MEXICO, Mo. – Sher-rÈ Bird, 30, doesn’t see much point in buying health insurance.
“Why pay for insurance you’re not going to use?” said Bird, who waits tables at a popular diner on the courthouse square here, about 120 miles west of St. Louis. “I don’t go to the doctor that often.”
Her attitude foretells the challenge faced by the national campaign that kicks off today to get the uninsured to use new online marketplaces to buy health plans.
The interactive websites are set to launch at 7 a.m. today, even if the federal government is partially shut down due to the ongoing fight in Washington over the health care law.
Sick and older people who lack affordable health care options are likely to flock to the insurance plans, which for the first time cannot exclude people based on pre-existing health conditions.
But for the marketplaces to succeed, plenty of healthy, young adults must participate. A pool made up primarily of people with medical problems would drive up the premiums.
So Bird and other 18- to 34-year-olds are likely to be bombarded with pleas to check out the options.
Through enrollment events, social media, targeted ads and mobile apps, the message will go out to young adults that: a) you may owe a penalty if you don’t buy insurance; b) you may be eligible for federal tax credits to pay for a health plan; and c) you’re not invincible.
The big unknown — for young adults and other consumers alike — has been how much the policies will cost. That question will finally be answered today when the plans are unveiled on the healthcare.gov website in the 27 states with federally managed insurance exchanges.
Julie Brookhart, a spokeswoman for the Centers for Medicare and Medicaid Services, said the exchanges will open “with full functionality … and consumers will finally be able to shop and enroll in quality, affordable health coverage….We have worked to ensure consumers will have a wide range of ways to sign up for health coverage this fall, including online, over the phone or in person.”
Beginning next year, most people will be required to carry health insurance or pay a penalty. The fine is $95 in the first year, or 1 percent of taxable income, whichever is greater. The penalties will rise in subsequent years.
While word about the penalties seems to be getting out, polls have shown that many consumers don’t know about the exchange. Three-fourths of the uninsured who were surveyed last month by the Kaiser Family Foundation were unaware the marketplace was about to open.
Count Bird, of Mexico, in that group. “I’m gonna get fined if I don’t” buy insurance, she said last week as she rested after the lunch crowd eased at the Jackson Street Diner. “To me, that’s pretty crappy.”
In addition to working three days a week at the restaurant, she puts in two days a week at an agency that helps businesses line up temporary employees. Neither of her jobs offers health insurance.
She had a medical visit scheduled the day she was interviewed, to see about a severe abscess on her finger. But Bird said a charity care program would help cover that.
She said she doesn’t have room in her family budget for insurance that would likely run more than $300 a month, compared to $40 a year if she only has to pay for one doctor’s visit.
“Whenever you’re on a budget, your budget gets tighter when you have to buy something you’re not going to use,” Bird said.
Advocates for the health exchange will try to respond to precisely that sentiment. For a peek at the message, take a look at a video by Jason Girouard, of Brimfield, Mass., who won $1,500 in the Health and Human Services Department’s Healthy Young America video contest for an entry titled: “We are not invincible, we are human.”
In Girouard’s video, the hero appears in a red mask and cape to proclaim himself “king of the world.”
Then he tumbles and breaks his arm, an injury that would cost him $8,000 without insurance and which provides an example of the high rate of emergency-related visits experienced by young people, according to the video.
The contest — which is taking online votes now for additional prizewinners — was overseen by a Washington-based group called Young Invincibles. The name is a tongue-in-cheek takeoff on the popular assertion that the young spurn insurance because they don’t think they need it.
“That’s the myth, that all young people think they’re healthy and don’t need health insurance,” said Brian Burrell, regional manager for Young Invincibles.
In fact, cost is a bigger reason that about a fourth of 18- to 34-year-olds in Missouri are uninsured, he said.
Young Invincibles, which was founded by Georgetown law students in 2009, received $100,000 from the Missouri Foundation for Health to handle “outreach” to young Missourians.
The pitch, which will hone in on students at community colleges, is that most young people enrolling in plans through the exchange are likely to be eligible for tax credits that will lower their monthly premiums. The tax credits will go to single people earning up to $46,000 or a family of four making up to $94,000.
Young adults, who have lower median incomes, “will be receiving tax credits at a higher rate than the general population,” Burrell said.
One study found the price for a 21-year-old buying a mid-range policy averaged about $270 a month, before government subsidies kicked in. That study, by Avalere Health, looked at 11 states and Washington.
For adults under age 30 and on a budget, another option is a catastrophic plan, though it has disadvantages. These plans require high deductibles of more than $6,000. Also, federal subsidies cannot be used to help pay premiums under that option.
“It’s better than having no health insurance. But we want to make sure people are getting educated that there are a lot of out-of-pocket costs” with a catastrophic plan, Burrell said.
For the uninsured, unexpected accidents can take a financial toll. Burrell said he broke his pinkie playing in a recreational softball league, an injury that would have cost $7,500 to $10,000 if he hadn’t had insurance.
The Affordable Care Act has already resulted in more insured young adults, because it allows them to stay on their parents’ insurance plans until they turn 26. The federal government says 55,000 young adults in Missouri have gained coverage this way.
The law’s critics, led by Lt. Gov. Peter Kinder, are urging consumers to use caution in buying policies on the exchange.
Kinder, who calls the Affordable Care Act “deeply flawed,” made headlines last week for encouraging people not to sign up. But his spokesman, Jay Eastlick, said Monday that Kinder is “not encouraging any kind of boycott of the health care exchange. He advises people to just know what they’re signing up for.”
So far, federal officials have provided only sketchy details about the participation of insurance companies and their particular product offerings.
According to the Department of Health and Human Services, at least two insurers will be offering products in the exchange in Missouri. Each of the state’s 10 insurance rating districts, including the St. Louis area, has two insurers participating, federal officials say.
In the St. Louis area, Anthem Blue Cross Blue Shield in Missouri and Coventry Health Care Inc., which is based in Bethesda, Md., plan to participate.
In the Kansas City area, Coventry again will be participating, along with Blue Cross Blue Shield of Kansas City. Information about the state’s other rating areas has not yet been released.
Insurance counselors, called “navigators,” are supposed to be available at various health care centers and social service organizations to guide consumers through the application process. But the training and licensing process has hit a few bumps.
So far, the state has licensed about 80 counselors, and about half of those licenses were issued Monday. As of late Monday, the navigators had not yet been told which policies would be available on the exchange.
The initial enrollment period will run through the end of March, though people who want coverage effective Jan. 1 must sign up by Dec. 15.
Jeremy Milarsky, one of the first licensed Missouri navigators, said he will be ready. Milarsky manages navigators at Primaris Healthcare Business Solutions, which received $1 million in federal funds for counseling by 11 organizations around the state.
He said he had two appointments scheduled with consumers in Columbia, Mo., on Tuesday.
Jim Doyle of the Post-Dispatch contributed to this report.