Last week, I had the enlightening experience of attending
‘Every Artist Insured’- Navigating Health Care Reform- at the Regional Arts Commission here in St. Louis.
I know that I’m probably not the only dancer or artist out there that has had to figure out how to find health insurance options as an independent and have been a little worried about my options once the health care reform kicks into gear. I found the lecture incredibly helpful and informative so I thought I would share a few things that I learned.
The talk was led by Ryan Barker, the Vice President of Health Policy from the Missouri FOundation for Health. (I’m not quite sure actually, how the MFoH fits in with the VLAA) This group, and Ryan, is somehow linked with the Volunteer Lawyers and Accountants for the Arts– the group was formed when hospitals switched to ‘for profit’ status and the leftover from companies such as Blue Cross Blue SHield created an endowment for its formation. They provide a lot of services for artists, mostly providing grants. They are prohibited from lobbying so there aren’t a lot of interior motives going on…let’s hope.
The talk started with the very terrifying statistics- 1 in 6 Americans don’t have health insurance, 1 in 7 in Missouri is without insurance, 60 % of the homeless in MO aren’t even eligible for medicaid.
The Affordable Care Act was designed to expand health coverage, regulate insurance companies, increase the quality of care with new models, and focus on prevention.
A lot of the insured are covered through their employers, often a tough thing for artists. I was asked in an interview why finding insurance was hard for me. Here are a few reasons- maybe you can relate:
- I am considered ‘part-time’ in several jobs, including teaching where I’m considered ‘adjunct faculty’ -In order to practice my art, I have to fit other work in where I can around rehearsals and class.
- I am a woman. I am of impregnable age.
- I have a pre-existing condition (type one diabetes)
- Trying to buy an individual plan as a 27 year old female with type one diabetes was extremely extremely expensive. I’m talking roughly 450 dollars a month. That is NOT including my actual medications or doctor visits. And as a diabetic, I will actually die without insulin. That isn’t just me being dramatic…like I usually am.
My health care has fallen to a lot of favors, sneaking around systems wherever I can, samples of medicine, buying test strips off of a friend’s dad, and an individual hospitals’ assistance plan (which will, I think, go away once the ACA goes into play. Noooooo!) It’s been a nightmare. I’m actually thrilled to be able to get coverage without being held accountable for a condition that is in no way, my fault for having.
The point I’m trying to make here is that health care is often a necessity for those that truly CANNOT afford it when the insurance companies have all the say so. We have no power as individuals. Employers with more than 100 employees have an easier time offering coverage because in a large pool, the degree of risk that one will get sick is spread and therefore a smaller risk. The idea behind the marketplace is that these networks will gather the individuals together so that we have the collective buying power of large employers.
Insurance providers have the option of joining the marketplace. At the moment, two have joined for the St. Louis area: Anthem and Coventry.
Each offers four levels of plan (platinum, gold, silver, bronze) plus a catastrophe plan.
The platinum buyer will pay more each month but the insurance company will cover a higher percentage of every bill. The bronze buyer will pay less each month but pay a higher percentage. There are 23 options between the two providers. You should check which network covers your prefered doctors. This is often grouped by hospital. For instance, all doctors at Mercy Hospital are in the Coventry Network. (So you can guess which I’m going with).
- A few exceptions: Health INsurance Companies will offer a separate plan that is NOT part of the market place. If you choose to go with this, you cannot apply for a tax subsidy that would make it more affordable. There was one lady at the meeting that said she had called her provider and they told her she could keep a plan of sorts with them and did not encourage her to enter the marketplace so that they get (guess what) more money.
- If you have had the same plan since 2010, you might qualify for what is called a ‘grandfather plan’. There are a lot fo rules to this that if this is you, you can look into. I tuned this part out since I don’t apply.
- Everyone is required to have insurance you are however, granted a three-month grace period without continuous coverage if you have major life changes such as divorce or moving. There is also a large group of people known as the ‘doughnut hole’ that SHOULD be covered by state supported medicaid and because our state turned up its stubby midwestern nose, they can’t apply. Those people, based on income, are exempt from the individual mandate. It’s something like, ‘if you can’t find a plan that is less than 9.5% of your income, you don’t have to have it’. What a nice perk for the poor- no money and you don’t have to you know, put a priority on your health. Cheers.
Some people are going crazy about the Federal information having too much information, invading our privacy. This is all wrong because we are now disregarding the system that was formed on our medical records.
It is no loner based on : gender health status, occupation It is now based on: income, your age (with a cap), family size, and use of tobacco (though how they would catch that is beyond me. Sniff check?)
Just a note- the Gold plan is pretty much the equivalent to a standard plan granted through major employers.
Here’s a nice benefit- if it still seems pretty steep, you can apply for a tax subsidy which is granted based on income. I think the maximum credit was 35%. Basically, they look at how much you make per year (adjusted gross income, essentially) and then say you must give a certain percentage of that towards your health care.
Another nice benefit, remember that whole preventative care thing? No cost sharing for preventative care. (I fully admit that I dont’ know what cost sharing means but everyone went ‘ooooo!’ when Ryan said this, so I’m assuming it’s good).
One thing that is making some of the youngsters angry about this whole health mandate is that a lot of healthy young people don’t think that they need coverage and are now being forced to pay for it. And worse, young people are paying more than they used to if they paid in the first place. I’ll tell you why this is- old people used to pay A LOT because of health risks due to age. So the idea is that we pay a little more now so that we pay less when we’re old, still living and healthy…because we’ve gone to the doctor when we needed it in youth.
We don’t have any offerings of Platinum care in Missouri. (Who needs health care when we have toasted ravioli and gooey butter cake! ) Congress has somehow tied the premium tax credit to the silver plan- so if you can get that and want the gold plan, you’ll pay more. If you choose the bronze plan, you can still get the maximum tax credit (this was recommended for the healthy, young, and poor as a possible good option. That, or prayers)
I’ve heard recently how inexpensive a lot of our prescription meds are, in places with…socialized health care! Aghhh! France!! Do you know why we pay those awful inflated rates? Because the insurance companies set it so pricey and we need it. Do you know why COngress was such a tantrum-throwing toddler about the ACA? Because it regulates prices for insurance companies. Drug companies are lobbyists. The stuff money in the congressmen’s pockets so that they will not pass bills that would make regulate those costs and make living a little better for the collar-wearing class….or the tutu wearing class. It keeps all the money at the top.
The plan was also designed with a huge expansion of state medicaid. Then the supreme court changed the ruling to make the acceptance of lots o’ free money was ‘optional’. For Missouri, for example, you CANNOT apply for medicaid as a childless adult without disability or blindness. This makes up a HUGE portion of the homeless in our fair state that have NO WAY to help themselves unless they poke their own eyes out or pop out a baby.
The poor people who should have been able to apply for medaid because of low-income don’t make enough to apply for a tax credit.For individuals, that is you if you make less than $15,282 a year. So health care is pretty much way too expensive for them. Good news is that they fall into the ‘exempt’ from the mandate group. Hooray. Stay poor and let’s hope you don’t get sick- even though they’re usually the ones that get sick anyways.
Laughter is also a good medicine: more zombie ballerinas here
I hope this helps anyone trying to understand what to expect in searching for a plan. I hear it’s quite tricky, even beyond the horror that is healthconfusion.gov . I was advised to sign up with the help of a navigator. You can find one through the zip code search on the covermissouri.org website.It should be FREE and navigators should have a FEDERAL licence, not just a Missouri licence.
<Huge thanks to Ryan and the VLAA. (Get involed, informed, or support here) Good health friends and good luck. It’s pretty daunting. Someone please get me some insulin and a doughnut hole. xo- Jess