Connections: Health Insurance Now

The goal is to see that all Americans have basic coverage, which is long overdue

    The East Hampton Star has offered, and helped pay for, its employees’ health insurance for as long as anyone can remember. As premiums have soared, what it has cost to do so has increased every year, as has the amount employees pay toward their coverage. Nevertheless, I am proud that, as a small company in an industry undergoing its own changes, The Star’s contributions to employees’ health insurance have stayed at the same level since 2007.

    This year, with the provisions of the Affordable Care Act in effect, we have turned to Susan Morrissey of the eponymous insurance agency in Sag Harbor to help us tread the waters. She has recommended chang­ing our insurer, and, to our surprise, the policies, which go into effect May 1, will provide more coverage at lower cost. What’s not to like about that? To understand why this is possible, you have to consider the expansion of services in the act’s basic provisions.

    Most of us know that insurance companies can no longer use pre-existing conditions as a reason to deny coverage or cancel coverage if you get sick. They cannot charge women more than men for the same plan, and annual or lifetime limits are no longer allowed. Young adults have been able to stay on their parents’ plans until they are 26 for some time, and they are now able to obtain health insurance as individuals through their parents’ employers until they are 29 under certain circumstances.

    What are really new are the many preventive services, categorized as wellness care, which now must be provided without cost, along with immunizations and H.I.V. screening. The Affordable Care Act also requires policies to cover mental health services for the first time, as well as annual pediatric visits to dentists and eye doctors and a pair of eyeglasses. Unfortunately the Obama administration, which has been besieged by criticism, didn’t do much of a job in broadcasting these improvements.

    The goal is to see that all Americans have basic coverage, which is long overdue. In New York State alone until this year, 1.1 million people were reported to have gone without insurance. It is not yet known what that number will be now that 7.1 million people throughout the country have signed up. Nor is it certain that everyone who has done so will pay up when premiums come due. But the Obama administration has every reason to be gratified by participation in the so-called exchanges, or marketplaces, so far, after such a terribly flawed start.

    The most troublesome thing about the health insurance provided to individuals through the New York State exchanges is that, unlike the policies obtained through companies like The Star from such private insurers as Oxford or Aetna,  the network of doctors and hospitals to which patients can go  is extremely limited. Even Stony Brook University Hospital, where many East End residents are treated when they are seriously ill, is off-limits.

    Something is very wrong with this, and who knows how long it will take  to correct, if ever. Premiums for those buying reasonably good individual policies used to average $1,100 or $1,200 a month, but lowered premiums through the state will backfire if patients are unable to continue treatment where they have had it without exorbitant bills.

    Those on The Star’s policies who remain relatively healthy, and who see their doctors or buy prescription drugs routinely, are indeed going to benefit from lower premiums and modest co-insurance payments in the year ahead. But there is more to the story: Those who require more expensive care or hospital stays will for the first time have deductibles to meet. This is also the case for those who qualify for premium subsidies through the exchanges.

    It’s all so complicated that a whole line of work seems to be growing up: so-called health insurance “navigators” online, who are supposed to help people understand what is and isn’t possible for them, and what it will cost. We are lucky at The Star to be able to rely on a professional like Ms. Morrissey.