CHICAGO (AP) — For uninsured people, the nation’s new
health care law may offer an escape from worry about unexpected,
astronomical medical bills. But for Stephanie Payne of St. Louis, who
already had good insurance, the law could offer another kind of escape:
the chance to quit her job.
At 62, Payne has worked for three
decades as a nurse, most recently traveling house to house caring for 30
elderly and disabled patients. But she’s ready to leave that behind,
including the job-based health benefits, to move to Oregon and promote
her self-published book. She envisions herself blogging, doing radio
interviews and speaking to seniors groups.
"I want the freedom to fit that into my day without squeezing it into my day," she said.
One
of the selling points of the new health care plan, which has a March 31
enrollment deadline, is that it breaks the link between affordable
health insurance and having a job with benefits. Payne believes she’ll
be able to replace her current coverage with a $400- to $500-a-month
plan on Oregon’s version of the new insurance exchange system set up
under the law.
Federal experts believe the new insurance option
will be a powerful temptation for a lot of job-weary workers ready to
bail out. Last month, congressional budget analysts estimated that
within 10 years, the equivalent of 2.5 million full-time workers could
be working less because of the expanded coverage.
But is the new
option a gamble? That’s a matter of debate, not only among the
politicians who are still arguing furiously over the law’s merits, but
among economists and industry experts.
"We don’t know what the
future of exchange insurance will be," said economist Douglas
Holtz-Eakin, president of the American Action Forum, a center-right
public policy institute. Premiums should remain stable if enrollment
picks up and broadens to include younger, healthier people. But if
older, sicker people are the vast majority of customers, prices
eventually could spike.
For Mike Morucci, 50, the idea of leaving his information technology job and its health benefits is
"terrifying," he said.
But
he decided to take the plunge after reviewing the range of coverage
available at different price points. Tax credits will help those with
moderate incomes pay their insurance premiums. And coverage is
guaranteed even for those with pre-existing conditions. Twenty-five
states also agreed to expand their Medicaid programs, providing health
care for more low-income people.
"It definitely freed up my thinking when I thought, ‘Do I want to give this a go?’" Morucci, of
Ellicott City, Md.
Morucci
has been writing scripts at night and on weekends for four years and is
on a team of writers for a web-based comedy series titled "Click!"
launching this spring. Before giving notice at the job he had held for
18 years, he made a spreadsheet of health plans available on the
Maryland exchange and found one for $650 a month to cover him and his
23-year-old daughter.
"I turned 50, so for me it’s time to focus on my passion instead of my paycheck," he said.
The
United States has been unique among industrialized nations in tying
insurance and employment closely, said labor economist Craig Garthwaite
of Northwestern University, who co-authored a frequently cited study on
how the health law may break what’s known as "job lock."
Even in
Germany and Japan, where insurance remains private, people who can’t
afford it get public assistance and coverage is guaranteed.
Job
lock "forces people to work at jobs that are not suited to their talents
just to get benefits," Garthwaite said. "Economists tend to think
that’s a bad thing."
In congressional testimony this month, Health
and Human Services Secretary Kathleen Sebelius said that "people will
have some choices that they don’t have today" including farm families
who "will have the choice of not having to have an off-farm job to get
health insurance for the family."
However, one rub may be the
cost.
The insurance on the new marketplace is often more expensive than
what a worker has now because employers often make large contributions
to premiums.
The average annual premium paid by an employee is
$999, according to a recent Kaiser Family Foundation survey. In the new
markets, the average annual premium is $5,558 for a 50-year-old and
$8,435 for a 60-year-old, according to an analysis run for The
Associated Press by HealthPocket.
But some employers are cutting back on their contributions, narrowing the gap.
At
this point, Americans over age 50 are most likely to take advantage of
the new freedom, Garthwaite said. They’re ready for a career change and
may have enough savings to take a risk.
Pamela Mahoney, 50, of Los
Gatos, Calif., decided to leave a job in corporate communications when
the U.S. Supreme Court upheld the health care law.
"I about did
cartwheels down the hall," she said of hearing the court’s decision. In
January, she joined her husband full time in the communications company,
BlueChair Group Inc., they co-founded. They recently chose an insurance
plan for $1,100 a month on the California marketplace.
She was
able to get coverage despite having asthma, a pre-existing condition
that might have made her uninsurable before the new law guaranteed
coverage.
"Prior to the Affordable Care Act, I felt bound to be an
employee rather than a small business owner," she said. "There’s
something to be said for having your own business and being in control
of your own destiny."
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Associated Press Medical Writer Carla K. Johnson can be reached at https://twitter.com/CarlaKJohnson
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