Nick Johnson is a 33-year-old Folly Beach bartender who hasn't had health insurance since he was 18. He also hasn't seen the inside of a hospital or a doctor's office for more than a decade, but two weeks ago he injured his left hand playing baseball with his nephew. It still hurts in the mornings, but he says he can deal with it.
Last week, the Affordable Care Act's online health insurance marketplaces opened for the first time, giving those without insurance the opportunity to buy it at, hopefully, reduced rates. In fact, some individuals can even receive government-subsidized coverage if they meet certain income levels. But Johnson is uncertain how much he'd be willing to pay for good coverage even if he did shop around. For the Folly Beach bartender, getting health insurance isn't a big concern.
And like many his age, Johnson doesn't have any idea what he'd do if he suffered a major accident and hospital bills started piling up. "I've never thought about it because I've never needed it," he says. "It just doesn't seem worth it to me."
Frank Knapp, president of the S.C. Small Business Chamber of Commerce and an advocate for the new healthcare law, says there's no reason a 33-year-old single male bartender shouldn't take responsibility for his own healthcare. As for those who are 30 and younger, the ACA offers low-cost catastrophic health care plans that cover major accidents but offer high deductibles, a good deal for those Knapp calls "young invincibles" who rarely go to the doctor. "I've heard some reports of these plans being almost free," Knapp adds.
The food and beverage industry is full of the kind of uninsured healthy young people the government hopes will sign up through the new exchanges. After all, the more people paying for coverage who aren't using it, the better the system is.
Here in South Carolina, state GOP leaders chose not to create state health care exchanges, so the federal government is operating them instead. While there are groups that are designed to help people navigate the process of getting signed up — like those who received federal Navigator grants — they can't reach everybody. And when it comes to Navigators, they can't recommend a healthcare plan, but they can show you your options. Licensed brokers, however, can do both.
One of them is Clark "Corky" Ullom, president of the Georgia-based HIX Marketplace who works for a private company licensed in 48 states to help people figure out the process of getting covered. Last Wednesday, he was stationed outside a giant Health Aviator tour bus parked in Marion Square as young guys tossed around frisbees and girls in bikinis sunbathed nearby. The insurance companies that are on the exchanges pay Ullom and his company for each individual they sign up. The Health Aviator bus will be in Charleston for the next three weeks, and Ullom says they've zeroed in on one specific industry.
"Hospitality is our main focus," he says from behind a pair of sunglasses.
His company has already partnered with the Greater Charleston Restaurant Association, and thousands of his business cards will end up in the envelopes of Lowcountry service industry workers when they get their next paycheck.
"You've got hard-working young people who don't have an opportunity for any type of reasonably priced health insurance," he says. "It's the biggest market out there." He also notes that a lot of these uninsured workers are confused about the recent government rollout and are looking for people like him to help them sign up.
One such worker is a local bartender and recent College of Charleston graduate named Charlotte Woodward. Most of what the 22-year-old has heard about the exchanges has centered around the right-wing/left-wing talking points. "I don't know much about the details," she says.
While she was in college, Woodward had cut-rate coverage that was rolled into her tuition, and she says it wasn't great. But now she's uninsured. Since she's under 26, she could technically be on her parents' plan, but she says that isn't an option.
Right now, Woodward's plan is to pursue another job outside the hospitality industry that will offer her an affordable and solid health plan. "I've done OK without it this far, but there have been some things health-wise I've been putting off and that's never good," she says.
Sue Berkowitz, director of the S.C. Appleseed Legal Justice Center and a supporter of the federal healthcare law, hopes Woodward gets covered. "I want the people bringing food to my table to be healthy," she says. "It's worth it to start thinking about how you care for your health and well-being and look at that as part of your expenses."
Berkowitz says Woodward should visit healthcare.gov and see if she's eligible for a subsidy. Berkowitz says the bartender could probably get an affordable plan that offers coverage and preventative care, including screenings and physicals, with co-pays as low as $30 or $20 for a visit. Prescriptions like birth control would be covered with a similarly-priced co-pay, the Appleseed director adds.
Berkowitz blames the state's Republican leaders for why many young people are largely unaware of the ACA. South Carolina is one of the states choosing not to expand Medicaid, and Republican lawmakers had opposed implementation of the law. In fact, a failed bill in the state Senate would have made it a crime for public officials to implement the law here. More recently, Republican Gov. Nikki Haley told the media the state was doing all it could to help people sign up, but pointed out that the healthcare.gov website hasn't been working for everybody. "We're going to continue doing what we can," Haley said, "but this is continuing to be the mess we thought it would be."
Problems with the federal website underscore something of a disconnect. Yes, there may be so many people clamoring for healthcare that the website is overwhelmed, but there are plenty of uninsured people with no clue that it even exists.
Consider Matt Vliet, a 26-year-old uninsured student in a welding program at Trident Technical College who works at night as an independent contractor for a local pedicab company. He's isn't sure how the ACA might affect him. When he was told about the healthcare.gov site and what it does, Vliet says he'd be willing to check it out, but he is also willing to go without coverage for the time being. He hopes he'll get a good job with a decent health plan after he graduates.
Vliet is clear about one thing. He knows he will be fined if he doesn't get coverage. After 2014, most Americans without coverage will have to pay $95 or 1 percent of their income (whichever is higher) when they pay their taxes if they don't have health insurance. That fine will go up the following year and could be as much as $695 by 2016. The Congressional Budget Office estimates the federal government could net some $7 billion from the roughly six million people who could end up paying fines. One of them might be Vliet.
"Just because of my age and my invincible nature, I probably would be willing to pay the fine instead of health insurance at this point in my life," he says while parked on King Street outside PURE Theater Wednesday night. "I think most people under 30 would be willing to pay the fine."
And it's that attitude that some anti-Obamacare groups are banking on. Actually, they're actively pushing such a message on college campuses. Virginia-based Generation Opportunity, for instance, is running an ad campaign called Opt Out. In one ad, a college-aged girl who signed up for Obamacare is led into a gynecologist's office and asked to put her feet in stirrups. After the nurse leaves, someone dressed in a creepy Uncle Sam costume rises from between her legs brandishing a speculum. "Don't let government play doctor," the onscreen text reads. "Opt out of Obamacare."
Part of the right-wing war on the new healthcare law could be an attempt to cripple its effectiveness, and people like Vliet are the ones caught in the middle.
Back on the King Street pedicab, Vliet thinks about some of his colleagues who have been hit by cars or injured on the job. He says if someone showed him how to shop around for coverage and he could get it really cheap, he might sign up. But even then he's doubtful he would purchase health insurance.
"I wouldn't be willing to pay $150 right now while I'm in school," he says.