NYers confused and concerned in wake of health care decision


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What will it mean to me?

Perplexity, resignation and cost concerns were aired in New York City Thursday as residents struggled to figure out how the Supreme Court's historic decision to uphold the Affordable Care Act would affect them.

Most people were happy that the law got the go-ahead, but were anxious about skyrocketing health and insurance costs.

Young, healthy people -- who are most likely to go without health insurance and who will now be mandated to purchase it or face fines of up to 1% of their income were less than thrilled at the prospect of being penalized to help subsidize what they saw as a sick system.

"I'll just pay the 1%," said Aamir Foster, 25, an Upper West Side caterer, who said he could not afford to buy insurance on his salary of $23,000-$25,000 a year.

Andrew Hamill, 29, an advertising account manager from Flushing, has insurance through his employer but said he'd "go naked" if he lost his job "unless they expanded Medicaid," to include him so he could avoid $500+ Cobra payments, he said.

That is a big problem with the mandate, which "penalizes people who are already having trouble paying for health care," said Dr. Daniel Lugassy, an NYC emergency room physician who is also on the board of NYC-Metro Chapter of the Physicians for a National Health Care Plan. While more people may become eligible for Medicaid coverage, some doctors will continue to refuse Medicaid patients, and even insured people will still be financially devastated by illnesses and accidents, Lugassy said. His organization contends that state assembly Member Richard Gottfried's "New York Health Bill" to provide a publiclysponsored, single-payer health care plan to New York state will save billions of dollars and increase access for all.

Parents were relieved that the provision permitting kids to stay on their parents' insurance until age 26 will remain in place. "That's great! I've got a 16 year old and he wants to get a PhD," said Lorraine Soto, 35, a managed care specialist from Soundview, the Bronx, who plans to keep her son on her insurance for another decade.

Vincent Bonomo, 43, the owner of Advanced Locksmith in midtown, is eager to see if the small business employer tax credit (up to 35% of an employer's contribution now and up to 50% by 2014) will help him obtain insurance for an employee who doesn't have any. Bonomo, of Deer Park, who is covered under his wife's insurance policy, said he's has been shocked by the cost, high deductibles and high premiums of plans he's reviewed. "There's got to be some kind of oversight," of the insurance companies, he said, because the right to insurance is meaningless if the services are not of value to patients. "It's all about cost," he added.

Indeed, America's Health Insurance Plans' president Karen Ignagni issued a statement citing studies that the ruling will increase costs but that AHIP members "will continue to focus on promoting affordability and peace of mind for their beneficiaries."

Dr. Laura Boylan, a neurologist at the Department of Veterans Affairs, doesn't buy that. Many health care groups lauded the Supreme Court decision, but Boylan predicted that insurers will offer "fewer and fewer services for the money." The ACA strengthens primary care, but does nothing to bring down the punishing cost of drugs, noted Boylan, citing an insured patient who was paying $1,000 a month for his epilepsy medications.

"You're going to see more gate keeping, more of a need for referrals and more limitations under this cheaped down insurance," which will cause grief for both patients and care providers, she said.

And, Boylan predicted, the country at large will continue to have an irrational, logic-defying blend of "excess and scarcity."


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