More on Dying for Care


‘This won't be easy’

The same month Young was diagnosed with cancer, President Barack Obama signed the Patient Protection and Affordable Care Act into law. The Obama administration has said the goal is to greatly reduce the number of people in Young's predicament, by providing comprehensive coverage to people throughout the United States.

In October, the American public is supposed to see the law's most significant changes to the health care system when a marketplace for health plans opens to allow uninsured people to shop for coverage.

But the law has created a daunting challenge for federal and state officials and for nonprofit groups who work with communities expected to most benefit from the overhaul. They have to get people, most of whom know little about the new law, to understand the changes and convince them to buy into the reform.

“There already is a big federal health care bureaucracy now that will be joining with the states' health care bureaucracy,” said Linda Fentiman, a professor who teaches health care law courses at Pace University. “This won't be easy.”

The law will require every American citizen to have some form of insurance. People will have to seek coverage through their employer, apply for government assistance or search for private plans. Critics say the law will likely function much differently than the Obama administration expects, with higher costs and fewer people getting coverage than projected.

If people skip out on care, they will pay a penalty.

What happens if I don't get health insurance?

In 2014, American citizens will have to get insurance. When filing tax returns in 2015, Americans will have to show proof of insurance. If not, they'll pay a fine. Here's how much.

Fines for individuals

  • 2014
  • 2015
  • 2016
  • $95
  • $325
  • $695

Fines for families

  • 2014
  • 2015
  • 2016
  • $285
  • $975
  • $2,085

Source: Kaiser Family Foundation

The Internal Revenue Service will check whether people have insurance, Fentiman said. People will first be faced with the government's enforcement when they fill out their tax returns in early 2015. Taxpayers must indicate whether they meet the mandate.

The penalties for failing to have insurance will be relaxed in the first year and become increasingly costly for those who remain uninsured.

For someone like Young, who worked as an independent contractor singing professionally for multiple companies, employer coverage wouldn't be an option. So the state's exchange will give people like him the chance to buy insurance.

If Young tried now to purchase his own coverage from an insurance company, the cost would be high. For instance, quotes for individual health maintenance organization, or HMO, coverage for New York's version of Blue Cross Blue Shield range from $1,150 to $1,437 a month. A plan that only pays for wellness visits like routine physicals and coverage for inpatient hospital costs with no other coverage costs $165 a month.

“One of the reasons why individual insurance is so expensive is that, in general, people who are healthy opt to not buy insurance,” Fentiman said.

So insurance companies believe the main reason people are seeking individual coverage is because they are sick, and thus, will increase costs for the carrier.

But when the law takes effect, insurance companies will get a range of people - healthy, young, sick and old - looking for insurance.

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