Road to healthcare coverage may have fewer bumps
On the same day that Daniel Rona qualified for healthcare coverage through his job as an emergency medical technician, an SUV slammed Rona’s motorcycle as he was riding in Santa Monica.
He was propelled more than 20 feet and landed on his head, breaking his cervical spine and injuring the frontal lobe of his brain.
The accident occurred on Jan. 18, 2009, three months after Rona had started working for Gerber Ambulance Service. The date also marked the end of the waiting period for him to qualify for employee healthcare insurance, but Rona — then 21 — had not yet signed the paperwork to start the coverage.
The new federal healthcare overhaul could affect Rona in a variety of ways because of his youth and the severity of his injuries.
Ten days in the hospital, including surgery to implant titanium rods into his back, caused Rona’s bills to soar to about $300,000 — an amount he must pay himself. His mother, Rebecca Rona Tuttle, paid about $100,000 for his aftercare and treatment at a rehabilitation center with money out of her retirement investments.
“If I had insurance, it would have taken care of the whole thing,” Rona said. The driver of the SUV paid $4,500 for Rona’s destroyed motorcycle, and her insurance agreed to pay $15,000 to help cover medical expenses.
During his nine months of recovery, Rona tried to buy private insurance, but was denied coverage. The reason: He was out of work and now had a preexisting condition.
“They wouldn’t even allow me to pay a higher premium,” Rona said of one of the companies he approached.
Under the new law, however, starting in 2014 insurers will no longer be able to exclude adults with preexisting conditions from being covered.
Rona returned to work at Gerber in September. He pays about $100 a month for coverage under his employer’s group health insurance plan.
But Rona is about to give up that coverage to pursue a dream. He plans to enroll in a nursing program at El Camino College in Torrance in the fall, and his long-term goal is to become a doctor.
Rona would be eligible to apply for COBRA, the federal program that allows former employees to continue with their company’s group healthcare benefits for limited periods of time.
But Rona might be required to pay 100% of the premium, plus administrative charges of up to another 10%, said Marian Mulkey, senior program officer at the nonprofit California Healthcare Foundation.
Rona said that continuing to use COBRA would cost him about $250 a month — not an easily affordable option.
He might be able to get student insurance offered through his college; purchase a short-term health insurance plan for a fixed duration through a company such as eHealthInsurance Services Inc., an online source of health insurance; or get onto his parents’ healthcare plan as a dependent, Mulkey said.
Starting this year, the new law will allow children to stay on their parents’ policies until they turn 26, as long as they can’t obtain insurance through their employer.
“This will have an impact on young adults transitioning into and out of different types of coverage,” said Sara Collins, vice president of the New York-based Commonwealth Fund, a nonprofit, nonpartisan foundation focused on improving the healthcare system.
Also, until 2014, people with preexisting conditions will be eligible for a federally funded so-called high-risk insurance program.
Collins said that starting in 2014, individuals who make about $14,000 a year and four-person families with incomes of about $29,000 a year — both groups comprise substantial numbers of young adults — would be eligible to enroll in an expanded Medicaid program.
In addition, adults younger than 30 will have the option to buy less expensive catastrophic health insurance.
Rona hopes his stepfather’s insurance plan is able to cover him for the expected two-year duration of his college courses, though he would like to be able to afford insurance on his own.
Even before his accident, Rona knew the risks of being uninsured, especially because he rides a motorcycle. Rona said he had tried to obtain temporary insurance to cover the three months before his company’s health insurance kicked in, but because he was making $8.50 an hour he couldn’t afford it. Then came his accident.
This is one in a series of occasional stories on the potential effects of the healthcare overhaul.