Why the Affordable Care Act doesn’t work for me

Read it in the November 11, 2013, print issue of Crain’s New York Business.

I had hoped that buying health insurance this time would be different. That the Affordable Care Act would deliver on its primary promise and I could find a plan at a price I could afford.

But it hasn’t. And that’s problematic not just for me but for the entire health system. I’m a 28-year-old freelancer—one of millions of “young invincibles” in the U.S. whom the health insurance industry wants as customers to ensure that the economics of the Affordable Care Act work.

People in their 20s and 30s account for nearly half of the state’s 2.2 million uninsured. We do not typically use a lot of health care, so if we bought insurance, our premiums could help offset the cost of insuring sicker Americans. If Obamacare is going to work at all, it has to work for people like me.

The health exchange website’s technical problems and the law’s complexity have so far dissuaded people on the fence from buying into the system. Just 13,000 New Yorkers of all age groups throughout the state have signed up for Medicaid or bought insurance, according to the state Department of Health.

Hoping to enroll, I spent the past month researching my options, patiently overcoming crashing websites and contradictory information. I fully hoped—expected, actually—that I would come away with a great plan at a price that would make me feel as though I were making a good investment.

Ultimately, however, I concluded that insurance is not worth the cost—at least not yet.

Relationship questions. 

During much of the Obamacare debate, I was a full-time student on Medicaid. But on Sept. 1, I got a part-time job as a health reporter with Crain’s. I earned too much for Medicaid and found myself staring at nystateofhealth.ny.gov .

When I first logged on to the exchange, I had a price in mind that I could afford: $200 a month. That amount is basically most of my disposable income after rent, utilities, transportation and groceries.

It also seems fair, given my low use of medical services. I go once a year to get a physical, my teeth cleaned, and see the OB-GYN. I have no pre-existing conditions. The worst thing that runs in my family is nearsightedness. I don’t even have cavities.

But being healthy doesn’t make insurance cheaper. After talking to an accountant, my earnings after deductions next year put me at nearly 400% of the federal poverty line, an amount that qualifies me for about $43 in monthly subsidies. I would pay between $264 and $350 monthly for a so-called bronze plan, which is the lowest coverage level allowed. Bronze plans have the lowest premiums but often the highest deductibles. Silver coverage would start at $303.

Though all plans cover a host of preventive services for free, I was surprised by the cost. When I first moved to New York in 2006, I deemed a $300-a-month policy too expensive for the grab bag of jobs I had at the time (waitress, intern, freelance photographer). I was hoping Obamacare would be cheaper.

I had one strategy left: my boyfriend. Two years ago, we entered into a domestic partnership so that I could add him to my former employer’s health insurance policy. As an artist, he earns less than I do, and our combined income would merit about $300 in monthly subsidies. Together, we’d pay between $303 and $780 a month under Obamacare, which I thought was doable. To find out if we could apply together, I went searching for a navigator.

Finding a way through the system. 

Navigators, who help applicants sign up for insurance, are themselves pretty hard to find.

I called three different numbers from the directory on nystateofhealth.ny.gov before I found an employee of the Brooklyn Alliance, the nonprofit branch of the Brooklyn Chamber of Commerce and one of the groups contracted with the federal government to enroll New Yorkers via the exchange. Eventually, I was able to make an appointment with a navigator at the chamber’s office.

The strategy of putting workers on the ground would make sense if I were looking to enroll in a free social program like Medicaid. But I needed advice, and navigators are not allowed to answer the most basic question: Which plan gives me the best value? Unlike brokers, they cannot legally recommend one plan over another. All they can do, as mine did, is log you on to nystateofhealth.ny.gov, ask the questions on the screen and type in the answers.

My navigator, however, answered one key question. My boyfriend and I could not jointly buy Obamacare. That means he will pay next to nothing once the state verifies his identity, which it promises to do by December. But I was back to square one.

Where are all the young people?

None of my similarly self-employed friends had better luck. Out of 15 people I spoke with who did not have insurance through their jobs, only one had purchased coverage through the exchange. “I’m waiting it out” was a common refrain.

A handful were able to qualify for Medicaid or stay on their parents’ insurance plan. By the time the ACA allowed young people under 26 to stay on their parents’ plans, I was too old. That was in 2010, when 23% of the state’s uninsured were 26- to 34-year-olds, according to the State Health Access Data Assistance Center.

The one person I found who bought insurance—like me, a freelance journalist in her late 20s—was highly motivated after years of being uninsured. “The last time I saw a dentist was 2011, and that was just for him to tell me how many cavities I had,” Clarissa León said.

Ms. León’s main problem with the exchange is cost. She is paying $320 a month after subsidies for a silver-level MetroPlus plan that includes dental care.

“I can afford it but barely,” she said. “I’m spending my last penny after paying for rent, transportation and all the rest.”

Costs and benefits. 

Susan Combs, president of insurance brokerage Combs & Co., says that since Oct. 1, she has fielded many calls from individuals looking to buy insurance. The youngest was age 50.

Asking a young person to pay $300 a month “just in case” is a hard sell. I almost talked myself into paying that much, but the $300 premium is just a baseline. Anything additional, such as using the prescription benefit, would require me to pay a deductible that starts at $3,000.

The full cost—$6,168 annually—would be just a notch below what I pay annually to rent a bedroom in Flatbush, Brooklyn.

Uninsured, I now pay $10 a month for one generic medication and $125 quarterly to visit the doctor who prescribes it. My yearly out-of-pocket spending on primary care barely hits $550. Throwing in the penalty I would pay for staying uninsured—1% of my income, or about $410—it still wouldn’t reach $1,000.

No wonder most of my friends are waiting it out.

Sure, I can get hit by a van. But I am lucky to live in New York, where I can go to a public hospital or qualify for the city’s HHC Options, a program for reduced-cost medical care that will continue despite Obamacare. For now, I can’t afford anything else. And without my premiums padding insurers’ bottom lines, costs may go up further still.

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