Andrew Heinze, a writer living in New York, is making plans for his future. It is a future that won’t be his alone: he is preparing for a life without health insurance. Like millions of Americans, Mr. Heinze buys his own health insurance. His plan is the Empire Blue Cross/Blue Shield’s “Tradition Plus” plan.
It is important to know two things about Mr. Heinze’s situation: why he will face a future without health insurance, and what his “Tradition Plus” plan is like. Let’s start with the second matter: “Tradition Plus” is a hospitalization plan. If Mr. Heinze ends up in the hospital because of sickness or an accident, all his hospital expenses are covered. Fees from doctors not on the hospital staff must be paid out of pocket. It’s a modest plan. To have insurance for major medical without paying exorbitantly:
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 will mandate that we all join what it designates a “qualified” health-care plan. You’ll have to select a “qualified” plan or pay a fine.
The “qualified” plan will have all the bells and whistles of the HMO-type plans that Mr. Heinze has rejected in favor of a plan that meets his needs. “Tradition Plus” will not qualify under the House plan. Heinze’s dilemma: I will have only two choices: buy an expensive qualified plan or pay a fine for being uninsured.
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.