Prior to Obama, low wage workers might be scheduled to work full time without health insurance. If they're poor enough, they might get Medicaid from the state; otherwise they get to ruin their credit and claim bankruptcy if they show up at the emergency room.

Obama passed ACA, which required employers with full time workers to provide health insurance or pay a fine per worker. Full time is defined as 30 hours per week or more by ACA. So in low wage jobs, employers responded by scheduling people for 29 hours.

So if you work multiple jobs or a job+doordash/uber/etc... you may work full time, and not have any health insurance because no one employer is going over 29 hours.

ACA also expanded Medicaid, but some states decided to decline that expansion. So whether that covers a low wage worker depends on where they are, the size of their household, and their total household earnings.

For many of these workers, it's not just the risk of unexpected medical bills that they can't pay... they rarely have savings, so if they miss a few days of work (say because they contracted COVID), that can spiral into a series of missed bills. And with the eviction moratorium coming to an end, that now includes losing their home.

It’s not a loophole in the sense that it’s an unintentional exploit. Everyone involved knew full-well what the point of that provision was. If Congress voted in something more stringent, their corporate donors (e.g., Walmart) would have been pissed. That’s a deal-breaker for most Congress-critters.

It was very distressing watching the news spin it all as being about the ACA when it was definitely much more about his opponent since everyone here already had something analogous to the ACA. But that's how spin works I guess, it's certainly even worse now.

Speaking as a French person, 15% of my pre-income-tax salary sounds close to what I pay for state-sponsored healthcare (I pay more than that, but it includes retirement contributions and stuff).

In the case of the UK where I live, approximately 20% of all government spending goes on healthcare. Taxes on businesses, retail sales, house sales, wealth, capital gains, etc all contribute to the cost of healthcare, not just income taxes. That means a lot less than 15% of anyone's individual tax is spent on it.

However, depending on how you define "socialized", lots of people are covered under several "socialized" programs by the US government, not just Tricare. Medicare (old or disabled people), Medicaid (the very poor), CHIP and things like that (poor kids). Also, if you're counting Tricare, probably any health insurance provided by any level of US government (federal, state, county, city) to government workers should count.

In the end, the US government pays for healthcare (or, at least, much of it—US prices for healthcare are very high, and the way our insurance works means that insurance is just part of how the bills get paid, though a large part) for an high percentage of our population, one way or another.

All those part time jobs would disappear since what kind of employer pay $5-10k per year in insurance premium for an employee who earns $600 per month before taxes?

And you might say “great! Who cares about part time work?” and you’d be wrong, plenty of people don’t need or can do full time work.

There's room for a class of contractors that do small number of hours for many different employers, either many within a quarter or many throughout the year.

One practical alternative would be universal health care.

Within our current system of insanely bad group negotiation for rates, establishing a house cleaning union that could negotiate as a class would probably be the second best alternative.

The third alternative is the Obamacare one, which is to pay your employees at a rate high enough so they can buy their own subsidized insurance on the health exchanges.

Single payer healthcare, not that your question is sincere.

Plenty of people are hired for work like that without forming a business entity, and sometimes under conditions that qualify as employment rather than contract work.

For the sake of conversation, let's consider the cleaner to be an employee and OP to be the employer. Even then, unless OP has 50 full-time and full-time equivalent employees, there is no requirement for the employer to provide group health insurance, according to the ACA.

Obviously if she only has one client that’s not going to be a lot, but it stacks with all the other employers

You would never be obligated to pay for their health insurance, it would be up to them, or their employer, to figure that out.

Walmart on the other hand has clear employees which are expected to turn up to non-negotiable shifts and wear a Walmart specified shifts. They’re currently forced to take on the risks of a contractors, but with none of the freedoms.

My recollection from working at CompUSA in college (a big box Best Buy like store) in the 90s was about 50-70 hourly employees, with 10-15 full timers.

The fact it's easier to afford if you make more money is...well, sort of the reason why people want it to be universal, and covered by taxes, so the rich can offset it for the poor.

At least with Obamacare, you (likely) won’t go bankrupt if you break a leg.

You also get preventative care fully covered (or ~$30 copay) even with plans that have $6,000 deductibles.

That includes both low & high cost items, like annual physicals and colonoscopies.

No, Obamacare shouldn’t die (as you said in an earlier comment) but it should be replaced with something that improves on what it’s already done.

Personally, I favor Medicare for all.

My anecdata for people on ACA is that it works pretty well, with a caveat that premiums are high due to various misaligned incentives in the US health care system.

- bartender friend of mine got laid off due to covid. With unemployment at ~$3k a month, he paid about $200 a month for insurance that had very low deductibles and overall seemed to be a good plan (silver). It was better than the plan I had as a university professor at a “good” university.

- another friend of mine started her own business. Very low income the first year (maybe $20k?) and was living on savings. She ended up paying about $100 a month for similar insurance to the bartender friend above.

The “downside” of these plans is that they scale aggressively with income. For reference, the entrepreneur friend’s business took off in year two, and now she’s paying about $1100 a month. This sounds high, but that’s what her group plan cost at her previous employer when you factored in the company contributions.

[0] https://www.irs.gov/affordable-care-act/employers/identifyin...

And employment contracts for hourly works are incredibly rare and pretty much nonexistent for part-time workers.

I'm not sure if going over one month does anything, and it most certainly doesn't do anything in a week: Some places will schedule folks around 40 hours for a couple weeks and then nearly nothing for a week to get the average down.

* American healthcare is too expensive. The problem is long known and nobody wants to solve it. That problem is administrative inefficiency. Solving that problem means terminating the a large segment of a massive industry (destroying a massive number of jobs). Drugs are expensive too, but drug pricing problems impacts specific persons that when averaged across the entirety of the population become only a tiny part of the industry wide problem.

Since medicine is expensive everybody is reliant upon insurance. The options are private insurance (expensive), employer offered insurance, and government insurance (designed for low income people and poor choices/service).

The exceptions are Obama care and military. Military has a wonderful health insurance plan called Tricare. Tricare is great for the patient because they cover just about everything but they are really hard about releasing funds to medical providers so some medical providers refuse to take Tricare.

Obama care is a new private insurance option from the government that provides an affordable insurance option partially subsidized by government funding.

I have known people who are not insured and refused to get insurance then just never go to the doctor. Wonderful medical insurance is a primary reason I remained employed by the military for a number of years.

My impression from looking at this for many years now is that the problem is everything. Every single individual and entity involved—and that's a whole bunch—is taking too much money. That's why it's so hard to point at any one problem and dig deeper and fine all the money. Every time, you find some of it, and usually a lot, but not all of it.

Doctors and other people actually providing care? Too few of them, and (or, "therefore") they're making too much money. Hospitals? Consolidation of hospitals and smaller providers into "networks"? Yes and yes, but still, that's not all. Administration costs? Yep, but not all of it. Insurance overhead? Yes, but... well, you get the idea.

It's absolutely shameful.

https://www.cbpp.org/research/health/medicaid-works-millions...

No.

> Or is this casual work where you get a higher hourly loading to compensate?

No.

It is precisely as horrific as you would imagine for those low-wage workers who want full-time jobs to obtain those healthcare benefits, but keep running into this issue in job after job. The official tax-oriented definition of "full-time" [1] is a bit more nuanced than what you will colloquially hear in discussions, but in broad terms, once you are put into the HR system for more than 30 hours in a week of work, the threshold to full-time is triggered. It is a binary switch, no spectrum, no gradient.

This doesn't even begin to get into how capital-inefficient and service-poor so many of the healthcare plans are once you do get access to them as a low-wage worker. Nor how so many of these workers are so completely unequipped and unprepared to comprehend the fiscal realities of engaging these plans.

[1] https://www.irs.gov/affordable-care-act/employers/identifyin...

And so of course 90%+ of the companies that can short on this, do. It's as awful as you think.

https://careers.walmart.com/us/jobs/WD597130-senior-software...

"Beyond competitive pay, you can receive incentive awards for your performance. Other great perks include 401(k) match, stock purchase plan, paid maternity and parental leave, PTO, multiple health plans, and much more."