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I Never Thought I'd Be an Outlaw, But the Affordable Care Act Might Make Me One
I want to – believe me, I do. But I'm not sure I should sign up for health insurance through the Affordable Care Act, because for me, it's not affordable.
Contrary to what you might think, I'm not some Obama-hating Tea Party supporter who resents government interference. I'm pretty far to the left politically, and as a freelancer without employer-sponsored healthcare, I really want Obamacare to work. I don't want to see it repealed, just improved, and if others like me don't sign up, perhaps this solidarity will make America's brave new healthcare world better for everyone – not the extension of the profit-making enterprise it remains. Leaving healthcare to the private sector, instead of expanding government-sponsored Medicare to those under 65, has not meant affordability.
But I hoped for the best when I registered through New York State's "marketplace" website (the name makes clear that this is business first, healthcare second). There you can compare plans from various insurers, and the most "affordable" one (from MetroPlus, without dental) was more than $350 a month – not affordable on my income. I was eligible for a subsidy, which reduced my monthly cost to under $200, but it was still nearly double the $100 I was hoping for.
Much has been written about the premiums being too expensive for people in their 20s, but the price is also a financial burden for me at age 43. Still, had that been the entire cost, I would have signed up. But additionally, each doctor's visit would cost $30, and there was a $1,750 deductible.
Quite a contrast to what I've paid the last several years. As a New York City resident, I've been eligible for a program called HHC Options, sponsored by the city's Health and Hospitals Corporation, which provides truly affordable care to low and moderate-income individuals. It's not insurance, and there's no monthly fee. You pay only when you see a doctor, and your copayment (between $15 to $60) is based on your income.
I felt guilty paying so little when I could afford a bit more, and hoped to contribute that when Obamacare kicked in – just not so much more. My healthcare expenses for last year (around $350) are about equal to the fine I'd pay if I don't get insurance by 31 March (and yes, the president just extended that deadline for some individuals, although now I have to figure out if I meet the requirements).
Though I hardly lead an extravagant existence, I've thought about ways to lower my expenses to pay for the premium. There's my already small $25-per-month gym membership, but regular exercise may mean less healthcare as I get older. Should I buy cheaper fast-food meals for lunch instead of healthier alternatives? How good would that be for my overall well-being? Maybe I could just not make any charitable donations next year, or forget about taking a vacation. But would I have to not do either of those things every year, indefinitely? Do I put less money into my already scant retirement savings? That doesn't seem responsible.
And I think I've been fiscally responsible with my modest income. I have no loan or credit card debt, and my rent-stabilized apartment is covered by renter's insurance. I don't have an iPhone, or spend loads of money on things like clothes and entertainment, and I don't relish returning to the hand-to-mouth existence I lived during my 20s. Is that what I have to do to be a law-abiding American in 2014?
When I went back to reassess my options I discovered that you can change the income on which the premiums are determined. They're not based on my last income tax return or on my 2013 earnings. The amounts I entered are what I expect to make from my various employers in 2014. And because it's hard to predict, I just put in how much I made in 2013, assuming it would be about the same.
But you can lower your premium by lowering your financial expectations for the new year. With more conservative earning estimates, I was able to get it down to $140 a month. Do I try to get it down to the $100 I could afford to pay? Has US healthcare become some inverted version of the game Angry Birds, where the lowest score wins and you can keep trying until you get three stars?
That sums up "universal healthcare" in America. Even with all the work that went into the Affordable Care Act, it remains a game of chance. Perhaps if enough Americans who can't handle the financial burden break the law and don't sign up, we can get it amended to something simpler and truly affordable, like the single-payer, free-choice system Ralph Nader, Bernie Sanders, and even Colin Powell support.
I never thought I'd be an outlaw, but I may become one next year.