Young, uninsured, and unconcerned
Citing the expense, some balk at health plan mandate
East Boston realtor Ulises Rosa is 31 years old and healthy. He has a taste for fine wine, likes to host catered dinner parties, and travels often. But he bristles at the idea that the state may force him to buy health insurance, just as he must buy auto insurance.
''A car you can choose to own," said Rosa, who makes more than $60,000 a year. ''You can't force me to get insurance if I don't want to. It's my life."
Rhetoric surrounding the healthcare debate in Massachusetts has been largely shaped by plans to extend coverage to the poor. But two of the major initiatives under consideration by the Legislature would also, for the first time, require everyone who is able to afford it to buy private health insurance. Massachusetts would be the first state to impose such a requirement, a shift being hailed by many observers as forcing a new personal responsibility in the national debate over how people should get insurance.
But such a requirement, which would be aimed largely at the 200,000 or so people in the Commonwealth who are young, single, healthy, and without coverage, is setting off resentment among the uninsured. Their voices have rarely been heard on Beacon Hill, where insurers, doctors, and hospital executives jostle for attention from lawmakers writing the bills.
''I have so many expenses. I have a mortgage on my condo . . . car insurance. You try to maintain a certain lifestyle. After that, all your money is gone," said Rosa, as he sat in his roomy office, where a $200 leather jacket he bought in Buenos Aires hung on the back of his chair.
Under proposals offered by Governor Mitt Romney and House Speaker Salvatore F. DiMasi, insurers would be permitted to create plans that analysts estimate would cost individuals as little as $200 a month, with subsidies for people making up to $28,710 a year. Even that is too much, though, for many young people.
''If I had a wife or a kid, I would definitely get health insurance," said Christopher Raymond, a 29-year-old bartender at Sister Sorel in the South End who says he brings home between $600 and $800 a week. ''But when you're single you don't really care. You feel like you can get away with it."
Emily Jackson, a 23-year-old waitress from Mission Hill who moonlights at a South End boutique, said paying for health insurance is ''a lot of money just to be going to something that you might not [need]."
Jackson said a requirement to buy it might force her to give up her big-city life and move back to Maine, where her parents live.
''Who wants to live in Maine when they're in their 20s?" she said.
Nathalie Degenhardt, a 28-year-old who works at a Cambridge clothing boutique, recently decided to forgo healthcare so she could afford a new condo in Lynn. Spending money on rent and monthly health insurance seemed less practical than investing in real estate, Degenhardt said.
''As long as you're healthy, living without health insurance isn't a great hardship," she said. ''I think in an ideal world everyone should have health insurance. It shouldn't be a choice of 'I have to choose to pay this thing or pay this thing.' "
Ideally, she said, her employer would provide coverage. ''Really, all we want is that 9-to-5 job that gives you benefits, your 401(k), your health insurance, and your vacations. But it's hard to find those jobs," said Degenhardt, who aspires to become a fashion designer.
Employer-provided health insurance is becoming less common, as companies try to trim costs and turn to independent contractors. Many healthcare specialists are convinced that an individual mandate is the only way to achieve the goal of covering everyone in the Bay State.
But critics say the requirement is mostly a gift to the insurance companies, who would get thousands of new customers who are unlikely to get sick.
For 21-year-old Ignacio Munguia, an office manager who works in Rosa's office in East Boston and makes only $18,000 a year, the strain of a new health insurance premium would be considerable. Every month, he sends about $300 to $400 home to his family in Costa Rica. Recently, he sent $1,500 so his older sister could get laser eye surgery her doctor said was imperative.
The state's proposal would punish people who can't afford insurance.
''It concerns me because as we're talking I don't have the money," Munguia said last week. ''Who likes to be penalized for not having the money? It doesn't make that much sense."
Supporters of the requirement say Massachusetts residents who do have insurance end up paying for those who don't. Inevitably, some of the uninsured do get sick or hurt, and when they do many of them rely on the state's free-care coverage.
Massachusetts spent $1.1 billion on the uninsured last year. People who don't qualify for free care and can't pay for the care they get drive up medical costs for everyone else when hospitals seek to recoup their losses.
Many of the uninsured forgo preventive care, visiting hospital emergency rooms only when their health problems worsen and are more expensive to treat.
Furthermore, the absence of many young and healthy people from the insurance ''risk pool" drives up premiums for everyone else.
Timothy R. Murphy, the state's health and human services secretary and primary architect of Romney's plan, said having health insurance should be part of the ''social compact" that binds citizens together for the common good.
''When you engage these individuals and give them a medical home, you have the ability to lower costs," Murphy said. ''People aren't, for example, showing up in diabetic shock. They're getting insulin. If you engage the consumer and bring everyone into the system, that begins to set up a more rational market."
Murphy said that individuals and families making more than three times the federal poverty level should be able to afford the low-cost plans that insurers would create under the Romney and DiMasi proposals. Three times the federal poverty level is $28,710 for individuals and $58,050 for a family of four.
But Raymond, the South End bartender, echoed the criticism of some liberal healthcare advocates who want a government-run system. He said the move to force people to buy insurance would funnel money to insurance companies, not provide better healthcare.
''You have other countries where it doesn't cost a thing, or $50 a month," he said. ''It's an awful system of people just trying to make money off people, and it's gotten way out of hand." 