This month, we’re focusing on the stories of several New Yorkers who are dealing with affordability issues on the Marketplace/Exchange. Although the New York Marketplace is one of the most competitive and robust in the country, there are still serious problems with the cost of insurance and health care. Premiums are too high, as are deductibles; in fact, deductibles are so high they discourage use of the health care system. Those making below $24,000 per year get comprehensive coverage for $20/month, but those making $25,000 per year have to pay over $400 per month for the same standard of coverage.
Those who happen to have a good year and make more than $48,000 must pay full cost for coverage, which in NYC ranges from $420/month to $1600/ month. That’s approx. 10% of their income (at least), whereas those making $24,000/year pay just 1% of their income for premiums.
These are problems that affect tens of thousands of people in our community. Here are their stories:
Sally*:
Sally is a 32-year-old actress who was on the Essential Plan in 2016, which allowed her to pay $20/month for very comprehensive coverage with no deductibles. When she got married, the Exchange asked her to re-estimate her household income, which now included her husband. This made her no longer eligible for the Essential Plan. She and her husband then had to pay approx. $400/month with a $4,000 per person deductible. The following year, her husband made more money; their updated combined household income of $69,000/year made them ineligible for any assistance at all. The lowest cost plan for the 2 of them was $841/ month with a $4000 per person deductible. Other than preventive screenings, they would have to pay for everything out of pocket up to $4000, in addition to their $841/month premium. They decided this was a raw deal, and are now uninsured. As Sally said, “we are making more money than we ever have by working our butts off, but we can’t afford anything. We want to start a family. But that isn't even a discussion that's on the table right now due to the healthcare situation.”
Jessica*:
Jessica is a 62-year-old single actress who lives in New York City and supplements her acting work with a job as a freelance consultant. Since the Affordable Care Act was passed 8 years ago, she has had health care coverage via 6 different insurance companies, 2 of which no longer exist. Her income fluctuates dramatically from year to year; one year she made $35,000 (making her eligible for reduced-cost insurance), and the next year she made double that (making her no longer eligible). She often has to change doctors when her insurer changes because they are no longer in her network. Right now she is slightly above the income limit for reduced-cost coverage and is paying full cost ($450/month) for her Bronze plan, with a $4000 deductible. If there was premium assistance for people in her income range, she says “I would be less concerned about my monthly nut and audition more, and take more acting classes. It’s kept me from doing what I love. And it makes me go to the doc less than I should. I should have insurance when I need it. It’s exhausting and disheartening.”
Kristin*:
Kristin is a 29-year-old dance instructor who is married and lives in Harlem. She was covered by the Essential Plan in 2017, but when her income increased, she was offered subsidized coverage instead. The cheapest plan she could find was $275/month for herself and her spouse. Copays for basic primary and specialty care were much higher, and mental health services were subject to a large deductible. As Kristin said, “I am so upset with the health care system. They have made us jump through hoops to get lesser insurance. I can’t even begin to think of all the money we’ve lost on a health insurance that we can barely use, due to the high copays.”
Jason*:
Jason is a 56-year-old musical theater teacher, singer and composer who lives in Brooklyn. Like many in the industry, he is an independent contractor and doesn’t get paid if he gets sick and has to cancel a teaching job. He made a couple thousand dollars too much to qualify for the Essential Plan this year. Though the premium for the plan he’s on now isn't much more expensive than the Essential Plan, it does have a deductible of $4,000. Jason said, “I was recently concerned I might have kidney stones; on my new plan, a doctor’s visit, an ultrasound and a bit of lab work came to over $500, which I had to pay out of pocket. With the Essential Plan, I felt I could get things checked if I was worried, without having to worry whether I could afford it or not. After seeing this bill, I'm going to be less likely to get things checked, unless it seems really serious, because I can't afford it.”
These issues are solvable. The Artists Health Insurance Resource Center recommends that New York legislators do the following: 1. Increase eligibility for the Essential Plan to those making up to $30,000/year. This would significantly reduce costs for over 116,000 New Yorkers. 2. Expand premium assistance to those making up to $72,000/year. This could alleviate the burden on approximately 41,000 people.
You can help make this happen, but time is of the essence! The New York State budget is due by April 1, and legislators need to set aside money for these programs. Please contact your state assemblyperson and senator (you can find contact information at this website before April 1 and tell them we need: 1. An Essential Plan that covers those making up to $30,000/year; 2. Premium assistance for those making between $48,000-$72,000/year.
Thank you!
Yours in good health,
Renata Marinaro, LMSW
National Director of Health Services
*Names changed for privacy
Do you work in performing arts and entertainment and have questions about health insurance? The Actors Fund provides assistance nationally. Contact our regional office closest to you to speak to a counselor.
New York City
917.281.5975
Los Angeles
855.491.3357
Don’t forget to use the resources section of our website. It contains tools to help you make decisions about your health insurance, including new online tutorials on how to choose providers and how to read an Explanation of Benefits. In addition, you’ll find an updated Stage Managers National Health Directory, our national online directory of health care providers recommended by industry professionals that can be used by theaters and touring companies. For these resources and more, visit actorsfund.org/HealthServices. You can also find out more about enrollment assistance and upcoming health insurance seminars near you!