We will occassionally post the stories and questions of Massachusetts residents who are uninsured. This entry is from Chris, a 37 year old college instructor, who lives in a suburb
west of Boston.
Here’s Chris…
As a part-time employee, I am wondering whether my employer will be required to offer me any medical insurance. I am guessing not from my survey of various web logs, news reports, and the Connector’s web site. There is discussion in all of these places
about the requirements for covering full-time employees, but I haven’t found any mention of what will happen to part-timers.
I am assuming that I will be required to purchase my own medical insurance without government subsidy. This assumption is based on my income from last year, which was above the benchmark of 300 percent of the Federal Poverty Level. As a part-timer, though, my income varies from year to year. This makes me wonder whether I will need to move from health plan to health plan, as one year I may qualify for Commonwealth Care, and the next, not. If so, this would require a lot of time and effort in filling out applications, providing proof of income, informing organizations of my previous coverage, transferring records to new
doctors, etc.
I am frankly hoping that I will qualify for the waiver recently adopted by the Connector authority, as I would rather save my money and cover medical costs myself than pay for mandated medical insurance. It would seem that the high-deductible plans being offered through the Connector will mainly give me the
opportunity to pay $2,000 or more a year in premiums for the right to pay another few thousand dollars in deductibles for medical care.
I would hasten to add that I am not relying upon emergency rooms for basic treatment, kidding myself that I’ll be healthy forever, denying that I could ever get into an accident, etc., as is sometimes noted about uninsured people. I do my best to monitor my health by watching my diet, exercising regularly and seeing a physician when a health problem merits attention by an expert. The costs of such visits when needed, albeit expensive, are still cheaper than paying for medical insurance that will be offered to me through the Connector.
Speaking of costs: I do wish that all the professionals, practices, groups, etc. who charge patients for treatment would not only inform us of the charges in advance, but also explain these costs. In my experience, a visit to a medical professional can cost at least one or two hundred dollars, even though the professional may spend only about ten or fifteen minutes with me. I appreciate those professionals who lower their usual charges when they learn that I have no medical insurance, but I am still astonished by the high cost. I am assuming that the charge to me is helping the medical professional to pay some cost that he or she is burdened with. If I’m right, I would like to know where my medical dollars are ultimately going. If I’m wrong, I would like to know why medical examinations are so expensive. This information would make me feel more comfortable as a patient, and would add to my admiration of and thanks to the professionals who have helped me to get and stay well.
If I do not qualify for the waiver, I will seriously need to consider whether it will be less expensive for me to take the financial penalty and go without insurance than to pay for an insurance plan offered through Commonwealth Choice. I would note that by
paying the fine, I would still be complying with the health reform law; I would just be in essence telling the Commonwealth that I am willing to suffer the penalty imposed under the law.
Our legislators may have been so preoccupied with making end-runs around ERISA that they failed to notice 58 may violate Articles 6 and 7 of the Massachusetts Constitution:
Article VI. No man, nor corporation, or association of men, have any other title to obtain advantages, or particular and exclusive privileges, distinct from those of the community, than what arises from the consideration of services rendered to the public; and this title being in nature neither hereditary, nor transmissible to children, or descendants, or relations by blood, the idea of a man born a magistrate, lawgiver, or judge, is absurd and unnatural.
Article VII. Government is instituted for the common good; for the protection, safety, prosperity and happiness of the people; and not for the profit, honor, or private interest of any one man, family, or class of men: Therefore the people alone have an incontestable, unalienable, and indefeasible right to institute government; and to reform, alter, or totally change the same, when their protection, safety, prosperity and happiness require it.
Chris –
Based on the information you’ve laid out it sounds like your employer will have to establish a Section 125 plan (if it doesn’t have one already). You will then have the option of participating in that plan or paying the penalty. The penalty will be the loss of your personal exemption for MA income tax purposes in year one. It will mean paying a penalty equal to 1/2 of the health insurance premium you would otherwise pay after year one.
Then it’s up to you to do the risk-benefit analysis, and decide whether to buy insurance or go bare.
See my HealthBlawg post of a week or so ago re: physicians and their general failure to take patient out-of-pocket costs into account when planning care.
Congratulations, Chris – you’re a member of the group frequently referred to as ‘Gen-X’, and presently, your age group is trotted out by the likes of Jon Kingsdale, present director of the Connector, when shilling about how ‘reasonably priced’ the new insurance ‘products’ are.
Interesting – the health insurance industry is obviously trying to attract the likes of you; young, healthy, with income in the targeted category to ‘qualify’ for the draconian mandate. They see you folks as the new cash cow – not that us boomers are less viable.
I applaud your refusal and will do the same.
Insurance by force is un-sure-ance of course!
Dave H
I have been reviewing my health care options for my family through the Connector and I don’t know how we will be able to afford any of the options. I am self employed as a social worker. My husband works in a company that is enjoying record breaking profits, but the newer workers (as my husband is) are contractors and receive no benefits.
My husband and I have been unable to afford health insurance for ourselves for the past 4 years. We have been able to insure our daughter under a Blue Cross plan for children, but now this plan is being discontinued due to the new health law.
We miss the state guidelines for Commonwealth Care by about $1000 year. Under that plan we would pay a family premium of about $212 a month. Instead we are faced with plans that start at $700 a month, because my husband and I are both in our early 50’s, OR paying significant penalites and having NO coverage for any of our family members. The new law has forced us to go from a bad situation to worse.
Health care costs are driven by the large profits of the pharmaceutical and insurance companies, not by people like us who rarely go in for a doctor visit (we seek care as needed from chiropractors and traditional Chinese medicine practitioners – all out of pocket – are non smokers, very moderate drinkers and believers in the need for good nutrition, exercise and stress management as the basis of health). All citizens need coverage for hospitalization in case of accident or major health challenge. It has been stressful to live without insurance. This new law does not provide the safety net so many of our families need, when we are already stressed by a changing economic environment and just doing our best to survive.
Real reform would address why the costs are so high in the first place and would seek to reign in those costs through regulation of the health care industry. To penalize those of us who have no power to affect this system is cruel and puts the responsibility where it doesn’t belong.
Especially for those of us who are self employed or contract workers, with no job or financial security, some significant adjustments should be looked at or exemptions made. The Blue Cross for Kids plan my five year old daughter has been covered under will soon be eliminated due to this “reform”. We go from 2 to 3 who are soon to be uninsured.
Hi Bea – Martha Bebinger here with a few thoughts:
1)if your income (for a family of 3) is just above the Comm Care cap ($51,510) then you will most likely will not pay any penalty for failure to have health insurance. You will, I think, be in the group of residents for whom insurance is considered unaffordable. That’s probably little, if any, relief.
2) I believe that your husband’s company will be required to let him buy health insurance on a pre-tax basis, as long as he works more than 64 hours a month. The plans cost 30-40% less this way than if you buy coverage using income that is taxed. But all in all, it sounds like you are in a tough spot.
3) thanks for the alert on the Blue Cross kids program. I had heard about this, but need to find out more about why it is being cancelled.
Thanks again for your comments.
Best, Martha
Chris,
I can comment on the cost of visits to physicians. I work in a physician’s office. On average, physicians collect 50% of what they charge an insurance company. So charges have to be set high enough that the 50% will pay the expenses of the practice. Medicare requires that physicians give their lowest fee to Medicare, so physicians can’t cut your fees very much or they would have to give the cut rate to Medicare as well.
The office I work at spends over 60% of practice income on overhead, largely staff salaries. To do all the paperwork, it takes about 2 staffers per physician. This ratio varies, depending on what kind of practice it is, but isn’t unusual.
I’m not trying to say that physicians make a decent income, and certainly some specialists who do procedures, such as surgeries or cardiac catheterizations, earn very high incomes indeed. But most primary care physicians (such as family practitioners, internists and pediatricians) have huge overhead costs and do not earn incomes anywhere near that of a typical attorney, for example.
That’s probably no comfort to you though, and I do wish we had better answers for people than the current system offers.
Who lobbies for the self-employed? I tried to get insurance from the state last May. At first no problem, but then for 3 months I got letters saying that I was inellegable because I refused insurance from my employer.I had phone calls with the “Connector” and /or Mass Health and was told to “ignore” the letters. I do not ignore letters from “THE STATE”, I might ignore phone calls but not letters. Finally in September a letter came, but i was so pissed-off that I refused to comply…then I got pneumonia and now I am stuck with a bill of over $2000 for an emergency room visit in which the doctor could care less, x-rays and 2 pills. I call this extortion. Self-employed, uninsured and exploited by a system that has tested us, poisoned us, and billed us for every dime of research and every mistake and never set up small local clinics toi really care for PEOPLE!
The system sucks and is made to profit first and care less.
Bob Smith