medicaid in Texas only covers low-income children and some of their parents. , pregnant women; , Texans with disabilities. , and a small number of very low-income seniors. The 40 states that expanded Medicaid now include adults with incomes up to 138 percent of the federal poverty level ($20,120), but Texas declined to expand Medicaid to that group. Therefore, even though Mr. Retton was living below the poverty level, he would not be eligible for Texas Medicaid.
This leaves you with a separate insurance plan. Americans can purchase private plans directly from their insurance company or through the ACA Marketplace at healthcare.gov. Many wealthy Texans purchase through private companies. I checked the Texas Department of Insurance website and found the following: 100 full plans Available in Harris County in 2023, monthly premiums range from $544 to $1,258.
The marketplace is 120 plan, monthly premiums range from $289 to $689. For low- to moderate-income Harris County residents, the plans come with a subsidy of several hundred dollars, and some plans have premiums waived. His Marketplace plan includes an out-of-pocket limit of more than $18,200, which is far less than the cost of a long-term hospital stay. By 2023, more than 2 million Texans will have purchased a Marketplace plan.
So why wasn’t Retton insured? He has only two options.
If she was living below the poverty level, she would have fallen into the Medicaid coverage gap as a result of the state’s failure to expand Medicaid. If so, we need to ask ourselves how we can allow someone who has contributed so much to our country to fall from grace.
If Ms. Retton’s income was above the poverty level, there would have been more than 100 plans that could have protected her from weeks of extremely expensive hospital stays. Thanks to her popularity, her family was lucky to be able to collect hundreds of thousands of dollars from strangers. Most people facing hospital bills aren’t so lucky.
Will she buy a plan for 2024? Now is the time: Open registration is currently underway and ends on January 15th.
Elena Marks is a senior fellow in health policy at Rice University’s Baker Institute for Public Policy.
