New York Consumers Glimpse Obamacare Future Ahead

Friday, September 27, 2013

The health insurance exchanges at the core of the Affordable Care Act debut Tuesday, and some New Yorkers are eager to see what their options are in the online marketplace—while others see a potential expense they are eager to avoid.

Andrea Arroyo, 50, an artist and book author in Washington Heights, recently looked at an estimator provided by the New York State of Health and was quite pleased. She and her husband currently pay more than $1,000 a month for coverage—between a fourth and a third of their income. Based on the preliminary website, it seems like she might be able to cut that in half, thanks to the buying power of the state exchange and the added discount from federal subsidies.

"If that’s the rate, I’m going to have a party," said Arroyo. "It’s very, very low compared to what I’m paying now."

But in order for those premiums to go down and stay down, and in order for Obamacare to work as advertised, insurance companies offering individual plans will need something they haven’t had in New York: young, healthy people. People who buy coverage who don’t really need it much.

People like Julie Ross.

"I’ve had a lot of friends who don’t have it, and they say, ‘You know what, actually? Since I stopped getting insurance, I stopped getting sick,’" said Ross, 33.

The dog-walker and apartment painter has been without health insurance since she quit her job five years ago as a public school teacher to focus on her aspiring rock n' roll career.

Ross is eligible for the lowest-level bronze plans, which could cost $150 a month after federal tax credits are applied. That would be about 8 percent of her income, but she says she just doesn't have the money.

"As much as it seems like a risk to not have insurance, it’s more of a risk for me at this point to pay for insurance that I may never need," she said. "I have a dog, and I had to save for two, three months just to take him to the vet. And that was $120 bucks"

If she doesn’t buy insurance, she’ll have to pay a penalty—around $250 next year. The fines ratchet up after that. But that’s still a lot lower than even the cheapest bronze plans—so Ross says she might hand over the cash come tax time.

"If I really believed that the government cared about my health, then, yeah, I would go along with this," she said. "But that’s not what this is about. It’s about money."

Obamacare supporters are losing sleep over people like Ross, the healthy people who are needed to make Obamacare work.

Mahmoud Khanfour, a cab driver from southern Brooklyn, hopes these “young invincibles” will step up and buy insurance—something he hasn’t had in years but would really like.

"I’m 61 now. I feel I need it," Khanfour said. "But if you ask me when I’m 20 years old, when I’m 30 years old, [I'd say] I don’t need this crap."

Khanfour looked into private policies, but his expenses for the cab while supporting a family of four are too high. So he has taken his chances. He recently went to an emergency room after a passenger closed the trunk on his head.

"It cost me $1,680 and I didn’t get any stitches," he said.

Khanfour will be able to get Medicare in four years. In the meantime, according to the estimator, he could get a silver plan for his household for $100 a month. His low income and high expenses qualifies him for a generous tax credit.

"The price is right. That’s what I was looking for," he said. "But I don’t know anything about what it covers and what it doesn’t cover."

Khanfour and everyone else will get more details about that in a few days. But what will not be clear for a while will be how many healthy young dog-walkers will go into the Obamacare system in order to offset all the higher-need cab drivers.  

State health officials estimate more than a million New Yorkers will be getting insurance through the new exchange. They project almost half of them will be under age 45—but they say it will take a few years, at least, to get there.


Here's the Obamacare premium estimator, if you'd like to check out the costs for yourself. Will you sign up? Let us know below.


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Comments [7]

Pierre from CA

When the state exchanges open Tuesday, does anybody know how much personal medical info the applicant is expected to provide? Will the estimator use pre-existing conditions in determining premiums? I know the ACA law says you cannot be turned down, but pricing you out of the market based on pre-existing conditions is effectively turning you down.

I thought the new law was supposed to aggregate huge pools of members to even out risk. I've been assuming this risk-pooling would be reflected by only taking into consideration a few personal factors, such as age, the metallic-level of the plan, state, and income level. I'm not expecting to sit there for an hour entering medical history. Am I wrong?

Sep. 28 2013 01:28 PM

Also, wait -- if Julie was convinced the government really, really cared about her, then she'd "go along with it"?

I thought she absolutely couldn't afford it?

Which is it, then -- principle or cash flow?

I just don't buy her argument.

Sep. 27 2013 05:07 PM

The links to the estimator and NY State of Health are broken, fyi.

Sep. 27 2013 03:47 PM

This person paints apartments without insurance? So what happens if you fall off a ladder and bust your ass? Who's going to pay for that?

Sep. 27 2013 12:03 PM

Health care is a right! This is forced ransom for your life! I don't believe in paying ransom for my life in a civilization. The prices for everything are completely insane price gouging! I will not pay 2000 for it. Because I don't believe in paying ransom for my life I will have to go to jail?

Sep. 27 2013 11:04 AM

If a cabdriver family of four pays $100/mo for a silver plan, why is a single dogwalker (most of whose income is probably undeclared cash) charged $150/mo for a bronze plan? This sounds fishy. Was it fact-checked?

Anyone who thinks canceling medical insurance prevents getting sick is not a reliable witness.

Sep. 27 2013 10:19 AM
Richard Grayson from Brooklyn

I understand Julie Ross's dilemma. She is healthy, and paying the fine seems to her -- as it might have to me when I was her age, half my lifetime ago -- to make more sense financially. It's great that she's healthy, but I have a young, healthy friend who recently was hit by a car as she was crossing the street. She's required a lot of health care, including three separate surgeries. If, God forbid, something like that -- or some other kind of accident, hurting herself while playing sports (something a lot of us have experienced) -- happens to a person like Julie, she's going to go the emergency room and be treated. She will be billed an astronomical amount, perhaps more than her yearly income. Someone will have to pay for that medical care, and if a person is not insured, it will be the rest of us: the insured patients whose premiums will rise, the taxpayers.
And Julie's credit will be harmed, perhaps ruined, because she failed to pay thousands of dollars that she owed.

This isn't the best system. We really need what all of us over 65 have: single-payer Medicare.

I wish Julie luck in avoiding any medical problems.

Sep. 27 2013 07:50 AM

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