Fell off Subsidy Cliff (before the American Rescue Plan ended it -- temporarily)


(Interview April 2021) (oil on canvas, 48” x 48”)


Two paintings side by side. Oil on canvas, 48" x 48" ea.



Update 2022

This portrait consists of 2 paintings. One stays in the Art As Social Inquiry (ASI) Healthcare in the US series. The other will be separated from Frank’s death portrait, be sold, and go on to live in a world without Frank. The ASI death portrait is called is called Frank; the detached painting, Without Frank.


In later emails, Amy shared this thought. “I am obviously now 100% for universal health care. Your healthcare should not be tied to your employment. And you shouldn't have to worry about whether you can afford to stay alive.”


Artist Note (2020)

“I am telling you this story so when you think everyone doesn't deserve basic health insurance you think of my father. And I hope you get embarrassed, and I hope you are uncomfortable. Because my father deserved better. This nation deserves better.” A stunned and appalled daughter vents on Facebook after her father’s sudden death. (Full Facebook post below)


In the United States, we fear the financial repercussions of being sick as much as the sickness itself. Amy admits to thinking, “The longer he is alive, the more money this costs.” Being afraid that the American healthcare system will bankrupt us is so ubiquitous, the fear infests our decision-making, grieving and national soul.

The daughter of the deceased sucker punches anybody within earshot with sarcasm, turning a phrase Americans are so fond of into derision – “we’re the best nation in the world.” And we deserve her contempt. Her father died at 61.


We Americans are good at flag-waving, horn-honking, and meaningless slogans. Supporting good policy that gives Americans like Amy’s dad easy access to comprehensive, affordable healthcare, not so much.


The call for a national health insurance plan persists. This idea of a federal health program coils itself through every decade’s politics from Teddy Roosevelt to the present. Medicare for All supporters keep the debate going today. Support blows hot and cold depending on what messaging people believe.

The 2010 Patient Protection and Affordable Care Act (ACA or Obamacare) is not a national health plan but it is the first massive health policy change since the establishment of Medicare and Medicaid in 1965.


It took ten years for the new healthcare law to poll favorably with the American people. Republicans ran a long and punishing campaign, a litany of distortions and even flat-out lies, to discredit the 2010 law. The American people have had enough time to experience the law’s benefits and get behind reform. They have seen preexisting condition discrimination end, the establishment of essential health benefits, no-cost preventive screenings, marketplace subsidies, and much more. But the new healthcare law is not without its flaws.


~


Frank drove a bread delivery truck and carved out a solid middle-class life for himself and his family. When Amy’s dad found himself uninsured (see story below), the Affordable Care Act did not make it easy for him to buy health insurance. Amy priced a plan on the marketplace at $1300-$1500/month.


Frank made too much money to qualify for financial help but not enough money to buy a full-priced policy. In healthcare wonkery circles, experts would say Frank fell off the Affordable Care Act’s subsidy cliff. (Frank may have benefited from American Rescue Plan Act of 2021 which temporarily ended the subsidy cliff. See blue text box)


The Affordable Care Act's high deductible plans were cheaper but as Amy put it, “He (her father) was not wrong for thinking what’s the point of an expensive high deductible plan? How do you go to a doctor with catastrophic insurance? You don’t.”


High deductible plans require the insured to pay their medical bills out of their own pockets until they reach their plans’ limits. The out-of-pocket limits are in the thousands with $8550 being the most a plan can expect an enrollee to pay in 2021 before insurance starts paying the medical bills.


The price tag ended the issue for Amy’s dad. Amy said, “People hear they have to get their own healthcare and they get scared…well, nothing’s going to happen.” Her dad was not willing to pay an insurance premium the price of a mortgage or sell off assets he worked his whole life to attain to pay for medical care.


Over the years, I have found the brokenhearted possess a raw eloquence. Amy does not mince words. “For those of you that are against or don’t believe in universal health care, I pray that you never have to make a life-or-death decision based on whether you could afford it or not.”


This is a death portrait. I paint a subject half in and half out of life if lack of access to healthcare contributes to a person’s early death.


Amy calls out our indifference to those like her dad who fall through the cracks. “One of the biggest things I want to say is my dad is everything critics say you’re supposed to be. He’s an American citizen. He’s a taxpayer. He owns his own business. He’s done all those things and still you don’t care. He checks all your boxes, and you still don’t care. He still isn’t important enough for you.”

Here is Frank’s story.


 

A study. Oil on canvas, 24" x 20"

Bakery Delivery Truck Driver, Deceased, Uninsured, Age 61

Frank’s daughter struggles with her father’s early death. “Dad died at 61. It frustrates me. Can you imagine working his whole life, making sure that we (his children) have this great life then he’s gone? He’s got nothing.”


Frank had health insurance for most of his working life. He delivered packaged baked goods in the Philly area for a national chain for over a decade. “The family had health insurance,” Amy remembers. When he fell ill and needed time off, he lost his job. “The company was forced to replace him on his route. He was really upset because he did like working there.”


Frank landed a job driving a bread delivery truck for a Philadelphia bakery famous for its signature hoagie rolls. In 2015 Frank’s employer moved to NJ as part of a merger between Frank’s employer and a NJ bakery. About 200 workers were terminated including Frank. All were invited to reapply and interview for positions at the new relocated company.


Frank lost his union job with the Philly bakery and was hired back as an independent contractor after the company’s move to New Jersey. Frank also lost the benefits a union job gave him – paid vacation, overtime, and health insurance. Amy said, “He used to do great. I would say that’s the easiest I ever saw my dad’s life when he was in the bread bakers union.”


Being hired back as an independent contractor also meant Frank had to buy his truck route from his former employer and, in effect, go into business for himself delivering the baked goods. His daughter said, “It’s almost like a mortgage.” A consulting firm for acquiring routes put it this way. “The bread companies don’t want to have the hassle of employees and managers, therefore they contract out the work to be done by some other company. That company is you when you buy a bread route territory.”


Frank did not live long enough to see the route paid off. He died March 2021. The route would have been paid off by the end of August 2021.


In 2015, Frank’s new life as an independent contractor meant he had to get his own health insurance as a middle-aged man. Fortunately, his wife worked for the state and she was able to add her husband to her employer-sponsored plan. Amy even stayed on her mother’s policy until she turned 26, a provision in the Affordable Care Act that permitted adult children to stay on their parents’ insurance plans.


Frank was insured when he had his first cardiac episode in 2016. His wife was still alive then. “Mom was there to guide him through it.” Amy said. Frank changed his diet, took medicine and got healthier.


~


Frank’s death was not the first time sudden death ambushed Amy. In 2019, her mother died. “Mom was not sick. She had her gallbladder out. She never recovered. She got a fever and never woke up. She got a bacterial infection.”


Frank’s wife was 2 months away from retiring with benefits. Amy said, “Mom worked for the state for 24 years and 10 months. Had she lived, she planned on applying for medical disability to get in those last 2 months so she could retire with benefits for herself and her husband.”


In 2019 after his wife’s death, Frank found himself with a health insurance dilemma. He was not eligible for Medicare, the federal health insurance program, because he was too young. His wife died 2 months before her retiree medical benefits would have started for the couple. He could pay full price for his coverage from his wife’s employer-sponsored insurance under COBRA, a provision that allows former employees and covered family members to continue with the same plan. But Frank would have had to pay full premium price for COBRA -- $1500/month ($18,000/year). “He said NO. He never thought it was worth it." Amy quotes her dad. " ‘I only go to the doctor every year? Every 2 years?’ ”

Frank owned a vacation house at the New Jersey shore. In our interview Amy could anticipate criticism from future trolls and deftly swatted it away. “Some people would look at that and say he could have sold that house. But why? Where do you draw the line? Where do you stop at? In the future when he’s retired…he wants to go to the house he’s worked for his whole life, but he can’t because it’s sold. So what’s the point?”


The chief of police, a friend of the family, called Amy. “When was the last time you saw your dad? He never showed up for work.” Another friend from Frank’s work went to the house. The dogs were not fed. The door was open. The police started searching near the house. “Did he pull off somewhere? Did he go to Wawa? Amy’s brother called around. He found his dad at a local hospital.


After some frantic calls, the family finally got the story. Frank drove himself to the emergency room and had a heart attack in their lobby. Amy said, “He arrested twice before they brought him back to a bed. This is what breaks my heart. This is all Sunday at 5PM. We didn’t know until Monday morning that anything was wrong. It was almost 24 hours before any of us knew anything. When they worked on him in the lobby, he was deprived of oxygen. He never woke up. His body temperature was lowered. They slowly warmed him up. The MRI showed no neurological function.”


On March 12, 2021, pansies were taking over garden center shelves, daffodils were busting out on random median strips but for Amy and her siblings these spring joys were overshadowed by the words “no neurological function.” They would wake up on March 12, 2021 and have to decide to let their 61-year-old father die.


For the uninsured like Frank who die in hospitals, the great billable unknown descends upon the family of the deceased. In the United States, we fear the financial repercussions of being sick as much as the sickness itself. Amy admits to thinking, “The longer he is alive, the more money this costs.” Being afraid that the American healthcare system will bankrupt us is so ubiquitous, the fear infests our decision-making, grieving and national soul.


The family does not know what will happen, but Amy would not be surprised if her father’s medical bills total around $150,000 based on back-of-the-napkin calculations from people she knows in medical billing.


Frank was a 61-year-old husband, father of 5, grandfather of 5. He was uninsured. His wife died. He was uninsured. He drove a bread delivery truck. He was uninsured. He did not get regular care as a cardiac patient. He was uninsured. He drove himself to the hospital and collapsed in the lobby. He was uninsured. His MRI showed no neurological brain function. He was uninsured. Frank died.


Amy calls out our indifference to those like her dad who fall through the cracks. “One of the biggest things I want to say is my dad is everything critics say you’re supposed to be. He’s an American citizen. He’s a taxpayer. He owns his own business. He’s done all those things and still you don’t care. He checks all your boxes, and you still don’t care. He still isn’t important enough for you.”


~


A friend alerted me to Amy’s Facebook post. She shared her story with me to honor her dad. We hope Frank’s story makes a difference in moving our country toward a true universal healthcare system.


Amy’s Facebook Post:

“On the anniversary of the signing of the Affordable Care Act I feel the need to share this story.


As most of you are aware my father died last week. He did not have health insurance. He was self-employed. My mother carried the health insurance for the both of them. When she passed away in October of 2019, she had worked for the state of New Jersey for 24 years and 10 months. That's unfortunately two months shy of what is needed to have lifetime benefits for both you and your spouse. That left my father without health insurance.


The cost of basic health insurance on his own was more than a mortgage and more than he could easily afford. As both a diabetic and a cardiac patient without health insurance, it was only inevitable what was going to happen. Before my father died, he worked 14 days in a row. He drove himself to the hospital where he arrested twice and was brought back twice. My father was a patient in a cardiac ICU for 6 days.


When his tests results showed no neurological function, we as his children had to make the awful decision to essentially stop all care. Above all else we had to factor in the fact that my father had no health insurance. And that is an embarrassment to this country.


My father is a definition of a man that slipped through the cracks. He worked his entire life and never had a chance to enjoy it. He could essentially lose everything he worked for to pay for medical bills.


Like most people in this country, he was uneducated in health insurance. But he did know he made too much money to qualify for anything, not that he ever would have taken it. But he didn't make enough money to be able to comfortably pay for health insurance.


We are allegedly the best nation in the world, and we can't even provide basic health insurance. For those of you that are against or don't believe in universal health care, I pray that you never have to make a life-or-death decision based on whether you could afford it or not.


I am telling you this story so when you think everyone doesn't deserve basic health insurance you think of my father. And I hope you get embarrassed, and I hope you are uncomfortable. Because my father deserved better. This nation deserves better.”