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Health insurance exchange costs may please young adults

This article first appeared in the St. Louis Beacon, Oct. 8, 2013: When Alexis Young, a graduate student and part-time health researcher, began looking at her own insurance exchange options, she didn’t experience nearly as much sticker shock as she had expected.

With an income of less than $14,000 a year, she had braced herself for what she’d have to shell out for premiums. The sticker price in her case turned out to be about $2,400 a year for each of two plans reviewed by the Beacon. Of that premium amount, she’d have to pay $280 a year or less out of pocket because she’d be eligible for hefty tax credits to cover the rest.

What has eluded Young and the public in general is detailed information about out-of-pocket cost beyond premiums. Such expenses remain hard to determine because the federal web site, healthcare.gov, that is supposed to provide the information is slow, due partly to the number of people trying to access it.

The Beacon decided to bypass the website and take the old fashioned route of asking a broker for Coventry Health Care about out-of-pocket expenses for a couple of plans that might fit Young’s budget.

One is a silver plan called Carelink offered through the SSM and Mercy networks. It charges a $15 copayment for a visit to a primary care provider, $75 to see a specialist, $5 for generic drugs, $15 for tier 1 drugs, and $45 for tier 2 prescriptions.

The second plan, called $15 copay PPO, is offered through the BJC network. Consumers will pay $15 for primary care services, $75 to see a specialist, $3 for a generic drug, $5 for tier 1 drugs and $30 for tier 2 drugs.

Contrary to some of the hype from critics of the Affordable Care Act (sometimes called Obamacare), expenses for these two plans suggest that young adults will have access to health care at reasonable prices. The challenge at the moment, though, is being patient enough to wait until healthcare.gov system is running smoothly.

Targeting young adults

Groups ranging from Cover Missouri, Missouri Health Care for All and the MoPIRG Foundation have all been targeting some of their message to the crucial population of young adults who are essential to making the health reform law a success.

There is a reason the ACA has a special mission in attracting young adults. They tend to be healthier and will help offset the cost of older consumers needing more costly medical services more frequently. Enrolling as many healthy consumers as possible can help lower the cost of health insurance for everyone.

Missouri has about 800,000 uninsured residents. About 40 percent, or about 320,000 of them, are young adults between the ages of 19 and 34. This population is being targeted by both sides of the health-reform debate. Like many other consumers, they will be taxed a minimum of $95, beginning next year, if they refuse to buy health insurance, either through the exchange or another way.

While ACA supporters are trying to enroll them, opponents argue that the tax is unfair. They say taxing this generally healthy population for a service they may not want might take away money they could use for other personal needs.

While many people might buy that argument, others like Young, 33, thinks it’s risky for members of her generation to opt out of the health insurance market. She says she’s pretty healthy, hasn’t needed to see a doctor this year, but notes that a few mild pre-existing conditions can put young people out of reach of health insurance in the private market just when they need it.

She believes the law offers good core benefits at what she now think will be reasonable prices. In addition to prescription drug discounts, she notes that consumers will have access to emergency services, hospitalization, maternity and newborn care, mental health and substance abuse services, rehab services and preventive services.

Reasons for coverage

Her view of the debate over the ACA has been shaped by working in health care in both Canada and the United States. She now works at Washington University as a health researcher with patients coping with chronic illnesses.

“In Canada and Europe, it’s basic health insurance for everyone,” she says. “The hospital that I worked at in Montreal looked old and rundown. It wasn’t like going over to Barnes where everything is first rate and you won’t find peeling paint. But that’s not to say the quality of care in Canada and Europe wasn’t good.”

She grew up in Tucson and moved to St. Louis to do undergrad work at Washington University. She had health insurance all her life until she began working part-time while doing graduate work at Washington University’s Brown School.

Her basic transportation these days is her bike, a bus or light rail. One concern among many underinsured young people like her, she says, is what would happen in the event of a serious illness resulting in a large hospital bill or in the event of an accident, such as being struck by a car when biking.

She adds that lack of health insurance is “a pretty typical worry for people. A lot of them are one health crisis away from changing socio-economic classes. When you kind of live on the edge financially, you worry about the things that can push you over the edge. Right now, I can pay all of my bills. And I am grateful for a good job, and a boss who has been very accommodating” about her working part-time to attend graduate school.

But the reality for many young people, she says, is that finding and keeping health insurance can be elusive. Her first solution upon moving to part-time work was to get insurance through the Gateway to Better Health program. It was recently renewed for another year, beginning in January, but it will exclude consumers earning more than 100 percent of poverty, which eliminated Young.

“I’m hoping things will change,” she says, not only for young people but for the uninsured in general. As part of her job, she says she has seen how people might stop taking their medications because they no longer can afford them.”

“If they have hypertension and don’t take medicine for their blood pressure, they can end up having a stroke. Maybe they can’t work after that and have to go on disability. If they don’t have health insurance, they end up costing us more money for treatment, doctor bills, hospital bills” that might have been avoided had the prescription drug been available.

Her larger message is that the young as well as the old can succumb to such illnesses. Among those trying to get that message to young adults is the MoPIRG Foundation, which is seeking to help them understand the law, says Alec Sprague, federal advocate for MoPIRG.

The group’s website includes people holding up posters with questions about the insurance law. The first question posed is: “Do I need health insurance?” Underneath the question MoPIRG says that “dealing with health insurance as a young person can be tricky. You might be uninsured, or could be about to lose coverage through your parents’ or college’s health plan, but aren’t sure what to do next. Looking for insurance raises all kinds of questions: Can I afford it? What’s covered if I get sick? Where do I look to find a decent plan?”

It goes on to explain some of the plans offered through the insurance exchange.

“Students have lots of questions about health insurance,” Sprague says. His hope is that the guide will assist young people in finding “good insurance that won’t break the bank.”

Until healthcare.gov is running smoothly, that will remain a difficult task.

More information

Missouri rates explained: www.legalconsumer.com/obamacare/rates.php

Should young people get health insurance? | Jim Gallagher, St. Louis Post-Dispatch

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.