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Insure this!

Why some twentysomethings won’t buy health insurance — even though it means they’ll be breaking the law

By: Mike Mallard

Boston Phoenix, October 31, 2007

 “Actually, y’know, no. I think . . . fuck ’em. I don’t care.”

Noel, a 38-year-old bicycle courier with gray eyes and a round, stubbled face, is sitting on a leaf-shaded bench in Post Office Square. And he’s just answered my question: do you plan to sign up for a health-insurance plan, now that anyone who isn’t covered as of December 31 will be penalized on their taxes?

I press. “Even though the Commonwealth is offering an array of subsidized plans for people whose income levels qualify?”

Noel laughs. And laughs. Hahahahahahaha. Aahhh-hahahahaha! “That’s funny, man! And how do you get these subsidized plans? You call one phone number, and then you’re redirected to another one, and another one?”

Well, to hear it told, that’s occasionally been the case. But it also seems fairly easy to navigate the Web site of the Commonwealth Health Insurance Connector (, an organization that was set up, in the wake of Massachusetts’s landmark mandatory-insurance law, to help people without coverage find a plan that fits them — and their income.

And this much is also true: being a bike messenger is an insanely dangerous job. According to a 2002 Harvard School of Public Health study titled “Occupational Injuries Among Boston Bicycle Messengers,” a sample of 113 couriers found that 70 percent had suffered at least one injury leading to lost work days, and 55 percent had accidents that landed them in a doctor’s office or hospital. Car doors swing open unexpectedly. Pedestrians stand stodgily on the sidewalk. Cars swerve around corners. Fractures, dislocations, and sprains! “Twenty-four percent of messengers reported wearing a helmet on a regular basis,” the study noted, “and 32 percent have health insurance.”

Noel does have a helmet. But he does not have insurance. This, despite the fact that he’s been injured on the job more than once. “Uh, I’ve been doored. Aaaaand I flipped over my bike on Beacon Hill and skidded across an intersection,” he says matter-of-factly. “One time I didn’t have to go to the hospital, I just toughed it out. And the other time . . . shit . . . I think I paid it myself.”

Although he confesses that “occasionally I think about it, and it kind of bothers me, yeah,” Noel has no plans to buy insurance anytime soon. He doesn’t like the government telling him what to do. If the financial penalties accrued get out of hand, he might be spurred to action, he says. But until then, he’s just going to sit tight.

Which is too bad. Because his participation is vital to the success of this groundbreaking program — one that has the potential to momentously influence the national insurance debate. In the meantime, Noel will go to work each day uninsured, hoping danger doesn’t loom just around the block.

The price you pay
“Individuals who cannot show proof of health-insurance coverage by Dec. 31, 2007, will lose their personal-income-tax exemption when filing their 2007 income taxes,” reads the stern-sounding diktat on Effectively, that’s a $219 fine.

Which is not chump change, of course, but compared, say, with the $3000 settlements extracted by the RIAA from people caught sharing music files online, it’s a bargain. So it’s not hard to believe that Massachusetts citizens with a libertarian bent might be willing to pay it rather than get the required insurance, just to make a point about governmental intrusion.

But that ain’t all. “Failure to meet the requirement in 2008 will result in a fine for each month [emphasis added] the individual does not have coverage. The fine will equal 50 percent of the least-costly, available insurance premium that meets the standard for creditable coverage.” As the saying goes: it adds up.

One can understand how young adults who don’t have health insurance through work (or through their parents) might be upset about a mandate — signed into law in April 2006 by an enthusiastic Mitt Romney, after being passed 154 to 2 in the House and 37 to 0 in the Senate — that requires them to fork out cash for an insurance plan, lest they be compelled to fork out more cash in punishment.

“[I] know a lot of people who will more or less be financially crippled by this,” wrote one poster on Boston’s lemmingtrail message board ( this past spring, “mostly because they are young, make close to minimum wage, and have student-loan debt.”

Wrote another, “it is a fucking CRIME that we don’t have universal health care in this country, and we instead get stuck with these weird laws that try and compensate.”

Several posts later, however, a member spoke up: “I find it very hard to believe that any of the people in this thread complaining about inability to pay have a very good reason. If you can’t afford 100 bucks a month — maybe you need to buy a few less CDs or records.”

Affordable options
In fact, premiums might be even less than that. For people who earn 300 percent or less of the federal poverty level (FPL) — which translates to about $30,000 annually for individuals, and $62,000 for a family of four — there are an array of state-subsidized plans offered through Massachusetts’s Commonwealth Care plan, the low-income arm of the state’s Commonwealth Connector.

Enrollees who earn below 150 percent of the FPL ($15,324 annually) would pay no premium, but would be responsible for minimal co-payments for doctor visits and prescriptions.

Anyone who makes between 150 to 200 percent of the FPL ($15,325–$20,424) would pay $35 a month, along with some minimal co-pays. For people making between 200 and 250 percent of FPL ($20,425–$25,536), the premium rises to $70 or $75 per month (depending on whether the insured lives in or out of the Greater Boston area), and between 250 to 300 percent of FPL ($25,537–$30,636), the premium would be between $105 and $111 per month.

For people who make more than $30,636, the Commonwealth Connector, according to its Web site, offers the Commonwealth Choice plan, an unsubsidized program that nonetheless offers people access to “a variety of high-quality, affordable, private health-insurance plans,” whose premiums and co-pays depend on which of the four levels of coverage one chooses.

“We’ve seen tremendous response” since the law has gone into effect, says Debbie Gordon, senior marketing director at Network Health, one of the insurance programs participating in Commonwealth Care. “Network Health has over 50,000 Commonwealth Care members [enrolled] in just a year of the program. That’s about 40 percent of the market.”

Still, she recognizes that “insurance is not a fun thing,” especially for people who are “young and healthy, who don’t believe they were likely to become ill or need services.”

All the same, says Commonwealth Connector spokesman Dick Powers, no matter what one’s age, “we’re all one accident or one diagnosis away from tens of thousands of dollars in medical bills. We don’t know when that’s going to happen, but, at some point in our lives, it will. Hopefully later rather than sooner, but the fact is that unforeseen possibility is there. So that’s a reason for purchasing.”

He adds: “Doing so to avoid the tax penalty may not be the best reason, but I think it’s also a very good reason.”

Suspicious minds
Munching a ham sandwich in Winthrop Square, Logan, 30, a bike courier wearing mirrored shades atop a battered Sox cap, doesn’t think so. “Honestly, I don’t care,” he says. “I mean, more penalties on my taxes is just . . . more penalties on my taxes.”

Actually, when I mention the mandatory-insurance law to him, Logan confesses that it’s “the first I’ve heard of any of that.” And considering that he’s “been hit [by cars] a bunch,” he says insurance might not be a bad thing to look into — even if the fact that it’s now mandatory won’t be forcing his hand any time soon. Not anything that’s pressing on your mind? “Nope.” Just gonna get to it when you get to it? “Yep.”

A few blocks away, Harrison, 20, Caitlin, 21, and Eric, 20 — two bike messengers and their unemployed friend — are sitting cross-legged and smoking cigarettes. Strictly in the interest of journalistic inquiry, I ask them for ballpark figures on how much they make. “I have no guarantees, so what I take home is fairly up in the air,” says Harrison. Eric, who’s unemployed, says, “Nothing. Absolutely nothing.” Caitlin takes home “about $340 a week. So, close to $1500 a month. But still far below the necessary amount to be able to pay for health insurance.”

“It’s not like a big deal to me right now,” says Harrison. “I can’t really afford anything.”

Caitlin explains to her friends, neither of whom have heard of the Commonwealth Care plan, that a program does exist that’s subsidized for people like them. But her problem, she says, is “that it’s inaccessible. I had a guy call me, and I’ve, like, tried to call him back six or seven times with no response. The paperwork isn’t easily readable or guidable. They say they have a different mix of all the things you can get, but you don’t. And their gynecological offerings are really, really weak. Signing up for health insurance, like, if they made it a little bit easier, I would be happy to do. But I work 50- or 60-hour weeks, so I can’t afford to go home and fill out six packets of paperwork and wait six months to find out if I can go to the dentist.”

And it’s not as if she doesn’t want health insurance. “I got diagnosed with endometriosis, and I was bleeding and had to walk myself to the hospital because I couldn’t afford $500 for an ambulance,” she says. “That sucked! Ha ha! Like, fuck! I’ve been trying to sign up, but I call once a month and I get no response. It’s because they’re tied up because a billion other people are trying to do it. I’m gonna attempt to sign up, but it’s probably not gonna be by the 31st.”

Commonwealth Connector’s Powers admits that, “for folks who’ve never had insurance before, the process can certainly be daunting. But we have tried to make it as simple as possible. We’ve created a very user-friendly Web site. Folks just have to punch in a couple demographic points, and they can see what policies are available to them, what the cost is, and the services that are covered. We also have a toll-free line, 1-877-MA-ENROLL, that people can call up weekdays and clear up any confusion they might have. We think we do a good job of it.”

Powers also allows that many enrollees are signing up for Commonwealth Care “perhaps somewhat reluctantly.” He would not be wrong in that assumption.

“It’s kind of a ridiculous law to put into effect,” says Eric. “To penalize you on your taxes because you can’t afford something?”

Indeed, the suspicion exists in certain quarters that the law was passed as a sop to the all-powerful insurance lobby. “These are big companies that are making money off us no matter what,” says Caitlin. “It’s really inhumane.”

“Yeah, that’s what I was thinking,” says Harrison. “These companies are huge. Seems like a scam. Something about that makes me uncomfortable. It’s required that I have to pay these companies, these corporations? I dunno. Someone’s getting kickbacks.”

Never mind the common-sense argument that it’s simply smart living to get yourself covered. And forget the economic argument that uninsured patients who rely on the emergency room for care are a drain on the whole system. Many young people see sinister motives at work here — especially considering the mandate was powered through by our erstwhile governor at the same time he was gearing up to run for president. It gives him a substantive piece of policy to run on and it siphons money to his wealthy cronies. A win-win!

On the lemmingtrail board, one member penned a little playlet that would’ve made Bertolt Brecht weep with propagandist pride.

Mitt Romney: Hello Health Insurance Lobby!
HIL: Hello Mitt! We aren’t making enough money! Can you help!
Mitt: Sure can! I’m going to pass a law making it mandatory for everyone in the state I’m governing to carry health insurance. There’s an estimated 500,000 people not carrying insurance with you guys right now! Since monthly premiums are estimated to average around $380, that means you guys stand to make close to $200,000,000 more a month, all while we fuck the little guy!
Mitt: No problem! Do you think you could donate a bundle of money for my presidential campaign?

It’s not just bike messengers who are facing a financial dilemma here. Freelance writers, artists, musicians, bartenders, waitresses, retail workers, or almost anyone else who chooses to make a living on their own — everyone’s in the same boat. Asked what he would tell an impoverished working twentysomething who’s suspicious of the new law, Powers laughs. “I think I was one of those, once.”

Basically, he says, getting insured just makes sense. “We’re all better off with the security of a good health-insurance plan.”

Also, not to put too fine a point on it, a law is a law. Car insurance is mandatory. And now so is this. If you don’t want to be docked that $219 exemption from your next tax return, you have to sign up. In order to be enrolled by December 31, people should purchase plans by November 15. Powers points out that “With most plans, the effective date is the first of the following month. So if you sign up by the 15th of November, we can guarantee your coverage will be effective the first of December, which would keep you in compliance with the law. If it’s after that date, chances are your coverage won’t be effective until the first of January.”

Despite suspecting ulterior motives, despite bristling at being told what to do and what to pay by a faceless bureaucracy, Harrison, the pierced bike messenger with a faded black X scrawled in marker on the back of his hand, does recognize the importance of insurance.

He got doored riding his bike in March. He wasn’t hurt too bad, he says, but “even though I was, like, ‘No, I don’t need an ambulance, I’m fine,’ they called an ambulance. That’s, what, like $500? $700? That’s a lot to pay for a ride. I can’t afford that out of pocket! But I’m still getting calls [from collection agencies]. I can’t pay it, so I just let it slide and slide and slide. I’ve already had it go to collection. There’s just nothing I can do about it.”

So, despite not being familiar with the Commonwealth Care program, despite — not because of — the fact that he’s being forced to, Harrison says he’s going to start shopping for an insurance plan. “I didn’t know much about it. But I’ll look into it now.”




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