With Affordable Care Act, Canceled Policies for New York ProfessionalsThe New York Times
http://www.nytimes.com/2013/12/14/nyregion/with-affordable-care-act-canceled-policies-for-new-york-professionals.html?hp&_r=0December 13, 2013
By ANEMONA HARTOCOLLIS
Many in New York’s professional and cultural elite have long supported President Obama’s health care plan. But now, to their surprise, thousands of writers, opera singers, music teachers, photographers, doctors, lawyers and others are learning that their health insurance plans are being canceled and they may have to pay more to get comparable coverage, if they can find it.
They are part of an unusual informal health insurance system that has developed in New York in which independent practitioners were able to get lower insurance rates through group plans, typically set up by their professional associations or chambers of commerce. That allowed them to avoid the sky-high rates in New York’s individual insurance market, historically among the most expensive in the country.
But under the Affordable Care Act, they will be treated as individuals, responsible for their own insurance policies. For many of them, that is likely to mean they will no longer have access to a wide network of doctors and a range of plans tailored to their needs. And many of them are finding that if they want to keep their premiums from rising, they will have to accept higher deductible and co-pay costs or inferior coverage.
“I couldn’t sleep because of it,” said Barbara Meinwald, a solo practitioner lawyer in Manhattan.
Ms. Meinwald, 61, has been paying $10,000 a year for her insurance through the New York City Bar. A broker told her that a new temporary plan with fewer doctors would cost $5,000 more, after factoring in the cost of her medications.
Ms. Meinwald also looked on the state’s health insurance exchange. But she said she found that those plans did not have a good choice of doctors, and that it was hard to even find out who the doctors were, and which hospitals were covered. “It’s like you’re blindfolded and you’re told that you have to buy something,” she said.
The people affected include not just writers, artists, doctors and the like, they said, but also independent tradespeople, like home builders or carpenters, who work on their own.
Some have received notices already; others, whose plans have not yet expired, will soon receive letters in the mail. It is unclear exactly how many New Yorkers are affected; according to state health officials, as many as 400,000 independent practitioners get health insurance through job-related group plans, but that number also includes people who receive coverage through their spouses’ employers.
The predicament is similar to that of millions of Americans who discovered this fall that their existing policies were being canceled because of the Affordable Care Act. The crescendo of outrage led to Mr. Obama’s offer to restore their policies, though some states that have their own exchanges, like California and New York, have said they will not do so.
But while those policies, by and large, had been canceled because they did not meet the law’s requirements for minimum coverage, many of the New York policies being canceled meet and often exceed the standards, brokers say. The rationale for disqualifying those policies, said Larry Levitt, a health policy expert at the Kaiser Family Foundation, was to prevent associations from selling insurance to healthy members who are needed to keep the new health exchanges financially viable.
Siphoning those people, Mr. Levitt said, would leave the pool of health exchange customers “smaller and disproportionately sicker,” and would drive up rates.
Alicia Hartinger, a spokeswoman for the Centers for Medicare and Medicaid Services, said independent practitioners “will generally have an equal level of protection in the individual market as they would have if they were buying in the small-group market.” She said the president’s offer to temporarily restore canceled polices applied to association coverage, if states and insurers agreed. New York has no plans to do so.
Donna Frescatore, executive director of New York State of Health, the state insurance exchange, said that on a positive note, about half of those affected would qualify for subsidized insurance under the new health exchange because they had incomes under 400 percent of the poverty level, about $46,000 for an individual.
But many professionals make too much money to qualify for the subsidies, and even if they are able to find comparably priced insurance, the new policies do not have the coverage they are accustomed to.
David Rubin, vice president of Teiget, the Entertainment Industry Group Insurance Trust, which had served as a broker for about 1,000 members of creative guilds, said a big complaint was that in New York City and much of the state, the new individual plans both on and off the exchange did not allow patients to go to doctors out of network. “All these people had these customized plans which are better than most of the things out there, and most of them are saving only a small amount of money,” he said.
Roy Lyons, managing director of Marsh U.S. Consumer, an insurance brokerage, said he had heard complaints from physicians, lawyers, pharmacists and optometrists. “At first they think it’s the bar association making the decision or the insurance company doing it,” he said. “We have to explain that this is the Affordable Care Act; that’s what was put into law. Once they understand, they’re less emotional, but they’re not happy with it.”
Among those affected are members of the Authors Guild; the Advertising Photographers of America; the Suzuki Association of the Americas, a music teachers organization; the Society of Children’s Book Writers and Illustrators; the New York City Bar Association; and the New York County Medical Society. (One group, the Freelancers Union, negotiated a one-year exemption with the state. )
“One of the reasons to join a society is to get health insurance,” said Dr. Paul N. Orloff, president of the New York County Medical Society. Even doctors pay a lot for coverage, he said, because the days of trading medical care with colleagues are long gone. “In the old days, professional courtesy was the norm,” he said.
The medical society has not yet formally notified its solo practitioners, because their insurance plans do not expire until April. But those letters will be going out soon, officials said.
It is not lost on many of the professionals that they are exactly the sort of people – liberal, concerned with social justice – who supported the Obama health plan in the first place. Ms. Meinwald, the lawyer, said she was a lifelong Democrat who still supported better health care for all, but had she known what was in store for her, she would have voted for Mitt Romney.
It is an uncomfortable position for many members of the creative classes to be in. “We are the Obama people,” said Camille Sweeney, a New York writer and member of the Authors Guild. Her insurance is being canceled, and she is dismayed that neither her pediatrician nor her general practitioner appears to be on the exchange plans. What to do has become a hot topic on Facebook and at dinner parties frequented by her fellow writers and artists.
“I’m for it,” she said. “But what is the reality of it?”
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