What Obama’s Plan Means for You
Photo by Zelena Williams/HU News Service/The Hilltop
Fit, healthy and just 33 years old, Odessa Phillips couldn’t see any reason to spend her hard-earned cash on the most expensive medical insurance.
“I was sure a high-deductible, low-premium plan that would only offer coverage if I were to have an accident or major illness would be enough,” says the Maryland engineer and communications executive. “When you’re young, you never imagine a need for more than $1,200 worth of drug coverage in a year.”
Phillips is referring to the shock of discovering her doctor had prescribed an $800-a-day, five-day drug regimen to help her recover from a pulmonary embolism brought on by fibroid treatment.
After getting out of the hospital, Phillips was also surprised to receive individual bills from every doctor that came near her that was not part of her plan. A full-time employee of a small company, Phillips was forced into the private insurance market when her employer refused to offer group coverage.
“They offered to increase my salary to cover the costs of a plan,” Phillips says, “but it didn’t really help, because I had to buy insurance as an individual, so I couldn’t get the types of protections offered to a group.” So Phillips made the choice millions make: She bet her odds of ongoing good health against her monthly budget and hoped for the best.
In the end, she could not pay for the medication and was forced to put her life at risk until a cheaper treatment could take effect. “Now that I’m well and I want more protection, I’ve discovered that I can’t buy more prescription coverage, plus my premiums went up because I got sick,” she says.
Health Insurance Hurdles
Underinsured, overcharged, going without preventive care, living with limited access or not having insurance at all is increasingly the case for many Americans, but for African-American women the potential health costs of inadequate health coverage are particularly high. President Barack Obama’s proposed plan offers reasonable solutions to these issues and therefore may have a very real and positive impact on the health of African-American women and their families. (See section on “Hope in Health Care Reform,” below.)
“Preventive care and access to quality care is very, very important,” says Frances Ashe-Goins, R.N., deputy director of the Office on Women’s Health at U.S. Department of Health and Human Services (HHS).
“When you look at the leading causes of death for black women, many are preventable—cardiovascular disease, hypertension, breast cancer, diabetes, conditions that also need consistent care. Yet in a recent focus group with black women, we found they were paying the rent or the car note before paying for health insurance, especially in their 20s.”
The number of black women living on the edge, without any coverage at all goes far beyond women younger than 30. Recent HHS reports say nearly 18 percent of black women up to age 64 are uninsured. In addition, “we are also seeing an erosion of coverage when people do have plans,” says Sara Collins, Ph.D., an assistant vice president at the Commonwealth Fund, “because people’s incomes have not grown along with the cost of insurance.”
Moms may also be struggling to find coverage for children. Currently, 1.6 million black children are uninsured.
High Risk, No Reward
The income-insurance premium gap can become overwhelming and exploitive, even for professional women with great jobs. As a vice president for a New York real estate firm, Denise Cataudella gets lots of perks; unfortunately, health insurance isn’t one of them.
“I work full time, but I’m an independent contractor and therefore only able to buy insurance as an individual, without any financial assistance from my employer,” Cataudella explains.
At age 50 and fighting to manage her diabetes, Cataudella tried to hold onto a policy with full coverage for office visits, prescriptions and hospitalizations. “But when my monthly premiums reached $580, I started looking for more affordable options,” she says.
Cataudella signed up for a $380 a month Oxford plan, with a $2,000 deductible, which meant she’d still pay less even seeing her out-of-network doctor for four annual visits.
“I thought I’d found a deal until I attempted to pick up the medication I take daily.”
Oxford had a strict “generics only” prescription policy. There is no generic version of Cataudella’s medication—Byetta—so Oxford wouldn’t cover it. In addition, they refused to cover the equipment needed to administer the medication.
“Out-of-pocket expenses for the medication added another $300 to my monthly health costs, so I tried a lower-cost, higher-risk plan and ended up paying even more for my overall care,” explains Cataudella, who’s now shopping around for another, more expensive plan.
Cataudella and Phillips have lots of company. “Right now about 160 million people get coverage through an employer. The individual market is the most challenging,” Collins says.
Hope in Health Care Reform
To add to the problem, finding an affordable plan is far more difficult for women. According to a recent study, women ages 19 to 55 pay as much as 40 percent more for health insurance than men, and that does not include maternity care. An issue even more critical for black women, “because infant mortality among blacks is still higher than other groups and this is directly related to whether or not they have health insurance,” Ashe-Goins says. In addition, millions of African-American women cannot afford even poor coverage and don’t qualify for Medicaid.
The centerpiece of the Obama plan would address the health insurance needs of the millions of sole proprietors, individuals, unemployed people who do not qualify for Medicaid (eligibility is capped at $20,207 for a family of one to four) and employed people who do not like their insurance options.
“The proposed plan would create a standard benefit package as part of a national insurance exchange, and the plan would look like the current federal employee’s plan,” Collins says of the largest and possibly most affordable collection of insurance plans in the country. The idea is that the cost-sharing created by an exchange would rescue individuals like Phillips and Cataudella by giving them the bargaining power and choices of a group.
The federal plan—available to groups in different states and Washington, D.C.—offers the largest selection of insurance options of all types available to any group in the country.
In Phillip’s home state of Maryland, for instance, 23 plan options are listed. Cataudella’s state, New York, lists 32. In addition to selection, federal employees enjoy the power of being the largest group of insured people in the United States. That drives down premium costs, while improving the quality of the benefits available.
“There’s a lot of potential in the proposed plan,” says Cara James, Ph.D., senior policy analyst at the Kaiser Family Foundation. “If it takes shape according to plan, most significant will be subsidies for low-income individuals, which is primarily about expanding coverage, as well as the expansion of eligibility for Medicaid and SCHIP (State Children’s Health Insurance Plan)—all of which should equal improvements in cost, access and quality.”
Sheree Crute is a Heart & Soul contributing editor.
What to Expect
- Greater coverage for preventive tests and screenings for diabetes, breast cancer, Pap smears, hypertension, cardiovascular disease and other preventable illnesses;
- Broad insurance coverage for disease management programs that would help a person with a chronic condition, such as diabetes, coordinate care with a team, including, for example, a nutritionist, a cardiolo gist and a primary physician;
- Subsidies for low- and middle-income individuals who are well above the Medicaid limit of $22,207 for a family of four or less, as well as the possible expansion of benefits to people receiving unemployment insurance;
- Greater support for people with HIV/AIDS, a critical health issue for African-American women;
- More funding for medical research, including women’s health research;
- Improved coverage for children, including school-based care; and
- Support for addressing health care disparities through increased research and increasing access to care.—Sheree Crute
