The 51-year-old house painter, who occasionally takes himself off to the ER when he has an asthma attack, was blunt. “You go there, they fix it and you pay,” he said.
Actually, he goes there, they fix it, and we all pay. But I wasn’t about to deliver a lecture about the high cost of emergency medicine. Instead, I asked him if he knew anything about the Affordable Care Act and the health-insurance exchanges scheduled to open for enrollment Oct. 1.
Not really, he replied.
What he knows is that he doesn’t want to pay for health insurance. “I just keep kicking that ball down the road,” he said.
According to surveys, most uninsured Americans actually want coverage but can’t afford it. Others who might easily afford it don’t actually want it, including my acquaintance from Hartland, who makes $50,000 a year. Healthy adults often forgo coverage because they object to spending a portion of their earnings on something they might not need. Almost a third of uninsured Vermonters had jobs offering coverage in 2012 yet chose not to sign up, apparently to avoid employee contributions and other out-of-pocket costs.
It’s doubtful that the holdouts will change their minds between now and January, when most U.S. citizens will be required to have health insurance or pay a penalty. Even the federal mandate might not move them. Anecdotally I’ve heard people say they’d rather pay the penalty than be forced to buy a health plan.
The challenges of expanding coverage are apparent in places like Texas, where almost a quarter of state residents lack health insurance. Volunteers knocked on doors in Dallas, passed out leaflets about the mandate, and described the benefits available through the exchange. What they found, according to The Boston Globe , was confusion, widespread ignorance about the new insurance market, and hostility toward the law. “I’m not interested,” said one woman as she slammed the door - and that was one of the more polite encounters.
Texas is a far cry from Northern New England, and Vermonters may be more receptive to the changes afoot. Still, the uninsured - and that includes 200,000 or so residents in the Twin States of Vermont and New Hampshire - share a common profile no matter where they live. A disproportionate number are between 18 and 34, and they typically earn less than $40,000 a year. Under the new law, most will qualify for either Medicaid or for the tax credits that will, in effect, discount the price of private insurance purchased through the exchanges. The subsidies are expansive, available to individuals making up to $46,000 a year, or to families of four earning $94,000. For some low-wage workers, premiums will cost next to nothing.
Yet somehow the affordability piece of the Affordable Care Act has been lost in the thicket of partisan politics, and that’s too bad, because if the exchanges fail to interest enough of the 48 million uninsured people in America, we’ll all be kicking that ball down the road - a bumpy road to a very uncertain future.
