Mind the Gap

An article by Michelle Andrews in the New York Times (May 31) reported that many employers are unwilling to extend health coverage up to age 26 for the adult children of their employee’s until January 2011, when the federal law requires it. Insurers, eager to sell the add-on, had led customers to think it would be available as early as September. But few employers are willing to take on an increase in the steep cost of employee benefits. Neither the insurers’ nor the employers’ position is surprising.

Yet as I read the story of what one family is planning to do—spend more than $500 a month for the rest of this calendar year—just to purchase health insurance for their young adult son, I recalled my own blithe years without health insurance.
As a young college graduate living on my own, I worked for two years at a local bank, which paid for my health insurance. The employee benefits package also contained a life insurance policy—my first. (Naming a beneficiary had seemed like a rite of passage, a step deeper into adulthood, after getting a Social Security card, going out of state to university as a teenager and renting my first apartment.)


But I soon left that bank job behind to travel in Europe, where for more than a year I took various temporary jobs. And after returning to the U.S., I eventually made my home at Koinonia Farm in Americus, Georgia, where I lived for nearly five years, working in a Christian community for subsistence pay. The lack of coverage extended into the early part of my graduate education as well. Working part-time and studying part-time meant that I fell through the cracks, covered neither as an employee nor as a student. In all this time—nearly a decade—I bought no insurance of any kind, nor did I have much money to spend had I wanted insurance. That changed after I became a full-time graduate student and took campus jobs at Notre Dame, then Harvard. But there were summers without coverage and a gap between graduation and when the benefits of my New York job kicked in again.

Who cared? I was young and healthy.

Not once during those years did I consider buying health insurance. Had I done so, I might have told myself that statistics are on the side of the young; that risk is minimal. As it was, I lucked out.
In the years since, however, I have marveled at my youthful lack of foresight and prudence. Why did I assume that I was impervious to the misfortunes that befell others, like accidents and illnesses? Answer: Youth is like that. Nothing and no one prodded me to think cautiously about the future. Or to consider that I might bear some responsibility to pay for my own health care now were I to need some later. Like millions of other young Americans, I took enormous risks with my health. But that will begin to change soon, and it is a change I applaud.
In my blogs and other writings for America, I have strongly supported health care reform. And if you have followed my blogs, you know that I would have preferred a “public option” to increase competition and keep coverage as low as possible. Now that the health care bill has passed, though, I am happy it will address this particular issue, among others. The new law will require all adults, including young adults, to buy health coverage or pay a penalty. Most Americans will continue to be covered through employer-sponsored plans. But young people who have been opting out, will have to pay a penalty to do so in the future. Part of the reasoning behind it is that other taxpayers already pay for the treatment of the 35 million uninsured Americans. It’s only fair that every adult who can contribute something. Young people also pay lower premiums, which are based on age, but their contribution increases the general pool, which lowers the premiums all pay.

In my view, it is good for society to confront young people with the very real possibility of illness and accident in this way, to help them face their own mortality, which is a vital part of maturation. And it is good to cultivate among the public, beginning with the young, the habit of paying up front and regularly for goods that benefit us all—goods like health care. We are generationally interdependent, a fact this practice makes clear.

Finally, the law will provide ways for individuals of working age to find affordable coverage whenever they are between jobs or unemployed. After a tendentious, yearlong battle in Congress, the law will soon provide the possibility of continuous, affordable coverage.

Karen Sue Smith

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john thoams
8 years 1 month ago
Thanks for given such a nice article, it is very nice and i like it so much.
Van Insurance Broker
we vnornm
8 years 7 months ago
Glad you are mentioning this. I, too, went without insurance years ago, and even more scary, my father did this between the ages of 62-65.
I think if there had been health insurance during Pope Leo's time, he would have addressed this, or maybe he did and I am ignorant. With all the riches of our nation, we should be able to reallocate so that all receive care and treatment. Justice demands this.  Being a consumer of health services, a provider, and father of a disabled son on Medicaid, I have some observations which cross party line.
At one level, I think we are not paying ENOUGH into health care. The medical advances of the past century are truly one of God's great gifts. Were it not for back surgery 25 years ago, I'd be disabled. I'm sure many or most people have a similar story. At that time, I was disabled and if someone had said to me, "Is it worth a million dollars for you to heal", I certainly would have indentured myself if there were no other option. Too many people who have huge houses, two houses, European vacations, Hummers to drive on the weekend, complain about the $100 co-pay for an emergency room visit that saved their life, or for the extra thousand dollars over insurance costs paid for a complex surgery. Politically, this if course leads us into the direction of a Christian socialism of sorts, which I know JPII supported as he saw the material excesses of our culture.
In a totally different area, I am afraid that heaping more restrictions on doctors or their incomes may ultimately lower our quality of care. Many of our best doctors-the neurosurgeons, OB/gyns, oncologists, are person of high drive and competitive Type A nature. A capitalist economy reinforces their ability to postpone wages through 6 or so years of med school/residency and then  3-6+ years of specialization because of the prize ahead Many young people are not going into these life saving specialities because of what they perceive, perhaps very accurately, as too much government interference or not enough earning potential in the future. I believe a neurosurgeon who holds brain tissue in his hands, or that OB/gyn delivering a high-risk baby (a very pro-life endeavor, by the way) deserves a salary at a different level than the rest of us.
To save costs, the new health care system will utilize more physicians assistants, nurse mid-wifes, LPNs, RNs, and nurse specialists. In the millions of cases handled and decisions made, they will miss tricky diagnoses or make decisions a qualified m.d. specialist will handle differently, and there will be lives lost because we have regressed from excellent/outstanding care to merely adequate.So this becomes a pro-life issue for me. We have to find a way to pay for and keep these life-saving professionals in what I consider a ministry.
Tort reform is needed. We have seen in the Church what an inappropriate use of the legal system can do. How many men want to be priests? How many priests want to coach the CYO? Yes, most accusations of abuse are true, but the number and possibility of a life-ruining false accusation is one factor keeping men from the priesthood. High-risk specialists in neurosurgery, OB/gyn, and orthopedics face a similar situation in terms of spurious and false malpractice allegations and their numbers are dwindling.
Of course, there is over-billing by specialists, wasted expense on tests, excessive administrative costs in insurance companies, etc. etc. But sometimes the thought of more government control over what has been a private system can put us in a place we don't want to be. Can the government promise us effective programs? Many who wait in line for food stamps or the SSI/SSD benefits, or those of us who watch postal employees saunter down the street while UPS and Fed-ex folks literally run to the door, will have doubts. We are told not to count on the social security system. So how do we know we can count on a government supported health care system?
I hope with good-will and necessary sacrifice on the part of many, the problems I describe can be addressed and handled in a just manner. Wonder what good Pope Leo would do? bvo
Tom Maher
8 years 7 months ago
Who can be surprised that employers do not want to have new significant per employee costs? One of the implication of these cost will be less employemnt nationwide.

Does it make for good social policy for employers to pay for 26 year ofl "children" of employees? Wouldn't it make more sense to have someone over eighteen be considered an adult and find a job and pay for their own health care or otherwise indedpendent of their parents have health care?

This helth car eprovison threatens job creation. Europe has this problem where young people seeking jobs can not find them. People do not get jobs until their late twenties. What a young person needs most urgently is a job not social welfare schemes that reduce total employment.

One of the resons that oppostion toe new health care law is rising - now over 60% is becasue people such as employers are only now beginning to discovering the hugh burdens the new health care mandates will place on them.

Health care can not be the highest concern of most families and individuals but has been made so by government fiat. What about savings, owning a home or a car or other personal plans? Why should health care be the mandated highest priority especially among young people who need to start a career and family? Are we all meant to be nuns? Most people do not want to be take a vow of celibracy and poverty. But effectively government with the the encouragement of the the church are imposing these obligations as mandates. This is terrible social policy when government mandates such rigid control over so much of an individuals private life and personal finances and choices.

Help repeal this terrible law. Sign the repeal petition at www.revereamerica.org
Jim McCrea
8 years 7 months ago
Tom:  you said:  "Health care can not be the highest concern of most families and individuals."
Tell that to parents who have a child, irrespective of age, with a chronic illness.  Tell that to an unemployed wage earner with a family who cannot afford (or has run out of) COBRA.  Tell that to people who are getting older and starting to experience "health issues" that they never thought could happen to them.
Beth Cioffoletti
8 years 7 months ago
Having been through unemployment, COBRA, and breast cancer the last 2 1/2 years, I can tell you that if an employer offers health insurance it will be so expensive (more than $1500 per month the employee must pay) that you are better off buying private health insurance if you can find it, or continuting the COBRA until it runs out.
In other words, if you do find a job, don't expect health insurance anymore.
National Health Care can't come soon enough.  It is not a terrible law, it is a Godsend.  If you don't need it now, your children will be sure to need it in time.  Just who are these people who want to repeal it?  People who have theirs, or people who are on Medicare?
8 years 7 months ago
It can be easy to blame companies for not offering new heath care mandates in advance of requirements. Our company just went through a renewal - with a rate increase for the same insurance of 47%. Our focus wasn't to see if we could increase the costs to our company and it's employees even more then required.
As you may know,the law will require companies to include the 19-26 year old adults in '' family'' coverage - thus increasing the costs of medical insurance to all families. Further young adults who have jobs and medical coverage can ''opt out'' and get a payment from their new employer while mom and dad continue to pay the same family coverage and cover them. Reports are  that this loophole is already being widely abused.
Like everything else in this heath 'reform' plan, costs will go up from new mandates but the other promise, real cost savings ,( not fake government savings from moving a billions from the left hand to the right hand) are non existent. No cross state competition, no tort reform, no allowing smaller companies to group together and bid for services together.
Tom Maher
8 years 7 months ago
What a cruel joke this new health care law is. People actually believe that this monsterously large govermnment program is going to save and surstain them over the years. Yet this very article discovers "gaps" in coverage in the law that is less than three months old. Hundreds of other surprises await them?

The 2500 page law was by design never read by anyone until after its passage. Wait to people discover the more serious surprises in the law such as the many burdensome mandates imposed on individuals and companies without public discussion or debate even in Congress.

Effectively this law is a blank-check for health care spending without limit. If you like governemnt deficits you'll love this law. Politicians have architected a unsustainable system of limitless payments for everything including abortions. Not only will insurance premiums cost not go down they will rise rapidly as has happened in Massachusetts the states that tried this failed individual mandate scheme.

Msssachusetts enacted a mandate on all individuals to purchase health care insurance or be fined. The hope was this much larger pool of payers would reduce health care preimium costs for all. The opposit has happened. Health care preimiums rose each year more than ever becasue the government contiued mandated unlimited payments on everything and finds new formally elective categories to pay for. Health care insurance is now run by a government controlled by free-pending politicians. Effectively the mandates takes from citiizens payments and redistributes this revenue based only on political considerations. The politicains are not responsible for new, ever-rising costs they create. Health care has become politicized in Massachusetts.

The double-digit increases in insurance preimiums can not be sustained. This costly system will drive the state into deficits as is happening now around the world from government open-ended funding pf costly social programs.

The federal government is now in the process of destroying our health care system. It is a cruel joke to beleive that governments can create better and cheaper health care.
we vnornm
8 years 7 months ago
For the 19-26 group......
Even 2 decades companies were taking on young employees with hopes of training them and keeping them...
This rarely occurs....somewhere there must be statistics, but it's common if not the norm now for persons in this age group to go from job-to-job....and not just for the dot.coms
So they need insurance. Even when you can get it on ajob you'll be at for two or three years, when you change jobs you have to go through the whole worry of pre-existing conditions, pregnancy waiting time,etc...
Yes, the devil is in the details, as pointed out in post #3 above. So let's acknowledge and work them out...
C'mon folks....these young persons will be funding our social security...we want them healthy and able to work   :-)
Beth Cioffoletti
8 years 7 months ago
thank you, Walter and Bill, for giving me some real dollar numbers to compare with, just so that I know that I'm in the same ballpark as everyone else. 
It's funny how you pay into insurance all your life, and most of us don't start needing medical care until the end.  The same with Social Security.  It feels somehow disingenous to be laying this all at the feet of our young people, but that's the way the system is set up, and has been set up. We depend on the young and healthy to carry the load for healthcare.
The truly are "intergenerationally interdependant", as Karen Smith points out in her post - the least we can do is make health insurance available and affordable for them.
Beth Cioffoletti
8 years 7 months ago
For those of you who are against National Health Care, who is providing your medical insurance, and how much does it cost you, out of pocket, each month?
(I've asked this a few times before, but no one has yet to answer.  I am genuinely interested since I am in search of a health care policy that is affordable.  What's the big secret?)
we vnornm
8 years 7 months ago
Just to answer the dollars question....for a single person at an employer who is self-insured...with about 1,000 employees
 Monthly premium is about $610 for a single person.
2-person premium about $1225. monthly
Family premium 1600. monthly.
If employer pays 85% of single premium employee contribution for a single person is about 92.
You can do the math on the others.
Sometimes the local Chamber of Commerce will offer group health insurance for its members. Usually costs about 300 bucks to join the Chamber. Then you can buy via their group plan. I would think free-lance writers can join Chambers, as well as many other small businesses.
Here is info about one of the top insurance companies:
Wonder if the entire US Catholic church could buy a group plan? Might have some clout with over 50,000,000 members! good way to evangelize :-)
best, bill
8 years 7 months ago
I suggest that all interested parties read the synopsis of the health care debate laid out by Sally Pipes during the 2008 campaign.  It is book in the form of a pdf and can be read easily on your computer.  Here is the link
The health care debate is far from over.  There may a law just passed but I do not think anyone believes this is the end of the debate especially as more realize how it actually works.  It does nothing to lower costs and this was the main complaint by most people.


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