This story continues the Gazette's coverage of the impact of health-care reform on West Virginia. For an overview, go here.
CHARLESTON, W.Va. -- On weekends, Tiffany Little, 25, serves lattés and scones at Charleston's Taylor Books. During the week, she works with disabled people. Zion Godfrey, 25, is looking for a job as a researcher in Middle Eastern studies when he isn't running the register at the bookstore.Like 73,000 other West Virginians between 19 and 29, they have no health insurance. "Insurance is completely unaffordable to me now," Godfrey said. "I have two degrees, but I just don't go to the doctor."Most of the 14 part-timers at the bookstore are in school, looking for jobs in their field, or making extra money. "Thank goodness for Taylor Books," Godfrey said.
Part-time clerk Chris Rodgers, 21, will lose insurance coverage as soon as he graduates from West Virginia State University. "I don't worry too much about it," he said. "I just hope nothing happens."Taylor's customer John Michael of Asheville, N.C., used to feel that way. At 30, the Roane County native has his own Internet business, but no insurance. Recently, his wife developed a brain aneurysm, he said. "I used to think, well, I'm young, so maybe I won't need insurance," he said, "but now we're talking with the hospital about charity care, and we're not sure what will happen."Thirty percent of young West Virginians between 19 and 29 have no health insurance, the largest percentage of any age group, according to advocacy group Families USA. Many work part time, go to school or have low-wage second jobs.If Congress passes a health reform law, they will all be required to have insurance or pay a penalty. "I don't think I can afford the insurance," Rodgers said.Under the bills on the table, four new options would make insurance more affordable for anyone who makes less than $43,000 per year:If they are over 18 and make less than $14,400, as many students do, they would be eligible for Medicaid insurance. Under present law, West Virginians over 18 are not eligible for Medicaid unless they make less than $3,700 per year, one of the lowest income limits in the nation.If they make between $14,400 and $43,000, they could get subsidies for their insurance premiums.Insurance companies must let them stay on their parents' insurance as dependents until they are 26 or 27, with their parents' OK. That takes effect as soon as the law passes.The Senate bill includes a "young invincible" provision that lets young people buy low-cost catastrophic insurance with a high deductible to protect them against financial disaster in case they need high-cost medical care.The subsidies and Medicaid expansion would start in 2013 or 2014, depending on what date ends up in the final bill.A House-Senate conference committee, including Sen. Jay Rockefeller, D-W.Va., will hash out the final proposal soon.
Tiffany Little urges them to remember the young people. "I have two jobs, and I have Medicare taken out of both my checks, but I can't get Medicare," she said. "I want to help the seniors, but I want the younger to be able to get care when we need it too."She looked over a schedule of subsidized premiums that would be available to a single person under the Senate bill.For a policy that ordinarily costs $3,500, a person earning $15,000 would pay $622 a year.A person who makes $20,000 would pay $1,153.If a person earns $30,000, he or she would pay $2,699.At $35,000, a person would pay $3,430.
"I could actually do this, if that's what it ends up being," she said.Customer Chandler Runyon, 24, had the same reaction. "A lot of West Virginians can't come close to affording insurance now," he said. "That, they definitely could afford."The House and Senate bills both require that insurance include doctor visits, hospitalization, maternity care, prescription drugs and lab work, chronic disease management and pediatric care. "That's solid stuff," Runyon said.The bills also contain $10 billion to $14 billion to expand sliding-scale community health center services.Critics say that the bills will not control costs, and future generations will end up with much higher taxes. "That could happen, but it's guaranteed to happen if nothing is done," said Perry Bryant, director of West Virginians for Affordable Health Care. "The difference is, 31 million people get health care."Under the Senate bill, insurance companies can no longer charge older people more than three times what they charge younger people. That would raise the amount young people pay on paper, Bryant said, but the subsidies would limit what they actually pay.With the subsidies, people who make less than $27,000 would get a substantial discount, and the discounts grow more modest up to $43,000. People making more than $43,000 will pay market rates, but most likely not as much as they would have paid, he said."The number of people who can't pay their medical bills will drop dramatically under these bills," he said, "and that will lower the cost of health care for everyone.""It's all very complicated," Taylor Books owner Ann Saville said. "I get very attached to these young people and their dreams, and I wish I could give them all insurance, but I'd have to close if they made me. As it is, I'm getting up at 5 a.m. most mornings to make scones and soup to sell in the store, trying to keep it going."Under both bills, small businesses are not required to provide insurance, unless they have a payroll of $500,000 or more. "I wish they'd tell us these kinds of details," Saville said. "I see the politicians on TV beating their breasts and blustering, and I get so annoyed at them, I tune it all out."One other thing should appeal to young people who dream of starting their own business, Bryant said. "They will be able to get insurance that isn't tied to a job."The government will set up an Internet insurance exchange, through which individuals can join a pool with other individuals for collective buying power.About 25 percent of employees stay in jobs because their health insurance is tied to that job, according to a 2007 study in the Quarterly of Business Economics. "Once people can get good, affordable insurance on their own through the exchange, you'll see more business startups," Bryant said. "If that happens, this whole effort will help people follow their dreams, and that's worth a lot too."More young adult West Virginians are uninsured than any other age group
Age # uninsured % uninsured 0 - 18 44,000 10.5%19-29 73,300 29.9%30-49 84,200 17.2%50-64 40,300 11.9% Total
241,800 Source: Families USAWant to see how the subsidies would work?
Kaiser Family Foundation has a subsidy calculator at http://healthreform.kff.org/Reach Kate Long at firstname.lastname@example.org or 304-348-1798.