Why It’s So Important to Have Health Insurance

This week, Maggie sat down with her friend and advocate, Nina Serrianne to talk about why it's so important for everyone to get healthcare coverage.

In honor of open enrollment season, Maggie sat down with her friend and healthcare advocate, Nina Serrianne. They talked about why it’s so important for people to have health insurance, what the options are, and how to make sure you get the plan that is right for you.


Since 2002, Nina Esperanza Serrianne has advocated on the local, state, and national level for reproductive health, rights, and justice; gender equity; LGBTQ rights; and ending gender-based violence. Nina is the Sexual and Reproductive Health Equity Policy analyst at the National Latina Institute for Reproductive Health and among other issues works to protect Title X, Medicaid coverage, the Affordable Care Act, and contraceptive access for Latinxs living in the U.S.

Some highlights of her career include working in the office of Congresswoman Jackie Speier (CA-14), working for Planned Parenthood Mohawk Hudson, and publishing her first book, America in the Nineties, a survey of the policies and politics of the decade, published by Syracuse University Press in 2015.

Follow Nina on Twitter to stay informed.

To learn more about Maggie and her coaching and speaking services, visit www.maggiegermano.com.

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The theme music is called Escaping Light by Aaron Sprinkle. The podcast artwork design is by my dear husband, Dan Rader.


Maggie Germano: 00:00 Hello and welcome to the money circle podcast. My name is Maggie Germano and I am your host. As always, please make sure that you are subscribed and that you take the time to put a rating on this podcast. It really helps get this to be elevated in platforms like iTunes so that more people can take a listen. So this week I am joined by my dear friend Nina Serrianne who is going to be talking to me about healthcare. So since 2002, Nina has advocated on the local, state and national level for reproductive health rights and justice, gender equality, LGBTQ rights and ending gender based violence. Nina is the sexual and reproductive health equity policy analyst at the national Latina Institute for reproductive health and among other issues works to protect title X Medicaid coverage, the affordable care act and contraceptive access for Latinx living in the U S.

Maggie Germano: 01:10 Because it is November, I am focusing very heavily both on my blog and the podcast on health insurance, open enrollment and just generally getting the health care coverage that you need. I am here to be giving you as much information as I possibly can, uh, making sure that you have all the resources that you need and making sure that you’re aware of what you need to do in order to get the coverage that you need. So this week, Nina and I, we talked about why it is so important for people to have health insurance. And then from there we expanded on to how people can be getting the insurance that they need, whether it is through an employer or through the marketplace or through Medicaid. And we touched a little bit on the different, um, stumbling blocks that are being put in our way to, you know, prevent us from getting the healthcare and the coverage that we need.

Maggie Germano: 02:04 So there is some advocacy action work that you can be taking. Yeah. All of which I will be putting in the show notes so that you can learn more and take action as needed. So this was personally a very informative conversation for me because I consider myself fairly informed and educated, but I am not working on health care on a daily basis. Like Nina is. So she gave a ton of really awesome information and I hope you take a listen and then as soon as you’re done, go and make sure you are enrolled in your health insurance, whether that is through your employer or through the marketplace you have until December 15th to enroll in the marketplace. So do not wait, go take action. But first listen to this episode.

Maggie Germano: 02:49 Hey, welcome Nina. Thank you so much for being here.

Nina Serrianne: 03:03 Thanks for having me, Maggie.

Maggie Germano: 03:05 Uh, well so I know a lot of about you cause we’re good friends. Uh, but I’m sure a lot of the listeners don’t necessarily know who you are, so why don’t you tell us a little bit about who you are and the work you do.

Nina Serrianne: 03:18 Sure. Uh, so my name’s Nina Serrianne. I’ve been advocating in the health rates and justice space and for LGBTQ rights since 2002. I currently work for national reproductive justice organization. Uh, my work both professionally and personally, focuses on access to health care ranging from coverage. Mostly I love wonky Medicaid work. Um, as well as reproductive justice issues, access to birth control, abortion care, um, and getting people the care that they need.

Maggie Germano: 03:50 That’s awesome. You’re a hero especially these days. Um, so how did you get into this line of work?

Nina Serrianne: 03:58 Yeah, that’s a great question. Um, so I actually started volunteering with planned Parenthood Mohawk Hudson in 2002 as a pure sex educator and volunteer lobbying. Um, I started working primarily when we would go to Albany to advocate on behalf of planned Parenthood for emergency contraception over the counter on the state level way back in the day, um, before we had federal emergency contraception over the counter and really got bit by the policy bug and the politics bug and did an internship with the policy and government affairs department, uh, the following year. Um, and just got totally, totally hooked on this work and I feel lucky that, um, both the kind of reproductive health rights and justice part of it and the policy and politics part of it. It’s just like the melding of my favorite things.

Maggie Germano: 04:58 I definitely relate to that as a political science major myself. Um, and why is this kind of work so important to you? Like why reproductive health? Why health care in general?

Nina Serrianne: 05:11 Yeah, it’s kind of a two part answer. Um, I worked at planned Parenthood Mohawk Hudson for several years, um, doing, uh, like Medicaid applications and financial assistance applications with folks, um, and helping them, you know, schedule their appointments and get, get everything they needed once they got to the clinic. Um, and just seeing the impact that coverage has on people’s lives, uh, seeing it impacts the lives of my friends and family members. Um, but also like when you look at a big picture, access to healthcare really helps us live our lives with dignity. Um, and when we don’t have that access, it, it hinders us from, from living our lives fully. Um, no, everything kind of relates back to health care.

Maggie Germano: 06:00 It’s true, right? Because we need our health in order to get through life. And if we don’t have health care and people there to help us when we’re getting sick or injured or to get us the, the medication and services we need, then that’s gonna hinder everything else.

Nina Serrianne: 06:17 Yeah, absolutely. And we see so many people like in doing this work over the years, people who have been living with pelvic pain or you know, different discomforts, um, that they just are suffering every day. And whether it’s because of a lack of access to coverage due to immigration status or different things, um, we know that their lives would be more improved if, if they weren’t living with that, that pain and discomfort.

Maggie Germano: 06:46 Yeah, absolutely. So, building off of that, can you talk a little bit more, you mentioned immigration status, but can you talk a little bit more about some of the other things that might prevent people from having access to healthcare?

Nina Serrianne: 06:58 Yeah, so I’ll elaborate a little bit more on immigration status. Um, there’s actually a five year bar in this country preventing, uh, lawfully residing immigrants from accessing the Medicaid program for the first five years of legal residency. Um, so even so otherwise eligible individuals, um, are not accessing the care like the care that they need because they’re not, uh, because of the 1996 law, not able to get that coverage. Um, we see similar restrictions with the, um, ACA marketplace and immigrants not being able, but some immigrants not being able to access subsidies. Um, also with immigration status, we see attacks coming down from this administration, um, in the form of regulations that are prohibiting people from getting, um, either Medicaid or, uh, food stamps, also known as snap. Um, but we also see losing track a little bit of the question, but I’m just going to keep going with this thought. Um, we also see restrictions, uh, with things such as the height amendment, which prohibits Medicaid funds and other federal funds from going to abortion care. Um, so there’s a lot of ways that people aren’t able to, even when they have coverage to access the care that they need.

Maggie Germano: 08:17 Yeah, that’s a lot. Yeah. It’s really frustrating because it isn’t just, it’s like a deliberate in some ways kind of restriction for a lot of people, not just kind of circumstance.

Nina Serrianne: 08:33 And I think that’s been, we’ll get into this more later. But I think one of the things that’s been really upsetting personally is looking at how the Trump Pence administration has been going after health care and, or even, um, you know, congressional attempts a couple of years ago to repeal the ACA and just looking at how cool it is. Um, and really for people, it’s not an exaggeration to say that this is life saving care, life saving medicine. Um, you know, an important part of having coverage is having the drugs you need covered. Um, and just how cruel and inhumane it is to be taking coverage away or, or keeping people from the care that they’re otherwise eligible or the coverage that they’re otherwise eligible for.

Maggie Germano: 09:16 I completely agree. Because yeah, like this is the kind of thing that like everybody actually needs, it’s official. It’s beneficial to literally everyone and it’s not hurting anybody else for like one person to get the healthcare that they need. And to get the coverage that they need and significantly harming the people that are not getting access to what they need. So I agree. It’s very cruel.

Nina Serrianne: 09:43 Yeah.

Nina Serrianne: 09:45 Ah, um, so this, this episode is going up in November, which is when open enrollment season starts both, you know, with most employers and also with, um, the healthcare marketplace and all of that. Can you expand a little bit more about, you know, why it’s so important for women in particular to make sure that they’re, have, they’re getting the healthcare coverage that they have potential access to? Yeah,

Nina Serrianne: 10:14 absolutely. Um, so as we were kind of chatting, you know, health care coverage in general is so important to be able to get any range of services you’ve need. Um, we’ve seen through the affordable care act, uh, lots of changes in what, uh, services are required to be covered. Um, so there’s actually like a whole host of services that you can get through your insurance because they’re required to provide it through the ACA. Um, I think the most important to note with that is preventative care services, also known as well, women visits. Um, you know, we know cervical cancer is a highly preventable disease. Um, and it’s most common that people just don’t have access to the cancer screenings that they need. Um, and one way that we’ve been able to reduce rates of cervical cancer is by the ACA being required to cover cervical cancer screening.

Nina Serrianne: 11:11 Um, so please people with services go get your well-woman visits or you know, preventative care screenings every year because it is required to be covered by your insurance. Um, but also as I mentioned, it’s, uh, there’s, uh, there’s all sorts of services and other items that are required to be covered. Um, also through insurance, despite attempts from the administration, your appeal, the protections, um, insurance carriers are required to cover your birth control. Um, so, and also just kind of big picture, we, we just don’t know what’s going to happen in our lives. Um, unfortunately. And it’s just really important for us to be getting the coverage we need so we can, can care of ourselves both for preventive care. And you know, if something unfortunately happens or I don’t know any number of things can happen in our lives.

Maggie Germano: 12:02 Absolutely. And that’s something that I hear like from friends and clients and other people I know who think that just because they’re young and they haven’t had anything go wrong, that they don’t need health insurance or those like high deductible plans that are cheaper maybe are going to be fine. But, and I, and I’ve never felt that way like I was, my mom says I was born like a 40 year old and so I’ve always kind of assumed bad things are gonna happen or I just always liked to have as much coverage and safety as possible. But a few years ago I ended up with a shoulder injury that was very painful and I needed an MRI and a CT scan and physical therapy and all of these things that went on for like a couple of years that if I didn’t have health insurance to cover those, I would’ve either just had to be in pain forever and not try to get it sorted out. And that would’ve been debilitating honestly. Or I would have been thousands of dollars in debt. And so you never actually know what’s gonna happen and paying more out of pocket on a regular basis. They cover your health insurance is better than ending up in a huge amount of debt or just not getting what you need.

Nina Serrianne: 13:13 Absolutely. Absolutely.

Maggie Germano: 13:16 Um, so you talked a little bit about kind of what’s at risk when people don’t have health insurance when it comes to just not getting like the medication they need or the health support that they need. Um, what happens when someone doesn’t have health insurance but they have to go get care anyway? What happens both, I mean, maybe, I don’t know if you can speak to this entirely, but like on the personal level and also societaly because I, if people have to go to the emergency room, they have to go to the emergency room, whether they have insurance or not.

Nina Serrianne: 13:49 It’s a great question. Um, so as you said, on a personal note, it’s also, it’s really about just taking care of yourself as you mentioned. Um, and we’ll get into this more about the costs that have, uh, plans for this year. But you know, paying anywhere between zero and $10 a month for insurance is much cheaper than the thousands of dollars that, um, medical bills can, can amount to. And you know, this, I, I’m generally a healthy person. I sprained my ankle a couple of years ago and couldn’t believe even with insurance, um, how much the bills were racking up as a result of that injury. Like the MRIs are not cheap, but so we know just on, uh, as I mentioned, you just never know what’s gonna happen in life and it’s really important for people to have coverage in that sense. Um, but also big picture looking at cost of insurance for four individuals, the more people that stay in the insurance pool, the cheaper plans actually are for folks.

Nina Serrianne: 14:48 Um, so especially when younger, healthier people are in the insurance pool, again, that reduces the cost of, of insurance for everyone. So with the repeal of the mandate, uh, the individual mandate required everyone to have health insurance and the Republicans were appealed at the end of 2017. Um, and it went into effect for the first time last year. Um, or sorry, this year, um, it’s now having the option to opt in or out, you know, with younger, healthier people having the option to leave the pool, um, were at risk of raising premiums for everyone. Um, so the more people who get insurance, the more you know, the more affordable it is for everyone.

Maggie Germano: 15:32 Yeah, that’s really good to know. And that’s something that I didn’t necessarily know either that like when young healthy people are paying into their premiums and all of that, it can kind of balance out for other people cause they’re not necessarily using the health insurance available to them. Is that kind of how that works out?

Nina Serrianne: 15:53 Yeah and one thing we’ll hear too, a lot kind of if you’re, if you’re listening to discourse around health care is sometimes you’ll have, you’ll hear these proposals to kind of create different pools or like a pool for healthy people, a pool for sick people. And really what that is is just bringing us back to like pre ACA conditions where healthy, healthy, younger people are paying less and sicker. Older people are paying more and the way that the marketplaces are working now, it’s a little bit more equitable where you’re not being punished with a high cost just for um, something you can’t control like your second history, your age.

Maggie Germano: 16:32 Yeah, that seems a lot more fair and like we’re moving in the right direction at least in that kind of way. So like I mentioned, open enrollment season is starting. What are the most important things that people should be knowing now that all this is about to kick off? Yeah.

Nina Serrianne: 16:50 So first and foremost, what’s the most important thing to know is the dates. So open enrollment starts November 1st I’ll say that again. Open enrollment starts November 1st and ends December 15th, which is a change from previous years. So again, open enrollment is from November 1st to December 15th. Um, the administration cut the open enrollment period drastically, um, from what it originally had been and additionally has also cut, uh, funding for ads, funding for navigators that help people get the care they need. Um, so most people aren’t even aware of me open enrollment period. So thank you so much for bringing attention to it. But also it’s important to note too, that open enrollment periods can vary depending on your state. Um, so States that have a ability, like States have control over their marketplaces, are able to adjust the dates a bit. Um, but I really encourage people to just go ahead and get covered before December 15th, um, or do the extra kind of legwork and find out what’s going on in your state, but would just recommend that everybody, you know, goes to healthcare.gov between November 1st and December 15th and get the to get the coverage you need.

Maggie Germano: 18:04 And that’s if they’re not getting healthcare coverage through their employer.

Nina Serrianne: 18:07 Right. Yeah.

Maggie Germano: 18:09 Okay. Yeah. That makes sense. Um, cause I think that that can get confusing for people sometimes. Like open enrollment for the marketplace is during that period of time. And it’s really important to do that during that period of time. So you’re not uncovered for an entire year until next year comes around. Um, but that’s typically when the enrollment period is when your employer has insurance as well. Not, not necessarily that big of a time, but like during that November kind of timeframe.

Nina Serrianne: 18:37 Right.

Maggie Germano: 18:39 yeah. And, and I think that’s something to keep in mind too. Like I’m, when this episode goes out, I’ll actually be in Peru. Um, and the bulk of the enrollment period for my husband’s health insurance plan, which I’m also on his while we’re gone. So I had to like mention that I like asked him like, Hey, when, when’s your enrollment period again? And he looked and was like, Oh, oops. Like it’s gonna be when we’re in Peru, but it starts a couple of days before we leave. So we just like literally put it on the calendar, like enroll the day before we go so that we’re not like shit or we just end up with the same plan we had this year, but maybe things have changed. And so it’s really important even when you have an employer with health insurance coverage to know when those dates are and to know what you’re actually being offered and what you can choose from.

Nina Serrianne: 19:32 Yeah. And you hit on that something really important there too, which is the shopping around. And we’ll again, we’ll chat about this a bit more. Um, but you know, it’s, it’s really important not just to assume that the plan that you had this year is the best plan for you and especially for people looking on the marketplace. Um, plans do change from year to year. Um, so it’s really important to shop around, um, both because you might be able to get the same plan for a cheaper price. Um, it’s kind of looking, just really encouraging folks to, to shop around. Um, even even with your, if you’re getting insurance through your employer though, as you mentioned, um, you know, taking that moment to kind of evaluate what’s, what’s best for you based on your needs and most employer plans to have, uh, people, I know we have people available that we can call and just bother with all the questions because it’s their job to help us get the best plan for us.

Maggie Germano: 20:26 Yeah. And literally, like you said, it’s their job. So you should not feel bad to be asking questions. I know when I had a boss at a job I, every year there was like a series of meetings and webinars and all those sorts of things where we can learn literally down to the most boring detail, all of the different options and all the different plans and what the specific changes were from year to year, which was really important because our plan, I mean over the seven and a half years I was working there, it went from like nobody had to pay out of pocket for anything to people having deductibles and things like that. And so knowing those changes is really important so that you know what you’re going to be responsible for. You can maybe have the opportunity to like switch to your spouse’s plan if that’s an option, if things are changing too much at your plan.

Maggie Germano: 21:18 Um, so yeah, just getting the information you need, making sure to go to those meetings. Um, uh, an article that I wrote for Forbes for November is all about this survey that came out recently about how people would rather, um, but they’d rather ask for a raise then talk about their enrollment benefit and their benefits during enrollment period and they’re like so uncomfortable with it. And rather I would rather do anything else. And that just, that frightened me a little bit because it’s really important to be making sure that you understand your benefits and making sure you’re enrolling in them. Um, but it also, it emboldened me a little bit cause I was like, yes, for those raises, like, you know, both of those things are very important, like do both of them. Um, but like you said, there are resources out there. If you’re employed, there’s resources and um, you should be getting as much information as possible.

Nina Serrianne: 22:15 And also for, uh, people looking through the marketplace there. There are plenty of resources in a variety of languages too. Um, there’s a lot of really wonderful Spanish language resources available on telecare.gov. Um, also Kaiser family has an amazing Q and a both in English and Spanish that I highly recommend, um, that, you know, just breaks down like what even is a marketplace, what does it mean to get insurance online? What is this whole thing? Um, I think healthcare, healthcare policy is so confusing. Healthcare coverage is so confusing. Like you said, it’s like, I mean, I do this for a living and sometimes I’m like, you know, this is overwhelming and I don’t understand what my insurance company’s saying. Um, so let alone, you know, if you don’t have a background in this, it can be incredibly overwhelming. Um, so I highly recommend those resources and yeah, and like we both said like customer, the people that are there to help you cause they’re there to help you.

Maggie Germano: 23:18 Yeah, exactly. And I was on the marketplace for 2018 and I found it confusing to sign up as well. And like you were kind of saying, I don’t have a background in the health insurance industry, but I’m fairly educated. English is my first language. I feel like I can usually get around things pretty easily, but even that I had to call and ask questions. So having that as a resource was really helpful for me. And so it doesn’t matter if you think you’re gonna sound stupid, you should just ask the questions no matter what. Cause you want to make sure you’re getting what you need.

Maggie Germano: 23:57 um, so related to that, how can people make sure that they’re getting what they need? Like what are the different things they should be kind of looking at?

Nina Serrianne: 24:06 Yeah, so this is it. This year especially, I cannot emphasize how important this question is. Um, so I’ll start first by saying, as I’ve mentioned several times, healthcare.gov is the best place to be going. If you’re looking for marketplace insurance. Um, you’ll see that there are brokers, uh, that w that basically say that they’ll do the legwork for you. Um, but this year it’s really important to do the work directly with healthcare.gov and not rely on a broker. Um, because I’ll explain a bit of some of the changes that the Trump administration has made to plans. We’ll make it that. So when you go through a broker, you might not be seeing all your options, especially your most affordable options. Um, and we really, you know, want people to not only be getting coverage but beginning affordable coverage so they can have access. Um, you can also use your, uh, state exchanges directly.

Nina Serrianne: 25:05 Um, so I really recommend to folks either going on healthcare.gov or going on your state exchange to find, find that care. Um, and that’s a bit different. Just to clarify, you know, going to like a planned Parenthood health center that has a navigator to help you, um, get, get coverage isn’t what I’m saying cannot do. Um, so still, like we just said, there’s ample resources and still reach out to those resources, but make sure that you’re getting the coverage directly through healthcare.gov or your state exchange. Um, so the thing that I want to talk about most with this though is what we call junk plans. Um, so the Trump administration allowed, um, for junk plans, also known as short term limited duration plans to be available through the marketplace. These plans come off as being, you know, super cheap, really wonderful. A lot of times they get advertised as like, you know, you’ll have exactly the same coverage you had through like your Kaiser and a plan.

Nina Serrianne: 26:08 You don’t straight up, you don’t. Um, so these plans opt in, don’t cover maternity care. They often, there’s, you know, there was a story recently in the news of a man who had a short term, limited duration plan and had a heart attack. And when he got the B ER, he had no coverage for his heart attack. Um, just heartbreaking stories of people truly believing that they had equal, uh, coverage for, you know, a ridiculously cheap price. And the price is cheap because you don’t have that coverage. So just, I know it’s a pain. I know it’s confusing. I know it’s terrible, but when looking at the plans, it’s just so important to really break down what, what do the plans cover? Um, because these junk plans disguise themselves as these wonderful options. Um, you know, they don’t come with a note saying like, actually I’m trash.

Nina Serrianne: 27:02 Um, so just really, really take the time. Again, I know it’s a pain, um, but just make sure that you’re not, not getting one of these plans and getting a care that, a plan that will truly cover your care. And I think the, as heartbreaking as it is, like the example of the man going to the emergency room with a heart attack, like first off, that’s not an atypical story with these, these plans. Like, um, but also, you know, you just, you just don’t know what’s gonna happen. And like, um, you know, I feel like it’s easy when looking at insurance plans to just say like, Oh, well I won’t need that in the next 12 months. And it’s like, just, just make sure that you’re getting the plan that really covers what you need.

Maggie Germano: 27:47 How, how can they kind of get away with that? Like how can they, I mean, I know you were saying the Trump administration is allowing them to be in there in the first place. So obviously there’s some kind of backdoor situation going on, but like, how can they say you have coverage? It’s the same as what you had before, but just really cheap but then not be like, I guess I don’t understand.

Nina Serrianne: 28:08 Well, some of us would say that this is illegal.

Maggie Germano: 28:11 It sounds pretty illegal.

Nina Serrianne: 28:16 There are lawsuits too. Also, you know, with a lot of the attack, you know, we’ve seen a whole variety of these kind of different junk plans, um, from the administration and different ways that they’ve been trying to sabotage ACA plans, um, by not complying with the affordable care act. Um, but again, a front friendly reminder, the, you know, ACA is still a law of the land and, um, and companies have to comply. I think also too, you know, we’ve seen wins as far as, um, the Trump Pence administration also released, as I mentioned, a regulation to repeal the protection that covers birth control. Um, and we’ve had win after win in the courts, knock on wood, um, that has, uh, allowed for a nationwide injunction. Um, so the rule is not, is not in effect, um, and hoping, hoping to see the same kind of progression with, with a lot of these others. But unfortunately the junk plans are in the market places here. So be aware.

Maggie Germano: 29:26 yeah, that’s really good to know cause I don’t know much about that and I wouldn’t have necessarily thought about that. So thank you for bringing that to our attention. And side note, thank you for being one of the people who fights to stop these terrible things and do what you can, you know, to, to uphold healthcare for people and make sure we get the access we need. We, we need people like you. Cool. Um, so you showed me your shirt that you are wearing, which says Medicaid is sexy. Um, can you talk a little bit about like when Medicaid is an option for people and who might qualify for that?

Nina Serrianne: 30:07 Absolutely. So Medicaid is a federal state program that is designed to give health insurance to individuals living with low incomes. I’m also, as I mentioned with the ACA, we’ve seen a lot of changes. So thanks to the ACA. A lot of States, 37 States have Medicaid expansion. Um, so what does that mean? That means that you’re able to have a higher level income and still be eligible for Medicaid. Medicaid is a income tested program. He gets confused easily with Medicare a, which is intended for elderly folks and disabled votes.

Speaker 3: 30:43 Um, some people are really eligible for Medicaid and Medicare due to their income, uh, disability and age statuses. Um, but Medicaid is truly a wonderful program. Um, if finances half of births in this country, um, due to systematic, um, kind of racism and barriers and discrimination in this country, we do see that the majority of folks on Medicaid are folks of color. Um, specifically women of color. Medicaid also, um, is known for funding, uh, with the children’s health insurance program, um, serves children, um, so seen often as kind of this like women and children’s program. Um, but truly it’s giving largely comprehensive coverage to folks living with low incomes. Yeah. So it’s really important when we’re talking, we sometimes get this confusion or stigma around like what does it mean for it to be a low income program or what does it mean to be an individual living with low income.

Nina Serrianne: 31:45 But the way it would be defined low income in this country is kind of even appalling. Um, so Medicaid expansion allows for low income adults at 138% of the poverty line. Um, which doesn’t mean anything that’s just kind of sounds like gibberish. Um, so it’s approximately $28,000 a year for a family of three or $16,000 a year for an individual. Um, and then for non-expansion States, it’s around 13,000 a year for an individual without children. And that’s not all a lot of money. Like we, I don’t know. I think we need to have more conversations about what is it, what does it mean to be covering people with low incomes? Um, because that, you know, like even $28,000 a year for a family of three, like that’s not a lot to make ends meet. Um, and if you’re making 2020 9,000 a year or $30,000 a year and you fall into the Medicaid gap, or if your state hasn’t expanded and you’re making $15,000 a year and you’re not like quote unquote poor enough to be getting insurance, like how are you supposed to both put food on the table and pay for unexpected healthcare costs?

Maggie Germano: 32:56 Right. And I’m sure most of the people listening would think of 13, 20 even $28,000 a year and be like, that is way less than I could possibly live on. And then you’re thinking about that also being a family. So multiple people and only bringing in that much, like of course they’re going to choose food and electricity and rent over their health insurance.

Nina Serrianne: 33:22 Absolutely. And I think it’s really important too to know in so under the ACA States we’re allowed to expand Medicaid. And then the Supreme court said, okay, you don’t, you can choose to expand or not expand. So only 37 States. And we’ve seen a trend in recent years of some States coming on board. Um, even though they’re not getting the same federal match that they would have. So they’ve lost money as if they had expanded originally when the expansion opportunities started. But it’s like you’re, you’re saying that people like you are otherwise eligible. So like in Florida there’s 1.3 million people, 1.3 million people that would otherwise be eligible if Florida would expand Medicaid. Um, which just is appalling to me. And like Texas, it’s like 1.6 million people. So it’s millions and millions of people that would otherwise be eligible for coverage, but their state has just said like, no thanks cause we don’t like the affordable care act.

Maggie Germano: 34:20 Hm. That’s a lot of people to be kind of less left in the dust in, in Florida and in Texas alone. So almost, you know, over a million, almost 2 million in some cases. And that’s not even considering all the other States where that is happening. And those are the people who need it most because they’re not making enough money to be able to afford it otherwise. Yeah. So related to that, what can people be doing to be advocating for more and better healthcare coverage both with themselves but also as a society as a whole?

Nina Serrianne: 35:02 Yeah, I think that’s a great question. I think recently we’ve seen the tendency for the conversation to go from like zero to 60 of like we’re hearing a lot of conversations about universal healthcare coverage or Medicare for all, which kind of the title of that makes no sense. And I have a lot of feelings about, um, you know, what are, what are we saying when we’re talking about universal healthcare coverage, but I think it’s really important to also have kind of the mid-ground conversation of just protecting what we have. Um, especially, you know, we chatted a bit about Medicaid and the importance of Medicaid coverage. Um, but you know, it’s like we as we’ve talked, like this administration has been attacking healthcare on all fronts. Um, we’re seeing, you know, they are, they’re coming from the Medicaid program. They’ve been coming for the Medicaid program.

Nina Serrianne: 35:51 Um, there is really dangerous. Um, there’s a waiver, um, right now that Tennessee is trying to get to be able to block grant their program, which would kick who knows how many people, um, off the rolls and um, you know, would just be really damaging to the financial structure of the Medicaid program and the integrity of the Medicaid program. Um, I think we talked a lot about junk plans today. Call your Senator. Um, and please tell them it might be too late by the time this podcast airs, but, um, tell them to vote for the congressional review act bill, uh, that would address these junk plans. And especially for people with preexisting conditions. We haven’t talked about that as much today. Um, but a lot of these bills really go, go after people with preexisting conditions and exclude them from getting coverage. And just a friendly reminder, being a woman was considered a preexisting condition before this having an irregular menstrual cycle was considered a preexisting condition.

Nina Serrianne: 36:56 Um, even some plans considered like bad acne, a preexisting condition. So it’s like this. I think sometimes when we think about preexisting conditions, we think about diabetes or cancer or other things, which again, to be clear, like you should still be able to get the coverage you need, um, despite whatever your medical history is. Um, so call your Senator asks them to protect, um, what, what we do have. Um, and also, I mean, I think it’s a little bit of a scary time. I don’t want it to scare people off from going to the marketplace, but also we are facing, um, a decision from the ACA lost to, um, you know, the judge O’Connor in Texas had ruled to repeal the entirety of the ACA. Um, and we’re awaiting the next decision in that case, and we’re expecting it to most likely go to the Supreme court. Um, so it’s not to say don’t get coverage this year because please, please go get the coverage you need this year. Um, but just really, you know, look out and remain vigilant in, um, all the different ways that health care is under attack in this country right now. And please call, please call your members of Congress, um, and ask them to do the right thing.

Maggie Germano: 38:15 Thank you. And I’ll link to ways to do that and I’ll link to the congressional review act and all of that in the show notes too so people can learn more about it and also just get access to how they can contact their senators.

Nina Serrianne: 38:30 I will say too, yeah, so one other thing with that is it’s not just to, I dunno, be in your about things all the time and only talk about the bad things. It’s also when I was saying we can have that like middle ground conversation before talking about universal health care. It’s also about asking for Medicaid to cover, um, individuals that have given birth 12 months postpartum instead of three months postpartum. Cause we know that a lot of maternal death happens and complications happen up to 12 months after birth. So really asking for the Medicaid program to cover individuals 12 months postpartum, it’s about, um, there’s a great bill and the house and Senate that would cover birth control over, like once it goes over the counter. Um, because if you don’t have coverage, is it really access? So, you know, asking, asking your member of Congress to sponsor that bill, it’s about, um, even we’re seeing the drug pricing bill move through the house and Senate right now.

Nina Serrianne: 39:23 Um, we talked earlier about just the importance of affordable drugs, what their, it’s Hep C drugs, HIV drugs or you know, whatever it may be. Um, although this bill is a bit more narrow in what it would allow negotiations for, it’s really important, um, to, you know, to be keeping an eye out for, for what progress we can make given the current political climate. Yeah. And one of those bills called the, the one for the, I think, the birth control coverage and the drug [inaudible] pricing. So the drug bill is HR three, given the bill number. It tells you that it’s awfully important to Nancy Pelosi. Um, and then the O COTC bill, the over-the-counter oral contraception bill is the access is affordability act. Um, and it’s sponsored, it’s led in their house by representative Presley and in the Senate by representative Marie’s two of our champions on this issue.

Maggie Germano: 40:21 Thank you. Yeah cause that’s something that I’ve thought about where, you know, birth control being over the counter would make it more accessible than like having to go to the doctor every time you want to refill. Which even though I’ve always had health insurance and have always been able to like take time off to go to the doctor, I have also found that very annoying and like why can’t you just me? Like I’ve always had this prescription just refill it.

Nina Serrianne: 40:46 I found too the actually studies have shown time and time again cause a lot of times, um, doctors will say like, Oh you need to come in for your pap and your birth control prescription. But studies have actually found in countries where it is available over the counter people as people still get their apps done. Um, so we know, we know that we know how to take care of ourselves and that, um, it’s in fact just creating a barrier and that we will get our birth control and we will get our paths given given the opportunity.

Maggie Germano: 41:14 Right. And, and like you were mentioning, making sure that’s still covered by health insurance because being over the counter, like you were saying, it makes it more accessible physically but maybe not more accessible financially if it’s just gonna be like paying out of pocket kind of situation. So making sure that that’s still covered by insurance, I think that’s a huge thing to not overlook. Um, and something else I wanted to say with what you were saying about like Medicaid and the affordable care act and just making sure that people are getting the coverage that they need. I think one of the crappier talking points is about like, you know, personal responsibility and like other people not having to pay more for their health insurance to cover people who are sick or whatever. But it actually does affect all of us when not everyone is getting access to the care that they need, whether it is, um, you know, emergency rooms being the point of care and then that money that those bills being kicked to, you know, the taxpayer because someone can’t pay their bills cause they don’t have health insurance or just generally, um, society being sicker and more injured and not being able to be as productive.

Maggie Germano: 42:33 It hurts everybody. And so I think the idea that like we should only be looking out for ourselves and who cares what’s happening to somebody else’s, just very shortsighted and not accurate.

Nina Serrianne: 42:46 I couldn’t agree more. Um, I think it’s really important to like when we look at programs like the title 10 program, which, um, fits into this conversation in that it’s the federal family planning program, um, that covers, um, under insured, uninsured low income individuals, um, serving nearly 4 million people a year. Um, for every dollar spent. It’s estimated by the goop marker Institute that for every dollar spent on federal planning, family dollars for the title 10 program we’re spending, we’re saving $7 for every $1. So it’s like when we talk about the cost, it’s, it’s all of these programs are saving, saving money in the long run. I think it’s one of the heartbreaking things that we see with immigrants who aren’t able to access healthcare coverage is a lot of them are avail, are able to access emergency Medicaid. Um, but again, you’re forcing somebody to be in dire straights going to the emergency room and relying on that care when we should be creating a society where people can just get the care that they need upfront when they, when they need us.

Maggie Germano: 43:52 Absolutely. It, it would just makes everything better for everybody. And, and I should also mention less related to like policy and more related to the personal side of like why it’s so important for people to have health insurance is that medical costs are one of the top reasons that people go into debt. And also one of the top reasons that people end up having to file for bankruptcy because those medical bills can just expand like crazy without you even realizing that they will. And so it can just destroy you financially. And so paying more out of in their shorter term to prevent that kind of financial like disaster I think is well worth it.

Nina Serrianne: 44:38 Yeah. And one of the things that we haven’t talked about the amount to talk about earlier is actually the cost of marketplace plans. Um, I think sometimes they get a bad rap for being like less than or something, but actually 84% of people are satisfied with their marketplace plans. Um, but for this year, as I was saying, it’s really important to shop around, um, because for, for this year nine and 10 people are eligible for financial help. That’s a lot. Nine and 10 people are eligible for financial help. Um, one in three people are eligible for a plan that’s less than $10 a month. I’m gonna say that one more time. 1 out of 3 people are eligible for a plan that less than $10 a month, and the majority of people are eligible for a plan that’s less than a hundred dollars a month.

Nina Serrianne: 45:24 So when we were talking earlier about like a little bit of investment, um, to not go bankrupt or have an unexpected healthcare costs, um, that’s really, really important. Also, most people don’t know that they’re eligible for a tax credit, um, to reduce their plan. And again, like a lot of those, uh, subsidies are offering people their plans as little as $0 million a month. Um, so there is a good chance that if you don’t have insurance and you’re looking for insurance on the marketplace, you can be paying between zero and $10 a month. So I’m really encouraging people both to shop around, um, you know, but to the, to look for, look for coverage.

Maggie Germano: 46:08 Absolutely. Yeah. That’s not a lot.

Nina Serrianne: 46:10 That’s like a couple cups of coffee.

Maggie Germano: 46:12 So exactly. Think about it that way.

Maggie Germano: 46:14 The odds are good that you will qualify for something affordable if you don’t have other options. So that’s so important to know because I think most people probably don’t know that. Um, so is there anything else before we let you go? Is there anything else you want to make sure that listeners know?

Nina Serrianne: 46:32 I think so, although this isn’t specifically coverage, I think it is just really important to talk. As I mentioned title 10 before. Um, there’s currently a final title 10 rule that’s referred to commonly as the domestic gag rule. Um, that is impacting title 10 funded health centers in this country. It restricts, um, providers from being able to offer a full range of services and discuss with patients all of their options, um, prevents providers from eating saying the word abortion. Um, if it goes fully into effect in March, it would create a physical separation requirement where they would have to have, um, separate parking lots, email addresses, phone lines, um, to separate. Um, and to be clear title $10 don’t go to abortion. There’s, like I said, it’s the federal family planning program. Um, but you know, we’re seeing, as I mentioned, this program is really essential for people who are uninsured, under insured, specifically for communities of color, um, for LGBTQ folks. Um, this is really an essential healthcare program that most people don’t realize that they’ve benefited from. Um, so told you so many times today, you didn’t call your member of Congress. Um, but also please, please call your Senator to ask them to support, um, the Maria amendment to protect the language, um, to, to provide protective language for the title 10 program. Um, it’s really, we’ve already seen 20% of the safety net program, uh, disappear with people pulling out. Um, and it’s, it’s just incredibly concerning and I hope that people will really activate on this issue and see how it’s going to impact communities.

Maggie Germano: 48:19 Thank you. I’ll definitely share more of that information in the show notes too so people can call and, and contact as needed and I’m sure there’s language to kind of help them make that case. Um, well thank you. Anything else you wanna promote either about yourself or your work or anything else you’re advocating for?

Nina Serrianne: 48:41 No, you can come follow me on Twitter @NinaEsperanza_, I posted a lot of wonky health care stuff. Also. Fair warning. I also post a lot of pictures of red pandas cause they make me happy. But, um, if you want, want frequent ranting about the regulatory process and what’s going on in healthcare specifically RePro come follow me on Twitter.

Maggie Germano: 49:04 awesome. We’ll definitely do that. Um, well thank you so much for taking the time to talk about this today. I, I know that I now know a lot more about all of this and the different, um, legislation that we should be following and advocating for. So I really appreciate not only you being here to talk about it yeah. Today, but also the work that you’re doing for all of us everyday. Thank you.

Nina Serrianne: 49:29 Thanks for having me on. I’m glad we got to chat.

Maggie Germano: 49:35 Thanks for tuning in to the money circle podcast this week. Make sure that you rate, review and subscribe so that you never miss an episode. It might not seem all that important, but subscribing and rating actually helps to get the money, circle podcasts and other people’s ears. If you’d like to get more connected with money circle or with me, there are lots of ways you can do that. To join the free Facebook group. Visit facebook.com/groups/moneycirclegroup. To stay informed of any upcoming events, Subscribe to my weekly newsletter at maggiegermano.com/subscribe. If you’d like to join the virtual money circle membership group, visit Maggiegermano.podia.com/inner-circle. To learn more about my financial coaching services, my speaking and workshop offerings, or just to read my blog, visit Maggiegermano.com. you can also follow me on Instagram and Twitter @MaggieGermano. Thanks so much for listening. Bye.