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September 27, 2013

Grateful for healthcare act but still hesitant about premiums

DUNCAN — Ben Moore subsists almost entirely on tips.

Moore, 33, is a full-time server at an Olive Garden restaurant in Oklahoma City. He said he reports every penny of his tip earnings to the IRS. His yearly income is around $22,000.

Olive Garden offers health insurance to its employees, but the monthly premium is more than $300, he said. That seems like more than he can squeeze into his monthly budget.

“It’s not necessarily the brightest thing on the planet, but I don’t take the health insurance,” said Moore, who is 33 and single.

“I won’t lie to you,” he said. “I should be looking at those kinds of things. But insurance just seems like a luxury item … The kind of money they want me to pay for that, I could go out and buy myself a new car.”

That could change next month when people like Moore can begin applying for subsidized health coverage through the Affordable Care Act insurance marketplace.

According to the Kaiser Family Foundation, Moore should be able to buy a “silver”-level health plan at a net cost of $259 per month, after tax credits are taken into account.

A cheaper “bronze” plan would cost him $182 per month, according to an online insurance cost estimator developed by the Kaiser Family Foundation.

Silver plans are designed to cover 70 percent of an average person’s health care expenses. Bronze plans are designed to cover 60 percent.

If he chose a silver plan, he would also qualify for additional medical cost-sharing subsidies that would reduce his total health care outlays.

The new online marketplace is not open to people who already can get affordable and adequate insurance from their employers. But it appears Moore would be eligible because the cost of his company plan exceeds an affordability threshold of 9.5 percent of his annual income, set by the health-care law.

Moore would wind up paying bigger premiums than many marketplace customers because he’s a smoker. A non-smoker at his age and income level would pay monthly premiums of $108 for a silver plan and $57 for a bronze plan, according to Kaiser.

Some health insurance advocates have expressed concern that the hefty premiums paid by smokers could deter marketplace participation under the Affordable Care Act, particularly in states like Oklahoma with high rates of tobacco use.

“I suppose I could afford something like that,” Moore said of the estimated premium amounts. “But it definitely would be a stretch for me, because every penny counts at this stage.”

Moore said most of the restaurant employees he knows don’t sign up for company insurance. Many are young and still covered by their parents’ policies, he said. Others consider the insurance too expensive or its benefits too limited.

The exceptions tend to be employees with spouses and children, who find a way to work the cost into their household budgets, he said.

Moore said he is grateful that the health-care act is now the law of the land.

“I was thrilled,” he said. “I didn’t think the Republicans would ever let something like that go through … I know we’re only weeks away, but it still seems unreal.”

He said his sentiment is not shared by other restaurant employees he knows. “They believe that any kind of health insurance is some kind of nanny state thing. They don’t even know what it is.”

Moore’s estimated silver plan premium is $259 per month. Moore’s estimated bronze plan premium is $182 per month.

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