Thursday, March 6, 2014
I alluded to my need to find a health insurance plan to replace my present one in an earlier post, "A Protective, Decorative or Disguising Shell". Today I continue that consideration, armed with more knowledge, thanks to the meeting I had this morning at 9:30 a.m. with Robert Izzo, a "navigator", as those charged with helping the public find a health plan under the new Affordable Care Act regime are called.
Robert is a sixty-one year old who works for the New York State Women's Chamber of Commerce. Normally, he helps women set up small businesses. As his organization was designated to provide assistance to the uninsured and soon-to-be-uninsured in my New York City area once the Affordable Care Act became the law of the land, he is now a "navigator", providing technical assistance to those who approach the office, to which the New York State health exchange directs them. In effect he is a "Virgil", guiding visitors through the underworld of government-run health care.
Helping women set up start-ups is a positive experience; helping men and women find health care under the new regime is not. "I have asked my boss for some 'mental health' days, because I am so stressed from doing this job. I like my job helping women start businesses. Now I have people coming here, women in their sixties, crying because they've lost their health care and the new system isn't working for them", he confesses.
The metaphor of the underworld is apt, because the system is not transparent and requires sophistication and doggedness to penetrate. And for many, there is no happy ending because the new health care they can obtain is more costly and less complete than that they had before. Some individuals are subsidized and obtain health care at reasonable prices, others, not much more well-compensated for the work they do, are shut out from subsidies altogether.
"A waitress who makes $28,000 a year can get a plan that costs $465 a month and a $200 subsidy", Robert explains. "With the subsidy the monthly cost of her health care is $265.
"A guy who makes $42,000 a year gets a plan that costs $700 a month and no subsidy. If his rent is $1600 a month, he can't afford that. It's a mess."
I ask Robert to verify whether it is true that some plans are not national, but limited to, say, the tri-state area of New York, New Jersey and Connecticut. (One of the insurance brokers I spoke to told me all the exchange plans were national in their coverage.)
"Yes, I've heard of that. You have to check the coverage details before you sign up to make sure you are getting national coverage."
Here's another "Catch-22": To find the doctors in a particular plan while working with a navigator, you have to be enrolled. Essentially you have to buy the goods sight unseen, unless the plan has a website that lists their doctors. And all the plans are "in-network" only, so if you have a rare disease and no in-network doctor is a specialist, you must pay out-of-pocket for appropriate treatment.
"I had a woman call me who said, 'I'm healthy, but if I get cancer next year, I want to be treated at Sloan-Kettering' Robert continued. "I couldn't help her. She went to Sloan-Kettering, but no one would assist her, they told her they were not the appropriate place for her to get the information she needed. Eventually, she found out that Sloan-Kettering had signed up for one plan, First Republic. --I don't know how she found that out."
Robert tells me a little about himself: he lives with two roommates in an apartment in the Columbia area. He can't afford cable so he has no television or landline, and the computer he uses is the one in his office on 135th Street and Broadway. "Can you imagine, I'm a professional, and I don't have my own computer?"
As I have decided to move, Robert sends an e-mail to someone higher up the health care bureaucracy food chain to ask how the system handles moves out-of-state. I want to know whether I can sign up for health care for the months I remain in New York, then cancel the policy, go to Europe for a few months and sign up in the state I want to settle in upon my return.
"'Life-changing events' are an exception to the rule that you can only sign up for health care during the yearly enrollment period," he tells me. "'Moving' is a life-changing event, so you could sign up for New York, stop paying if you go to Europe, move outside New York on your return and sign up in whatever state you settle in."
Having mentioned moving to him, Robert is curious about how greener the pastures are in any of the places I've explored. Talking a little more, Robert reveals he's thinking of moving out of New York.
"Is it better in North Carolina?", he asks me. I end up counseling him as to what states have no income tax, how to compare the cost of living in one locality versus another, to look out for a city or town income tax, to evaluate what the level of sales tax is.
It would not be unreasonable to speculate that the Affordable Care Act will lead to some outmigration from places, like New York City, too expensive for the middle-class to survive in. The financial squeeze is too great and Americans have always been a mobile and practical people.
"At the turn-of-the century, our ancestors left Europe for a better life in America. I feel like now our generation, the baby-boomers, are doing the same in reverse" a friend told me. She and her husband are leaving Westchester for the same reasons I will be leaving New York.
It feels odd to leave a place that my family has lived in for more than a century. It is an uprooting, no question about it. Thankfully, it's a big country and Americans respect resourcefulness and don't have prejudices against "new" people, as can be the case in other parts of the world. So I'll navigate my way out of New York: It's a relief to have decided, at last, to go.
***
Later in the day I go to visit my physical therapist, with whom I discuss my search for health care. She tells me that her health care plan covers her only in New York State, thereby confirming what Robert, the "navigator" said; and contradicting an insurance broker who, pushing the "Oxford Liberty" plan (one of the most expensive), told me "emergency coverage out-of-state is always covered".
When I arrive home, an e-mail from Robert is waiting for me: he has the answer to my question about what would happen if I sign up for health care in New York, go to Europe for the summer, and return to the U.S., but to live in another of the fifty states. It is a two-part answer:
"Yes", I can sign up for health care in another state when I return under the "moving" exception. However, if I do not keep paying the premiums to New York while I am in Europe, I will be subject to "the penalty" for not carrying health insurance. That "penalty" is the yearly $125 penalty imposed on anyone not enrolled in a health insurance plan. That penalty is anywhere from $1,000 to $2,000 less than what it would cost me to keep up New York State health insurance while I am in abroad.
As none of the U.S. plans provide coverage abroad and I have to pay for travel insurance (which does not cover routine medical care, but is much cheaper) the choice is obvious: carry a New York State plan until I leave for Europe, stop paying once I leave the country and pay the penalty; then enroll in the state I settle in when I return.
***
I read in the newspapers that the Obama administration has announced a new policy providing that anyone wishing to keep their health insurance coverage may do so through 2016. However, state insurance commissioners and the insurers themselves have to be willing to continue to offer the plans. This news does not provide me with much comfort, though: my coverage is through COBRA, a program mean to bridge coverage between jobs, or to provide coverage to dependents of a someone covered under an employer plan who has died. It is a "one-off", meant to cover extraordinary events. So my health coverage is not covered under the new policy, and I have to keep looking for a health insurance plan to replace the old one.
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