(Interview March 2010, oil on canvas, 40 ins. x 30 ins.)
Update 2021
This subject worked in the US for many decades. Shortly after reaching retirement age she decided to return to England, her home country. She said, "England is kinder to old people."
At first this self-employed draper was enthusiastic about the new plan she enrolled in. She didn't understand she would have to pay the first $5,000 of her medical bills on top of the $584/month premium ($741 in 2021 dollars) before insurance coverage started.
Once we sorted it all out, she was crestfallen. The premium rose to almost $700/month ($888 in 2021 dollars) before she could get out of the private insurance market and onto Medicare. She would have to soldier on until she reached Medicare eligibility age.
Her strategy is to try not to get sick, and avoid check-ups and treatments until she's eligible for Medicare. "I feel uninsured," she said.
Healthcare reform had not been in place when this subject needed to buy an individual policy. If it had been, she would have been able to buy a health insurance policy on the Affordable Care Act's online marketplace without regard to her health history. The new law bans insurance companies from discriminating against individuals because they have preexisiting conditions. The law also says that she could not be charged more than three times what a younger person pays. The subject might have qualified for financial help to pay her premiums. She had none of these options in 2010.
Artist Note (5/2012)
This subject enrolled in Medicare last December. Medicare is a federal health insurance program for seniors and other groups. The subject expressed great relief in having affordable medical coverage.
Today in 2012 there is so much more information about health savings accounts (HSA). Opponents of the 2010 healthcare reform law, the Affordable Care Act, tout them as a way for individuals to take more responsibility for their healthcare choices. The thinking goes that if we are saving our own money in health savings accounts, We will shop around and be judicious about our healthcare spending.
The logic strikes me a bit disingenuous. One of the subjects in this project had a stroke at 27. I don’t know how much shopping around she was in a position to do. This insured young woman said that getting health insurance claims paid was a lot harder than recovering from the stroke. She reached the point where she was discussing how the billing departments were coding her procedures on the claims forms.
Scrutinizing pricing practices seems far more intelligent and realistic over putting the onus on patients to shop around when they clearly can’t in medical emergencies, or when they are too sick to do so. On top of that, the system is complicated. Let's not forget, people don't pick doctors like a pair of shoes on the clearance rack. Patients value relationships with providers they trust to accurately diagnose them. Trust is not a shoppable commodity.
HSAs are a key component in a plan put forth by anti-Affordable Care Act forces who believe that, along with tort reform (debunked), and allowing insurance companies to sell across state lines (also a specious argument), HSAs will help the free market bring down costs.
In my research, I see the HSAs as a product that should be sold by financial advisors to people who wish to leverage their health for financial gain. The well-off can fund the HSAs for tax advantages. They can use their HSA savings to cover their high deductibles before the insurance starts covering their medical expenses. The average American does not earn enough money to fund an HSA.
Artist's Note (2011)
As of 2011, the subject's premium for her policy w/ a provision for her to fund her own health savings account rose to $683/month. She is responsible for the first $5,000 before her health insurance pays any medicial bills.
(Interview March 2010)
Draper, Self-Employed, Age 63, Insured on Individual Market
This draper is the sole person in her company. She designs, quotes, and sews high-end window treatments.
She always bought a single health insurance policy for herself throughout her career.
The day this woman turned 60 years old, her health insurance premiums increased 45%. She could not pay her new $802/month premium to keep her insurance policy with a $500 deductible.
The insurance company offered the subject a high deductible plan with a health savings account (HSA) for $584/month. She had no idea what any of it meant but she had to take the high-deductible plan because the almost $600/month premium was all she could afford.
The new policy has a $5,000 deductible. This means that the subject must pay the first $5,000 of medical expenses out of her own pocket before the insurance company will pay her medical claims.
In addition, the subject has the option to fund her own health savings account (HSA). She is not completely clear on how health savings accounts work but she says, "What choice do I have?" She can barely afford the premium. She won't be setting aside other money in a separate savings account.
The subject thinks of her high deductible plan as catastrophic coverage. Her strategy is to try not to get sick, and avoid check-ups and treatments until she's eligible for Medicare. "I feel uninsured," she said.
The subject also discovered that since she is buying insurance on the individual market, her tax deduction is 20% of the premium, not 100% as is the case for group policies.
The subject is eligible for Medicare on Dec. 1, 2011.