Concern, confusion over next stage of reform

In six months, Jimmy Rowalt will no longer have health insurance.

For the past two and a half years, the 25-year-old Athens resident has worked at Highwire Lounge without worrying about the job’s lack of health benefits. Now he’s a manager there, working 45 to 55 hours a week.

A rule allowing young adults to remain on their parents’ health insurance policies until age 26 was one of the first provisions of the Affordable Care Act to go into effect, in September 2010.

Jimmy Rowalt fixes a drink at the Highwire Lounge in Athens
Jimmy Rowalt fixes a drink at the Highwire Lounge in Athens

Rowalt was among the many young Americans who took advantage of this provision. Nationwide, the rate of uninsured people between the ages of 19 and 25 dropped 6 percent within a year, according to CDC data.

When the law kicked in, Rowalt was 22. The day he would turn 26 seemed far away to him. Now, however, he hears the clock ticking.

Rowalt’s options will be meager after his October birthday, when he will be dropped by his parents’ insurance company.

A separate feature of the health care law, an online marketplace that is intended to enable uninsured people to obtain reasonably priced health insurance, will go into effect in January. But specifically how that will work is still unclear.

Like many people working for small businesses, Rowalt can’t turn to his employer for relief.

“I am not insured by Highwire Lounge,” says Rowalt. “I was not offered insurance.”

These days, he considers not only his own situation, but also the well-being of the other employees. He thinks about their vulnerability to sudden illness or injury.

“After becoming a manager,” says Rowalt, “I have felt a great deal of responsibility for my employees, and I do feel responsible for their health. If they got sick, it would affect the business and the other employees for which I am responsible.”

Rowalt says he does not know what the health insurance marketplaces, also known as exchanges, will mean for him and his co-workers. And he’s also unsure about some other ACA programs.

The effect on small businesses

Under the health care law, small businesses with fewer than 50 employees will not be required to offer insurance. Individuals such as Rowalt will be required to buy coverage, though they may qualify for subsidies, or discounted coverage.

(The ACA already offers tax credits to small businesses, to help them cover their employees. Many small businesses with 25 or fewer employees have already received tax credits of up to 35 percent of their health insurance costs.)

One block away from Highwire Lounge, at the National Restaurant, chef and owner Peter Dale is plagued by a similar uncertainty.

“We don’t have a companywide [insurance] policy,” says Dale. “We should.”

The National has fewer than 10 full-time employees. Health insurance companies often charge high rates for such a small group, because a handful of policyholders paying premiums may not be able to share the share the cost of a single member’s catastrophic illness. (By comparison, some large employer groups have thousands of members.)

The insurance rates available to the National are high enough to run the restaurant into the ground, Dale says, making it an impossible benefit to provide.

“I hate the way our health care is set up right now. I really hate it,” he says. “If you don’t have insurance, you could go into severe financial hardship by having an accident or an illness. In no other industrialized country do people have that fear. So, I just think it’s really irresponsible of our society to treat health care as a for-profit business.”

Although Dale is hopeful about what the ACA could mean for his employees, he is frustrated by the slow dissemination of information.

“Right now it’s just crazy,” says Dale. “Part of the problem is I don’t even know how I’m affected.”

Big changes on the way

Confusion surrounding the ACA is common. It’s a wide-ranging law that has taken effect in stages, and though some of its provisions have been hotly debated, some are still little known to the public.

The U.S. Department of Health and Human Services is offering brochures on the law, and other educational resources are available through the campaign titled “The Health Care Law and YOU,” a program designed for easy access to the provisions of the ACA.

Even in the face of these publicity campaigns, the government may be short-staffed to address such an enormous problem as enrolling millions of uninsured Americans.

“I think there are not enough resources all around for the task at hand,” said Cindy Zeldin, executive director of Georgians for a Healthy Future.

“If you look at Georgia, we have about 1.9 million people who are uninsured,” said Zeldin, “and if you look at who is eligible for tax credits and subsidies in the exchange . . . If you wanted to get them all signed up in the first open enrollment period, you would have to enroll something like 4,000 people a day.”

The effort to insure everyone will take a number of years and will require cooperation from many different stakeholders. The success of the program, and especially the insurance exchange program, hinges on widespread enrollment, experts say.

“The higher the enrollment, the better,” said Zeldin, “not only for the sustainability of the program but also for the benefits of the program.”

The ACA’s requirement that people buy insurance or pay a penalty is meant to maximize enrollment. But if too many people choose to pay the penalty instead of buying the insurance, the law won’t work as well.

The law provides that a Navigator program will help individuals like Rowalt and Dale identify health care packages available in the insurance exchange that are most beneficial and cost-effective for them. It will also facilitate their enrollment in the plans for which they qualify.

“It’s hard to predict what will happen,” said Zeldin, “but there are certainly a lot of people thinking about the huge need before us.’’

Jodi Murphy is a graduate student at the University of Georgia Grady College of Journalism and Mass Communication, pursuing a concentration in Health and Medical Journalism.  She is particularly interested in environmental and global health, as well as women’s issues.