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PRESS & MEDIA

By Felice J. FreyerFelice J. FreyerProvidence Journal

Journal Medical Writer

ffreyer@providencejournal.com

Published: September 28 2013 11:15
http://www.providencejournal.com/news/health/20130928-consumers-talk-as-r.i.s-health-insurance-marketplace-set-to-open-tuesday.ece

PR.jpg Nobody knows whether it will work.

As the Obamacare marketplace for health insurance prepares to open for business Tuesday, its potential customers are waiting — some skeptically, some eagerly — to see what it has to offer.

The marketplace or exchange, called HealthSource RI, will serve two main groups: those who don’t have access to health insurance through an employer and small businesses with 50 or fewer employees.

Through the exchange’s website, people will see a menu of insurance options and compare them based on price and benefits. Individuals who qualify will also receive federal tax credits to lower their premiums, and people eligible for Medicaid can enroll.

Those running HealthSource RI hope it will be so convenient and economical that uninsured people will sign up and small companies will want to keep offering, or start offering, health insurance.

Five people who are contemplating using HealthSource RI described their hopes and concerns.

Gary Metts, a co-owner of a 14-person business in Tiverton, wants to do right by his employees. He offers them insurance (about half have taken it up) and pays 50 percent of health insurance premium costs for an individual, about $50 a week.

“I’ve kind of always looked at it as like, we’re all just a team here,” Metts says. “I want to make sure everyone on my team is covered and not exposed to this great risk.”

But the design of Obamacare puts him in a bind, says Metts, who is among three owners of Sixteen on Center, a design and building company.

 

Many of his employees have income low enough to qualify for federal tax credits to reduce their premiums — but only if they buy insurance on their own. If they have employer-sponsored insurance, they can’t get the subsidies.

So, as Metts sees it, his employees might actually have to pay more if he offers them insurance. But he won’t know until HealthSource RI opens on Tuesday and he can see the details.

 

Despite his disappointment on the tax-credit issue, Metts welcomes HealthSource RI. For one thing, if it works as promised, he may not have to spend 20 to 25 hours each year trying to understand his insurance options.

“It’s not the magical panacea that’s going to solve everything,” Metts says. “It’s going to be an improvement over the system that exists now.”

Maria Gil, owner of Chase Machine and Engineering in West Warwick, believes offering health insurance to her 30 employees is essential. “To be able to attract and retain good people, everybody needs health care,” says Gil, who pays 70 percent to 85 percent of her employees’ premiums. “You try to give them the best plan you can buy.”

 

As premium costs have gone up over the years, finding the best plan has involved choosing ones with higher and higher deductibles. Every December brought “doom and gloom” when it came to renew the policy.

 

But this year, Gil says, “I’m really excited about it. … Now we actually have some choice. I’ve never seen that before.”

Alice Roher has always been healthy and prefers to avoid doctors. A self-employed consultant, she buys her own health insurance through the Direct Pay program of Blue Cross & Blue Shield of Rhode Island.

 

Over the years, she’s done what she could to keep her premiums in the vicinity of $500 a month by buying plans with higher deductibles. After all, she’s healthy and doesn’t expect to use health care.

 

But as Roher moved into her 50s, she learned that even when you maintain your health, stuff happens to you. Expensive stuff.

One day in 2011, her boot caught on the carpeting of a stairway and she fell, breaking her ankle in three places. The next year, a retina detached, requiring eye surgery — once for the retina, once for a cataract that developed as a result. And then she learned she needed additional surgery on her ankle.

 

With deductibles, co-pays and limits on her coverage, she paid about $10,000 out of pocket in 2011 and close to $15,000 in 2012.

Roher, who develops training for companies installing new computer systems, is currently “between projects.” But even during this period of unemployment, she remains committed to buying health insurance, and she’s looking forward to seeing what HealthSource RI has to offer.

“I’m thrilled to have more than one choice,” she said. “I’m hoping prices won’t be too much higher.”

“I’m a strong believer in seeing both sides,” says Kristin Gennuso, who owns Providence’s Chez Pascal restaurant with her husband, Matt. “Whatever it is, it’s always good to know what the other side is thinking.”

Gennuso has read many articles, pro and con, about Obamacare. And she’s reached a conclusion: “From what I’ve read, people who are saying that it is bad — there’s nothing to back it up.”

 

So you can count Gennuso among the businesspeople who are happy that HealthSource RI will open its doors on Tuesday. In fact, she plans to make a personal visit to the contact center at 70 Royal Little Drive in Providence to talk about the best plan for her employees.

 

Even so, she’s not expecting a huge change from the plan Chez Pascal now offers to its six full-time employees, who are mostly young and healthy. The plan costs about $300 per person each month.

 

But Chez Pascal employs more than a dozen part-timers who are uninsured. And that’s where the biggest difference may be felt: Through HealthSource RI, her uninsured part-timers can shop for insurance and, she hopes, find an option they can afford.

“I am excited and I’m very proud of our state and the folks that put this together,” Gennuso said.

Pepin Lumber is a family business — a lumberyard, hardware store and gift shop in Woonsocket. Of the seven employees, only one is not a family member. And for the five employees who get their health insurance through the lumberyard, the company pays 100 percent of the health-insurance premiums.

 

But over the years it’s been an ordeal for treasurer Louise Sutherland.

No matter how carefully she reads the plans and consults her broker, it seems there’s always a nasty surprise. Such as finding out that hearing aids are not, after all, covered. And that the $50 co-pay at the urgent care center is just the beginning — you also have to pay for any procedure they do.

 

“It goes up $5,000 every year,” Sutherland says. To keep costs down, she’s selected plans with higher deductibles.

Is Sutherland looking forward to the opening of HealthSource RI? Glancing at the information available on the website, she’s not sure whether it will help. “From what I’ve seen, they were up there in price. It didn’t look like it was going to be much cheaper than what I’m paying now.”

 

She’s skeptical that the contact center will be especially helpful, at least in the beginning. “I don’t know how well it’s going to work. This is a new job, this is something they’re learning now.

 

“All I know is, it’s out there. I know nothing about it,” Sutherland says. “But I’m going to look at it.”


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