For too many New Yorkers, even the new, lower rates of health insurance are just Too Damn High.
New Yorkers who don't have health insurance by March 31, when the exchange closes until the fall, will face an introductory fine of $95 per person or 1% of their annual income -- whichever is more -- when paying their 2014 taxes.
Despite lower rates and better plans offered on the state's health exchange, many money-pressed New Yorkers lament they just can't afford the plans available to them, or are still debating how much they can pay.
Young New Yorkers who are often burdened with high housing costs, student loan debt and unreliable incomes in the new "contract economy" find a robust new monthly expense especially unwelcome.
"I'll probably just take the hit," and pay the fine, said Brandon Adams, 25, a dancer who lives between Harlem and North Hollywood, Calif. When he was dancing in "The Lion King" and on other Broadway shows he could afford union-offered insurance, but his income is more tenuous now that he's nurturing an acting career.
"I don't know what I can afford," he said, because he never knows how much he'll earn. He relies instead "on prayer -- and the hope I don't get hurt. Trust me, it's scary."
The Affordable Care Act affects a huge number of New Yorkers who do not have employer-sponsored health insurance. According to the 2012 American Community Survey, 308,187 city civilians between 18 and 64 who worked less than full time had no health insurance. More surprisingly, another 438,947 who worked full time also reported having no coverage.
"I'm aware of the deadline and I am worried -- but I have no idea what I'm going to do," said Myrna Mangual, 42, a merchandiser and sales person who lives in the South Bronx. While her children are covered under a state program, Mangual hasn't been insured since her husband, a truck driver, lost his last benefit-bearing job and both wound up "naked" in insurance parlance.
Last summer, Mangual, whose mother died of breast cancer, found a lump in her breast and she was treated at Lincoln Hospital (the lump turned out to be benign) for minimal expense. She explored obtaining insurance after her cancer scare, but was further terrified by the $500 monthly premium quote she received. "I'll have to rebudget every single dollar that comes into the house," should she enroll, she said.
New York State's health exchange website (nystateofhealth.ny.gov) has been a symphony of efficiency compared to the federal site, enrolling 717,207 people as of Monday, convincing officials that New York state will beat its enrollment goal of 1.1 million by the end of 2016. Another 338,724 people have completed online applications but have not yet selected a plan. A year-end report revealed that 37% of all enrollees came from NYC and that 30% of enrollees statewide were under 35 -- the "young invincibles" that government officials have said are integral to the success of the Affordable Care Act.
More than 70% who signed up did not have insurance at the time of enrollment, and navigators working in area churches and community organizations say they are swamped with procrastinators who waited until the last minute to sign up.
The Seedco navigator program in the Flatiron District has seen a surge of interest in the last couple weeks, but there are some applicants "who can't afford it," said Program Director Mauricio Garcia. "It's a balancing act," he explained, noting that people "are looking for ways to manage that new cost or expense in their life."
Many New Yorkers complain that housing costs gobble up so much of their paychecks, their household budgets just don't permit a substantial new expense. (A report this month from the state Comptroller confirmed this hardship, noting that 44.4% of Manhattanites and 57.6% of Bronx residents spend more than 30% of their household income on housing, with percentages from the other boroughs falling in between those of Manhattan and the Bronx.)
John Ford, 29, a personal trainer and merchandising contract worker who lives in Hell's Kitchen, has been saving money for months in anticipation of enrolling, but has yet to pull the trigger on buying the catastrophic plan for $186.20 a month with high deductibles.
He believes everyone should have insurance, but as a contract worker is also concerned about digging himself into a financial pit. "People say you need insurance in case something happens, but something could go wrong with my job and then I'll be obliged to pay premiums when I'm not being paid," he explained.
Sabina Ciari, 27, signed up "but not on purpose" and hopes she has found a happy ending to her quest for care. A painful dental problem drove the Prospect Heights resident to a medical clinic in Harlem where she was directed to an "amazing" social worker who punched her income information into nystateofhealth.ny.gov and found that Ciari's qualified to be one of the 374,312 recent enrollees eligible for Medicaid.
Medicaid asked Ciari, a freelance scenic artist, for additional pay stubs, which she provided. She's still waiting for confirmation of enrollment and for a Medicaid card.
"I was very happy," to discover she qualified for Medicaid, said Ciari, as the cheap plans had high deductibles and provided scant coverage. "Even $100 is really a lot for me."
Rates may seem expensive to New Yorkers, "but they're still 53% less than if they obtained them last year on the direct pay market," said Bill Schwarz, public information director for the New York State Health Department.
It's unknown how many enrollees have followed through and actually paid their premiums, Schwarz said.
"The Affordable Care Act didn't say health care would be free, but there are now more plans and better quality plans available than there used to be," said Schwarz.
BY THE NUMBERS
People in New York State who have completed exchange applications
People who have actually enrolled and selected a plan
People who are now enrolled in Medicaid
People who enrolled in a private insurance plan
Source: New York State Department of Health
with Shawn McCreesh