This year, health insurance premiums are expected to rise to an average of more than $14,500 for family coverage. As it is, individuals pay an average of almost $4,000 per year for health insurance cover.
The U.S. government spends more than four times as much on health care as it does on national defense, and yet in 2003, individuals were spending $230 billion on individual health care plans.
Amongst the Irish community in the U.S., health insurance has become a critical issue in light of the high numbers of Irish immigrants working in the service industry, where employers rarely offer health insurance plans.
For some Irish immmigrants, health insurance can literally become a matter of life or death, as was demonstrated in the case of Madeline Polcer, a Long Island mother-of-two who was left uninsured with a newborn baby and in debt to the tune of over a million dollars after her husband died of cancer, the treatment of which was not adequately covered by the family’s health insurance.
For employees working on a contract or freelance basis, getting insurance cover through a company plan is often not an option. With a range of plans to choose from, finding the right individual cover can seem like a daunting task. In addition, mistakes can be costly – considering that some individual premiums can run as high as $500 per month.
“For those who have legal immigration status, it’s very useful to use a broker,” advised Patricia O’Callaghan, coordinator of Project Irish Outreach, a drop in center in Manhattan where Irish immigrants can go for advice about healthcare and immigration issues.
“A broker can help you cut through all the complications in terms of location of services, costs and procedures,” she said.
In this category is broker and insurance agent Terry Freehill, who has been working in the Irish community in New York for nine years.
“You can get group cover by a professional association,” he said. “But be advised that nowadays, you have to show all sorts of proof of employment.
“The main thing is to try to figure out if you can get into a group,” agreed Sarah Horowitz, executive director of Working Today, a union that offers low-cost insurance to employed freelance workers in certain occupations.
“The best way is to go through a professional association or try and get their employer to set up a group,” she said.
According to Horowitz, “The Encyclopedia of Associations,” which is available in most New York libraries, is an invaluable resource in this regard.
Freelance workers whose declared income is under $25,000 per annum may qualify for Healthy New York, a low-rate insurance plan offered by New York State. Working Today offers insurance cover to eligible individuals ranging from $114 to $286 per month.
Jim Barrett runs Business Enterprise for Irish Americans, a company that offers insurance to employed people and small businesses in the Irish business community in New York State. At the moment, he has around three hundred clients, most of whom work in waitressing or bartending. His premiums range from $299 per month for individual cover to $1100 per month for families.
“I’m glad someone’s finally addressing this,” he said. “The biggest obstacle we face today is cost, with rising rates from 7 percent up to the mid-20s. Most everyday people just can’t afford it.”
For employees leaving jobs where they had insurance cover, journalist and employment researcher John Rossheim recommends investigating COBRA, a federal law that allows employees continued coverage from their former employer up to 18 months after they leave the job.
“The catch is you’ll have to pay your own premium plus extra to cover administrative costs,” he said in a recent article on recruitment website monster.com
“But these costs, while high, will likely be lower than what you’d pay on the open market,” he explained.
If your spouse has health insurance, you could stand to save significantly by joining his or her insurance policy, according to Rossheim.
“Your spouse may be required to pay an additional premium, but it will probably be much less than what you’d pay for your own policy,” he said.
For the estimated tens of thousands undocumented Irish immigrants living in the U.S., however, there are fewer options. According to the New York Immigration Coalition, all hospital emergency rooms in New York State will provide medical screening and emergency care to patients, regardless of their immigration status and regardless of their ability to pay.
The New York City Health and Hospitals Corporation has hospitals and clinics around New York City where they provide non-emergency health care services for patients regardless of their status or their ability to pay.
“We’re a federally funded community health center, we operate on a sliding fee scale for non-insured patients,” according to a spokesperson for the HHC affiliated Ryan-NENA Community Health Center, which is located in the East Village.
“It’s based on family income. Our lowest fee is $29. We have a subsidized pharmacy plan where the person pays a fee and the hospital covers the difference. If the patient needs a service we can’t provide then we make a referral to a local hospital,” the spokesperson added.
HHC hospitals offer subsidized treatments and prescriptions to low-income individuals, including undocumented immigrants, and above the income cutoff, their fees operate on a sliding scale under a plan known as HHC Options.
“Our hospitals treat patients regardless of their status and their ability to pay,” according to a spokesperson for the HHC.
“We have an option available for people who are either undocumented or over the cutoff up to around 400 percent above poverty level. Above that threshold they have to pay whatever the fee is,” the spokesperson said.
The HHC encourages patients with health or insurance queries to visit their nearest clinic, where advice and counseling services are available.
Everyone is entitled to emergency treatment in hospital under the government’s Medicaid Emergency program. Since 1993, low-income New York State residents have been able to avail of Fidelis, a low-cost insurance cover that was set up by the archbishops of the seven Catholic dioceses. Fidelis offers free insurance cover to all children up to the age of 19, including children who are undocumented. Adult individuals qualify for Fidelis if their income is below $10,000. There are no provisions in either Medicaid or Fidelis for undocumented adults whose incomes are above the specified cutoff levels.
Pregnant women living in New York as citizens or immigrants are eligible for PCAP maternity care throughout their pregnancy and up to at least 60 days following delivery. Income threshold starts at $26,000 for a single mother with one child.
For undocumented Irish immigrants whose wages are above HHC cutoff levels, however, there are few options but to pay the full cost of health care treatments.
“It’s just not possible to get insurance cover if you don’t have the paperwork,” according to Freehill.
“Getting in touch with the Aisling Center or the Catholic Charities to discuss their options and maybe explore the possibility of Medicaid is really the only viable option for them,” he said.
Both the Aisling Center and Project Irish Outreach have worked tirelessly to highlight the need for insurance cover for undocumented immigrants. But there is no resolution in sight, as yet.
“It’s very hard and stressful, thinking about the bills can be as stressful as thinking about the illness,” said Sr. Christine Hennessy, a social worker with the Aisling Center.
O’Callaghan urges people to contact Project Irish Outreach if they need advice.
“Emergencies happen — in that case, people should go directly to an emergency room and get appropriate care. Clinics attached to hospital will often fee-scale based on people’s income. They should feel free to call our office if they want confidential information,” she said.
Project Irish Outreach, Tel: 212 419 3726
The Aisling Center, Tel: 914 237 5121
Terry Freehill, insurance agent and broker, Tel: 718 721 5008
Jim Barrett, Business Enterprise for Irish Americans, Tel: 718 729 7655
For more information about Healthy New York, contact 1-866-HEALTHY NY
(1-866-432-5849). Calls are toll free.
Working Today, Tel: 718-532-1515, log on to www.workingtoday.org or email firstname.lastname@example.org
For more information about Fidelis, contact 1-888-FIDELIS (1-888-343-3547). Calls are toll free.
For a list of HHC affiliated clinics and hospitals, log on to www.nyc.gov.html.hhc
Next week: Once covered, how does one navigate the medical minefield? See the conclusion to the Irish Echo’s series on insurance.