18 years uninsured, but no more

health isurance-stethoscopeBeth is a home renovator and woodworker who lives north of Edmond. For the last 18 years, she has operated her own small business. For 18 years, she also went without health insurance. This finally changed January 1st, when the Affordable Care Act took effect and Beth became one of the first 15,000 Oklahomans who gained coverage through the new health insurance marketplaces.

Beth’s story is similar to that of many self-employed small businesspeople.  In the mid-1990s, Beth left her job with a large company to start her own business. Initially, she was able to  purchase health insurance through a national association serving the self-employed. She was offered a great introductory rate, but six months later, her premium got hiked and the plan became unaffordable, so she dropped her coverage. She shopped the individual insurance market over the years, but was never able to find an affordable plan, even though she didn’t have any pre-existing conditions.

Since 1996, Beth has been one of the roughly 650,000 Oklahomans without health insurance. In 2011-12, 24.4 percent of working-age adults in Oklahoma, or just under one in four, were without health insurance, according to the U.S. Census Bureau. The uninsured rate among working-age adults has risen steadily over the past fifteen years due to a decline in employer-based coverage. But for the self-employed, the uninsured rate has always been high. One in four entrepreneurs was uninsured in 2012, according to a Gallup poll, a rate two-and-a-half times as high as for other workers. 

Beth, who is now 58, has been fortunate to  avoid chronic health problems and major injuries. But her job involves using sharp tools and twice on the job she cut herself badly. Not being able to afford a visit to the ER to get stitches, she prevailed upon a doctor friend for a tetanus shot and relied on over-the-counter butterfly bandages and antibiotic creams. For 18 years, she has not seen a doctor for regular checkups or annual tests.  “I couldn’t afford the treatment anyways,” she said, “so it’s almost better not to know.”

When Healthcare.gov launched on October 1st, Beth was among the hundreds of thousands of Americans who immediately went online to find insurance. Like most everyone,  her initial attempts to enroll were frustrated. But she kept plugging away and got a little further along in the process each time. By late November, after the Obama administration’s “tech surge” got the site fully up and running, Beth was able to sign up for insurance. 

Her silver plan with Blue Cross Blue Shield costs $381 per month. But with an annual income of about $20,000, Beth is eligible for a large subsidy that will lower her premium costs to just $8 a month. Her plan has a $500 annual deductible, but Beth also qualifies for subsidies that will help with her cost-sharing. Like all plans sold on the new marketplaces, her insurance will cover a comprehensive set of benefits without any annual or lifetime limit and without regard to health status or pre-existing conditions.

By creating a new marketplace for individuals and small businesses, the Affordable Care Act is expected to provide a major  boost to entrepreneurs who until now have been unable to launch and sustain their own business due to concerns about health insurance.   The author of a recent study on the impact that the ACA could have in reducing “job lock”, where people stay in a job mainly  for the health insurance, stated in November, “Assuming we get the website working, it’s going to be the biggest step we’ve had in a long time in the U.S. in terms of changing the structure of the economy.” Due to the ACA, the number of self-employed people will be 1.5 million higher nationally and 23,000 higher in Oklahoma than it would otherwise have been, according to estimates by the the Urban Institute and the Georgetown University Health Policy Institute.

Just under 15,000 Oklahomans had enrolled in health plans through the new marketplaces through December. An additional 36,600 individuals had completed applications for coverage but had not yet enrolled in a plan.  Seventy-two percent of those who had enrolled in coverage in Oklahoma had received financial assistance as of December.

Even though enrollment in marketplace plans in Oklahoma increased tenfold between November and December, the current number represents only a fraction  of the total population who are eligible to sign up for coverage. Intensive and ongoing outreach will be needed to reach the eligible population and to provide needed assistance. However, with time, as awareness spreads of the positive impact that the Affordable Care Act is having for people like Beth, the crucial task of convincing Oklahomans that affordable, quality health care is really out there will ultimately get easier.

An earlier version of this post appeared in the Journal Record.

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Former Executive Director David Blatt joined OK Policy in 2008 and served as its Executive Director from 2010 to 2019. He previously served as Director of Public Policy for Community Action Project of Tulsa County and as a budget analyst for the Oklahoma State Senate. He has a Ph.D. in political science from Cornell University and a B.A. from the University of Alberta. David has been selected as Political Scientist of the Year by the Oklahoma Political Science Association, Local Social Justice Champion by the Dan Allen Center for Social Justice, and Public Citizen of the Year by the National Association of Social Workers.

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