Asbury Park Press

No Health Insurance — Universal Coverage Law Proposed

Asbury Park Press — Sunday, February 24, 2008

By BOB CULLINANE
STAFF WRITER

For Stephen and Tina Seaman, it boiled down to this: Either pay the rent on their Seaside Heights apartment, or pay for their son's medication. They couldn't afford both.

The Seamans chose to buy the medication that prevents Devin, 9, from having seizures. And shortly thereafter, on Jan. 15, they faced the consequences: The couple was hauled into court to face eviction proceedings.

"As far as I'm concerned, it wasn't a choice at all," said Stephen Seaman, 60, a telemarketer who works on commission. "I will do anything to get Devin what he needs."

The Seamans found themselves in such a predicament because of quirks in Devin's Medicaid coverage and because, like nearly 1.3 million New Jersey residents, the Seamans don't have health insurance. It's not offered through Stephen's employment, and the couple can't afford the $600 to $800 monthly premium for private coverage.

So they do what uninsured people do: They hope and pray they don't get sick.

But, of course, they do. And that's when the doctor bills roll in, the credit cards are maxed out, and the hard choices – the "rent or medication" types of choices – are made.

"It's really an untenable situation for many people," says state Sen. Joseph F. Vitale, D-Middlesex, chairman of the Senate's Health, Human Services and Senior Citizens Committee. "Health care insurance has simply become so expensive that it's unaffordable, even for many people who work full time."

Vitale is hoping to change that.

In the next few weeks, he's expected to introduce legislation that would overhaul the state's health care system and essentially provide health insurance for all New Jersey residents, regardless of employment status, income or pre-existing conditions.

The plan utilizes what's called an individual mandate – everyone would be required to purchase a health care policy – and it envisions three basic methods of obtaining health care insurance:

Employers who currently provide coverage would be required to continue to offer these plans to their employees.

Medicaid, Medicare and New Jersey FamilyCare would continue to provide coverage for those who qualify.

Those not covered under the first two categories would be required to obtain coverage through a state-run managed-care network utilizing current commercial health care companies such as Horizon Blue Cross Blue Shield. For those unable to afford it, the state would provide income-based subsidies to pay premiums. Non-citizens would be excluded from the plan.

Cost concerns, remedies

"I think that as a government, we are obligated to provide a health care program just like we provide education," Vitale said.

Joel Cantor, director of the Center for State Health Policy at Rutgers University, adds that "New Jersey is the one state with the most room for (health care) improvement."

But like public education, there is a hefty price tag attached to a state-sponsored health care system. A state estimate puts the first-year cost at $1.7 billion, and that's causing sticker shock for some.

Gov. Corzine, who previously endorsed changes in the health care system to benefit the uninsured, has backed away from pursuing such a plan this year, citing the high cost.

Already facing a state budget deficit approaching $3 billion, and engaged in a pitched battle over his toll-hike plan, Corzine isn't anxious to float a $1.7 billion health care idea before voters.

Vitale counters that the $1.7 billion estimate represents a maximum cost, and it fails to include anticipated revenue from premiums paid by new enrollees, a number he puts at $800 million.

He also contends that the new state-run health care system will eventually eliminate the need for most of the charity care funding the state provides hospitals to care for the uninsured.

He says that funding – New Jersey is expected to reimburse hospitals $715 million in charity care this year – can be applied to the new program and cover most of its cost.

Eve Weissman, a spokeswoman for NJ Citizen Action, a state watchdog coalition, agrees that the redirection of charity care dollars will provide a viable funding source for a state-run plan.

Weissman also argues that cost containment must be a goal of any comprehensive program. She says that 25 percent to 30 percent of the costs of private health care coverage is driven by administrative overhead and that a consolidated, state-run program could significantly cut that spending.

Costs aside, Cantor, of the Center for State Health Policy, said New Jersey needs to act swiftly on health care reform.

Last year, Cantor was a member of a nationwide team that produced a state-by-state scorecard on health system performance, under the direction of The Commonwealth Fund (www.commonwealthfund.org).

In the scorecard, New Jersey ranked 26th overall and 29th in the percentage of state residents currently covered by health insurance.

"For a state with one of the highest income averages to have such an average uninsured rate seems unacceptable," he said.

Cantor concluded that a plan like Vitale's "could be effective in reducing some administrative costs and lead to better care for the uninsured. Some of the care (the uninsured) get now is inefficient and low-quality."

Lost job, health benefits

For the Seamans and others without health insurance, reforms can't come too soon.

"For a long time, I just didn't go to the doctor," said Marilyn Manfrini of the Bayville section of Berkeley.

Manfrini, 48, suffers from fibromyalgia, a chronic condition that leaves her exhausted and mentally fogged.

When first diagnosed seven years ago, Manfrini worked for a bank that offered health benefits.

The illness eventually forced Manfrini from the job in the summer of 2005, but she maintained her health care benefits for another two years thanks, in part, to the federal health care continuation law known as COBRA.

However, she had to pay the $450 monthly premium herself, which was almost equal to the temporary disability benefit she was receiving.

"I was borrowing from relatives, friends . . . paying my bills with credit cards," she said.

Manfrini's COBRA period ended in June 2007, and she lost her health care benefits. That's also the month she was diagnosed with emphysema.

"I was petrified," she said, and though she was placed on permanent disability at this time, her monthly benefits were only enough to pay for her medications.

"So I'm not buying all the meds I need," Manfrini said, adding that she also relies on free pharmaceutical samples from a doctor.

As far as doctor visits, Manfrini has gone to a local free clinic and accepted charity care at Community Medical Center in Toms River and Deborah Heart and Lung Center in Pemberton Township.

"Not having health insurance is like floundering in the darkness," Manfrini said. "You are constantly fearful for the future of your health."

For George Cameron of Jersey City, who has been without health insurance since losing his job in 2001, the situation reflects the misguided priorities of a nation.

"My father fought in World War II. I enlisted in the Army in 1963," said Cameron, 63. "I live in the wealthiest country in the world . . . and here I am having to accept charity (care). It's humiliating."

Treatment for the flu

The Seamans eventually settled the dispute with their landlord, agreeing to pay the back rent in installments.

But that doesn't mean their health care worries are over.

Three weeks ago, both Stephen and Tina Seaman came down with the flu. Stephen missed a week of work and eventually sought treatment.

"I went to see a guy (doctor) who doesn't charge me much," he said, and the doctor also gave him free medications in the form of samples.

Two days after Stephen went to the doctor, Tina, 44, went to the emergency room of Community Medical Center for treatment. The cost of the visit was covered by charity care, but Tina's prescription was not.

"Seventy-five bucks, cash out of my pocket," Stephen said of the cost of his wife's drugs. "I hope I can pay the rent this month."

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