Sunday, May 20, 2018

Profiles in coverage: Tampa Bay residents weigh health insurance options

Jason Seibert, 31, Dunedin

Jason Seibert has nothing against doctors. He just thinks that, with certain exceptions, he doesn't need them.

The owner of Sublime Yoga in Dunedin practices yoga five days a week, skips fried and processed food, and practices "mindful eating."

He rarely gets stressed or sick. The last time he was injured — a strained wrist from his daily regimen of 200 pushups — he simply took a few weeks off.

He and wife, Jade, had a water birth, with Seibert delivering their baby in a birthing center tub. Ana is 5 months old.

"We never saw a doctor," he said.

But Seibert must weigh his options now that the federal health law makes coverage mandatory for most Americans. Though his wife and daughter have insurance, Seibert does not. He said he could probably use it, say, if he were in an accident — but because of his good health he hasn't given it much thought.

After opening the yoga studio 15 months ago, he realized he couldn't afford to offer his 14 staffers insurance, though he did offer stipends if they wanted to go out on their own and buy coverage. No one seemed interested, he said, because most of them got coverage through a spouse.

"Teaching yoga is not how you get rich," he said.

Ana is covered by Medicaid, and Jade, who is 25, is still on her father's insurance plan, which covered prenatal visits at the birthing center and a couple of ultrasounds. The federal health care law already allows adult children up to the age of 26 to remain on their parents' plans, even if they are married or not dependent on their parents.

Seibert said he hasn't done much research on the plans that might be available. He's just a year too old to be eligible for a catastrophic plan, which would come with a lower premium but can't be offset by a subsidy. Seibert, who also has a Web design business, wasn't sure if he could qualify for a subsidy anyway.

"If we have to get (insurance), we'll get it," he said. But having a way to pay for medical care won't change his philosophy. "Our body is the best healer in the world. There is no pill, no therapy that can do it."

Nicole Holman, 29, Tampa

Last year could not have started better for the new biology teacher and swim coach at Hillsborough High School. Her enthusiasm and energy had already made her popular with students. She was engaged to be married in March.

But in late February 2012, a pickup truck collided with her motorcycle, leaving Nicole Holman with a traumatic brain injury. Her employer-based insurance plan and a $250,000 accident settlement covered her medical costs, which were significant after a month at Tampa General Hospital.

Six months later, she was married and back at work. Eight months later, she had their first child, a boy named Darwin.

Only when she left work to spend time with her baby did she realize how the accident would reverberate through her life.

Husband James has health coverage through his job at an optometrist's office. But adding Nicole and Darwin to the policy brought the cost to $900 a month — a whole week's pay. So James put just the baby on the policy. Nicole, who had temporary COBRA benefits from the school district, went hunting on the individual market.

The rejections came in fast. Because of her brain injury, Holman was considered to have a pre-existing condition. She never saw that coming.

"I thought pre-existing condition only applied to old people," she said.

A broker told her she should just wait until the federal health care law goes into effect, since it forbids insurers from denying coverage or hiking costs over pre-existing conditions.

Incomewise, they might qualify for a subsidy. On the other hand, the law's "family glitch" may stand in the way of reducing premium costs for Nicole.

The law says workers, along with their spouses and children, are not eligible for subsidies if the employer offers "affordable" coverage for the employee alone. That was mainly to make sure people don't abandon their workplace plans for subsidized insurance through the marketplace.

But the law fails to consider the expense of adding a spouse or child to the worker's plan. So if James' coverage for himself is considered affordable, that would make his family ineligible for a subsidy through the exchange.

But with the pre-existing condition provision in the new law, at least she will be able to get insurance at group rates, even if she has to pay the full price.

"People are so against Obamacare, and I don't understand why," she said. "It means I can get health insurance."

Justin Gray, 28, Tampa

Justin Gray works as a bartender, a profession that suits his sociable nature. So when he got serious about looking for health insurance, he didn't want to go out on his own.

As vice president of the Left Coast Bartenders Guild, Gray has been trying to drum up interest among Tampa Bay bartenders in purchasing group insurance. Few bartenders work at places that can provide coverage, leading many of them to go without.

"This is a real job," he said, "so there's no reason we shouldn't have the same access as everybody else."

The Hillsborough High graduate hasn't had coverage of his own since aging out of his parents' plan a couple of years ago. When he's not bartending at the upscale Anise Global Gastrobar in downtown Tampa, he's covering shifts at a Davis Islands nightspot or working for a vodka promoter.

Gray, who majored in economics and African-American studies at Notre Dame, has made a social cause out of helping his fellow bartenders pool together for affordable coverage. He said he has seen too many charity nights for bartenders who got stuck with high medical bills.

"If we put 20 years into this, we should know we shouldn't have to worry about how we'll pay for health care," he said.

He's less concerned about his own prospects for coverage, though he admits his health habits aren't the best. In addition to working long hours, he doesn't pay a lot of attention to diet. He likes rare steak and good wine.

"I eat horrible. I eat like a dog," he said with a chuckle. "A very expensive dog."

Gray said he wants coverage, but he hopes to get it as part of a guild plan. If that effort doesn't pan out by next year, he isn't sure if he'll buy individual coverage simply to comply with the law's requirement. He could face a $95 fine if he does not get coverage in the first year — not enough to make him lose focus on his bigger plan for guild members.

"I'm not going to get too worked up about it," he said.

Cindy McNulty, 58, Largo

If anyone understands the importance of good health insurance, it's Cindy McNulty. A community liaison at the Healthy Start Coalition of Pinellas County, she often helps young pregnant women gain coverage.

McNulty, however, has what she calls "a dirty little secret": She hasn't had health insurance in nearly 20 years.

"I have felt so guilty living on the edge, especially with me being known as a health advocate," she said.

How did the single mother of one end up in that situation? She could never fit it into her budget.

Her employer couldn't afford to offer coverage and instead offered a stipend that workers could put toward insurance. But McNulty put her money toward helping to pay for her mother, who had Alzheimer's, to stay at an assisted living facility.

Returning to college for a bachelor's degree meant getting a $36,000 loan. The car payment was $400 a month. After the real estate market tanked, she owed more for her condominium than it was worth.

McNulty shopped on the individual market and learned that coverage for herself and her son would cost $800 a month. Too much. For basic care, she went to federally qualified community health centers, where payments are based on income. She got her son, now 17, signed up for Florida Kid Care, a sliding-scale Medicaid program.

She cuts her pills for high-blood pressure, shops for the cheapest mammograms and "eats fiber morning, noon and night" to help prevent colon cancer, which runs in her family.

But she knows she's always one disease or injury away from financial disaster. Which is why she can't wait to shop the online marketplace for subsidized insurance. "I don't want to be a burden," she said. "I can't wait to be more responsible."

She plans to stay up late on Sept. 30 — and log on to the marketplace website just after the stroke of midnight.

Ed Bradley, 62, St. Petersburg

For four decades, Ed Bradley got health insurance through his jobs in the medical equipment field. When he retired last year, he opted to stay on his employer's group plan with temporary COBRA benefits, meaning he foots the bill without an employer subsidy. Still, it's a good deal: He pays about $530 a month for a plan that includes dental care, a wide network of providers and an ultralow $500 deductible.

But the benefits run out in May. That leaves Bradley in a situation familiar to plenty of baby boomer retirees too young for Medicare.

Eager to understand his options, Bradley has been doing his own research. Based on his current retirement income, he believes he may qualify for an annual premium subsidy. But he's also thinking about starting to draw Social Security benefits, which could push his income too high to qualify for a subsidy.

So he'll need to calculate which option makes more sense.

If he can't get a subsidy, he will likely end up buying a plan through an independent agent who has access to many insurance companies so he can see all his options.

"I'm hoping I can find something attractive and just as fulfilling as I have now and maybe save some money," he said.

Mary Brantley, 45, St. Petersburg

She is unemployed and uninsured and has diabetes. But it's not as bad as it may sound, Mary Brantley says.

The 45-year-old gets regular care at the St. Petersburg Free Clinic, which also helps her obtain an expensive diabetes medication, Victoza, for free.

One recent morning in a clinic exam room, she watched as nurse practitioner Trudy Grossman made notes on her medical charts.

"I feel like I get better care from Trudy than when I had insurance," Brantley said.

She lost her full-time job at an auction house three years ago. Unable to find work, she decided to seek a degree in substance abuse counseling at St. Petersburg College. To pay for her coursework and rent, she took out $10,000 in loans. "That's how I'm surviving," she said.

When she's not at school, she's babysitting a grandchild and checking on her own mother, who lives in a nursing home. She's happy with the care she gets at the St. Petersburg Free Clinic but worries about what could happen if her health worsened.

The Affordable Care Act marketplace, however, likely won't help her gain coverage. Her income is so low, she doesn't qualify for subsidized coverage. She could have been able to get Medicaid under the health law, but Florida refused to expand the program to cover people like Brantley.

"I do want insurance," she said at the clinic. "If I can work and have insurance, somebody else can take my spot here."

Md. Arifur Rahman, 34, St. Petersburg

Growing up in Bangladesh, Md. Rahman remembers a trip to the doctor as a sort of lottery: Buy a ticket with a number on it, wait at the clinic all day and cross your fingers. He was grateful, then, for a relatively short wait at the St. Petersburg Free Clinic, where he went recently for help with high blood pressure and diabetes.

The diabetes, especially, is starting to bother Rahman, a slender man who defies the stereotype linking obesity with the condition. He has tried cutting sugar from his diet, but didn't see much improvement. "I think the doctor is going to say to take medication," he said glumly.

That would be a difficult expense for a tight family budget. A part-time worker at a grocery store, Rahman holds a green card by virtue of having married an American citizen, Maksuda. Together they have nearly 2-month-old daughter, J. Alia.

The baby is covered by Medicaid, he said, but he and his wife, who works part time at a nursery school, have no insurance. Rahman, who plans to apply for citizenship, had not heard many details of the federal health law. But he may qualify for subsidized coverage through the online marketplace.

Green card holders and other immigrants who are "lawfully present in the United States" may shop on the marketplaces. Rahman said he wants coverage for his family. "When I can afford insurance, I will get it," he said.

Rose Kraemer, 22, St. Petersburg

Like a lot of people, Rose Kraemer lost affordable insurance coverage when she left her job, and then learned to do without.

The Eckerd College student came here from California, where she worked as an administrative assistant at a college.

"And now that I'm back in school, I'm not working at my job anymore."

So she skips nonessential doctor appointments. "Every time I have a cold or the flu I usually just wait it out," she said. "Luckily I'm not on any prescriptions so that's helpful."

When Kraemer does need medical attention, she looks for low-cost clinics that don't require health insurance.

"My sister is the one who told me about these in San Francisco," she said.

Though she hasn't done extensive research into which health care plan she'll buy when it's required in 2014, Kraemer's first thought is affordability.

"I'm worried that it will be more expensive than I can afford," she said.

She was glad to find out that at her income level, she'll likely be eligible for subsidies to offset the cost of premiums, though she knows she'll have to pay her share to have insurance.

"I feel okay about it because in general I'm very supportive of health care," Kraemer said.

Like countless others, though, she has an eye on the future.

"I am, you know, a little worried about what my situation with making money in the future will be — such as after college when I have to pay off loans. But I'd also have to research more into what the insurance I'm being put on consists of and how that plays out with student loans."

Malena Carollo, Times Correspondent

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