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Facing up to insurance changes

When the new insurance rules kick in this summer, some people will get better medical care. Others say the coverage will come at too high a price.

Annabelle Blake(Mark Wilson / Globe Staff Photo)

Annabelle Blake

If she had a choice, she might opt to skip the insurance

Annabelle Blake recently cancel ed her cable television service. With that money saved and a bit of budget tightening here and there, she will be able to buy the least expensive health insurance plan approved by the state. Including drug coverage, that would cost $174 a month -- far less than the $435 quote she got from a health insurer two years ago. And the bill might be lower still, if her employers allow her to set aside money before taxes.

But if she had a choice, she'd skip the insurance . At 34, she'd prefer to put the money in the bank, or to treat herself. She likes living by her own rules.

"It's a basic trespass on who we are as Americans," said Blake, of Roxbury, who works as a temporary administrative assistant or accounting clerk. "They get to decide what's best for me."

So, faced with the July 1 deadline for getting insurance, she's aggressively looking for a full-time job with health benefits. It's not been an easy search, since she doesn't have a college degree. But there have been several promising interviews in the last few weeks and she's optimistic.

"It's so weird to consider a job for the benefits," she said. "The money isn't so great, but the health benefits would be terrific."

Blake had several permanent jobs with health insurance a few years ago, but one company went out of business and another moved out of state. To better her employment chances, she's been taking classes toward a degree at the University of Massachusetts when she can afford it.

She's licensed to sell real estate and do manicures, which bring in a little more money. All told, she earns about $30,000 a year, just enough to make her ineligible for state-subsidized insurance.

To keep her bills down, she says she eats lots of pasta, tofu, and vegetables. She drives a $1,000 car and pays a small mortgage on a rowhouse in Roxbury that she bought in 1998, when the next-door residence was a crack house.

"I don't have any savings, but I don't deprive myself either," she said. "I never spend $100 on jeans, but I have nice clothes."

Without insurance, she's paid out of pocket when she needed care, or avoided the doctor. Last year, she saw a dermatologist for a couple of moles and ended up with a bill for $600. She borrows an inhaler from friends when her asthma acts up. And she battles mild depression on her own.

But she does occasionally worry about not having regular check ups, since two of her grandparents died of cancer and other family members saw their depression worsen with age.

"If the jobs don't pan out, I'll probably go with the $174 plan" rather than face a penalty, she said.

Osmani Rodriguez(David Kamerman / Globe Staff Photo)

Osmani Rodriguez

Says the state should rethink the insurance options it is offering

Just a few years ago, the Rodriguezes had no worries about health coverage. Osmani Rodriguez and his wife, Rena Pemper-Rodriguez, were managers at Boston banks with good benefits.

Then their jobs were eliminated in a succession of bank mergers, forcing them into debt and their children briefly into the state Medicaid insurance program.

Slowly, the couple pieced together enough freelance work and part-time jobs -- teaching, singing, and acting -- to pay their bills. And they purchased insurance through a church where Rodriguez works. But they will lose that coverage on April 1.

Because of their two boys, ages 5 and 7, they don't dare go without coverage. But the new lower premium plans approved by the state this month carry out-of-pocket expenses that Rodriguez fears will put the family deep in debt.

"I'm not going to be able to afford the mortgage and utility bills, let alone put food on the table," said Rodriguez, who is 39 and emigrated from Cuba as a child. "And if I don't buy insurance, we're going to be penalized, considered criminals."

The Rodriguezes support the idea that everyone should have health insurance. And they are willing to pay something for coverage.

But the new Commonwealth Choice plans aren't affordable and aren't good enough, he said. The lowest - cost plan carries a monthly premium for his family of $690, but it comes with a $4,000 deductible. The one plan without a deductible has a higher premium of $880, and would require the family to pay 35 percent of the cost of any hospitalization, up to a maximum of $10,000.

"That would kill us," he said.

Together, they expect to earn about $64,000 this year. Pemper-Rodriguez teaches music at Our Lady of Lourdes Catholic Church in Jamaica Plain. They are cantors at St. John's Chrysostom Church in West Roxbury and direct its children's choir. And Rodriguez is program manager for arts and education at the Hyde Park Presbyterian Church. They sing at weddings and funerals. In a lighter moment, they created a cabaret of their life story, including their first encounter, when she played Maria in a Boston high school production of "West Side Story," and he played Chico, Tony's killer.

Still, sometimes they have to charge expenses to their credit cards to afford the $640 monthly health insurance premium though the Hyde Park church, which subsidizes their plan. Last week, Rodriguez learned that job -- and the insurance benefit -- will be eliminated April 1.

With the state's July 1 deadline looming, when the law says everyone must have coverage, Rodriguez is frightened and angry.

"Commonwealth Choice is not going to give us -- a hardworking family -- a chance to get back on our feet," he said. "They need to rethink these options."

James Charles Roy(Erik Jacobs / Globe Photo)

James Charles Roy

His family's long standing health plan is no longer good enough

James Charles Roy has downgraded his family's health insurance year after year to keep the premium remotely affordable.

"It's been absolutely brutal," he said, of the rising healthcare costs.

As a writer of history and travel books who is married to an artist, he needs to keep expenses down -- especially with one daughter at Bowdoin College and another starting college in the fall. Their yearly income is typically about $70,000, mostly from investments and past sales of real estate, he said.

While their health policy covers most services, the family faces a $4,000 deductible before the insurer will pay any hospital costs. They must also buy prescription drugs on their own. And the monthly insurance bill is more than $1,000 a month, even with a discount through the Newburyport Chamber of Commerce.

About three years ago, when they had a lower deductible, their younger daughter, Dana, needed an appendectomy and they paid about $3,000 out of pocket. Since then, the family has been healthy. Drug costs have been minimal.

But now the state says Roy's insurance isn't good enough to meet new requirements. He must buy drug coverage, starting in January 2009, or pay a fine -- unless the rules are changed before a final vote in June.

"I'm not a libertarian," he said, during a break from writing at his Newburyport home. "I recognize the need for coverage and recognize we have to provide for people below the safety net. But I ought to have some choice in this."

Roy, 61, is self-employed. His books include "The Back of Beyond: A Search for the Soul of Ireland" and "Islands of Storm," a history Book-of-the-Month Club selection a decade ago. His wife, Jan, 58, designs silkscreen posters and cards, and paints landscapes in her Haverhill and Newburyport studios.

"My wife and I have been completely responsible," Roy said. "We've been shelling out the money."

He said that drug coverage will cost him an extra $1,300 a year -- for insurance he doesn't need or want.

He could change insurers and save about $1,000 a year in premiums by buying the lowest-cost plan sanctioned by the state, but his out-of-pocket expenses could be higher. "I probably wouldn't go through the bother," he said.

"The goal of universal coverage, as I understand it, was to get poor people coverage," he added. "What are they doing messing with me?"

Betty Gitlin-Rich(Michele McDonald / Globe Staff Photo)

Betty Gitlin-Rich

It's been a long time since she could afford peace of mind like this

For the first time in 15 years, Betty Gitlin-Rich and her husband may be able to afford health insurance. A small increase in their income, combined with the lower premium costs of the new plans approved by the state last month, may finally put insurance -- and peace of mind -- within their reach.

"We risked it and then we both got illnesses," said Gitlin-Rich, referring to their long stint among the uninsured. Five years ago, Michael Rich had to have a kidney removed, and last November, Gitlin-Rich said she nearly died from a systemic blood infection linked to kidney stones.

"When I was at the emergency room at Newton-Wellesley Hospital, I cried about how I could afford" the care, she said. She was transferred to the intensive care unit at Massachusetts General Hospital and was hospitalized for five days.

The state's free care program covered most of her hospital costs, and she is extremely grateful for the financial help and the care she received. But the family is still paying off more than $17,000 in medical debt, she said. She has since had two surgeries for the stones and may need to have another.

She hopes to sign up as soon as possible for insurance -- as long as her trusted primary care doctor is covered. The monthly premiums for the couple will range from $513 to $950, depending on which of the new state plans they pick.

"We'll have to work harder to make the premiums," she said. "But it's better than the $1,200" they were quoted before.

Michael Rich, 55, runs his own law practice, specializing in family and children's law, and Gitlin-Rich, 54, helps around the office. This year, they hope to make about $60,000, too much to qualify for free care.

They face mortgage payments of more than $2,000 a month on their Arlington home -- a result of borrowing against the house to get through lean years when Rich worked as a bar advocate in the district courts and they raised two sons. During that time "when we were always broke," Gitlin-Rich said, they were also caring for her mother, who had Alzheimer's.

Now, they are making payments on college loans for a son at Lehigh University and chipping away at the medical debt. Their older son is financially independent.

"This new insurance will come just in time," Gitlin-Rich said. "It will ease my mind if something catastrophic happens again. But I wish it wasn't so expensive, and I worry that it will become unaffordable again if they raise the prices next year."