What Health Reform Will Do to My Insurance

Congress wants the nation to adopt the same rules that have made coverage expensive in New York.

By ANDREW R. HEINZE

I'm a registered Democrat living in New York City, and I buy my own health insurance. But now, having seen the health-care reform bill that passed the House, I'm preparing for life without health insurance. And unless I'm the only person covered under the Empire Blue Cross/Blue Shield "Tradition Plus" plan, a lot of other people will end up just like me, uninsured.
I will gain one thing, though—an annual fine for losing my insurance. The exact amount of that fine isn't clear yet, but so far it looks like I'll be paying about the same amount—$2,000 a year—for having no insurance as I do now for having it.
Let's get specific. What is the "Tradition Plus" plan that I've purchased each year since moving to New York in 2006? It's a hospitalization plan. If an accident or illness puts me in the hospital, all my hospital expenses are covered. Why is it so affordable? Because it covers only hospital expenses. Any fees from a physician who is not a hospital employee (i.e., who bills the patient privately) I would pay out of pocket.
Before I come to the big question—why will I lose this insurance plan if anything like the House bill becomes law?—I want to address a smaller one. Why do I choose the Empire "Tradition Plus" plan instead of a comprehensive HMO-type plan that covers physician fees, prescriptions, etc.? Because, unlike other states, New York already mandates two things that the current federal health-care reform will mandate. The first mandate prohibits insurers from denying coverage because of a pre-existing medical condition. The second mandate prohibits insurers from denying coverage, or determining prices, based on age. The result is that HMO plans in the state are now very expensive. The price of Empire's basic, least expensive HMO plan is more than $13,000 a year for an individual, more than $26,000 a year for a married couple, and more than $39,000 a year for a family with children. Empire is a reputable firm and those prices are typical of what's available to New York City residents. Upstate New Yorkers pay slightly less.
The only less expensive alternative is the "Tradition Plus" plan. That's why I buy it. The money I save by not buying the basic HMO plan—roughly $11,000 a year—I can draw on to pay for any doctor visits I choose to make.
The House health-care reform bill hinges on what it calls a "qualified" health-care plan. Individuals will be required by law either to buy a plan that meets the criteria of a qualified health-care plan or pay a fine. What are those criteria? They're the basic components of a comprehensive HMO-type plan, which means that Empire's "Tradition Plus" will not qualify because it covers only hospital costs. In other words, if President Obama signs into law the kind of health-care reform bill that is currently on the table, I will have only two choices: buy an expensive qualified plan or pay a fine for being uninsured.
And there is nothing in any of the pending health-care legislation that will make the cost of a qualified plan significantly lower than it is in New York now. On the contrary, once the health-insurance mandates that already exist in New York become the law of the land, insurance premiums everywhere else will rise as they did here. What I can't figure out is why Congress would want to prohibit someone like me from keeping an affordable hospitalization plan. It works for me and it works for the hospital. I guess that's the problem. It's simple, it's easy to understand, and it works.
I realize that we who buy our own health insurance are a fairly small percentage of the market, but there are millions of us. Millions more may have an employer-based plan today, but not tomorrow. So, as I prepare for the winter of my disinsurance, at least I'm not alone.
Mr. Heinze is a writer in New York.