Health care reform, if it survives the election of Republican Scott Brown to Ted Kennedy's old Senate seat, will make insurance accessible and provide a slew of new consumer protections for millions of Americans.
But for thousands of Rhode Island artists, musicians, writers, young professionals and entrepreneurs, reform will also bring a new dilemma: by 2013 or 2014 — depending on whether the House or Senate bill prevails — they'll have to buy insurance even if they don't want to.
And not just any policy will do; it will have to be, as the Senate bill puts it, "acceptable" coverage, including preventive care and other "essential" benefits. In Massachusetts, where similar requirements are in place, the cheapest plan available to a Boston 25-year-old (a "Young Adult Plan") costs $152 per month; for people over 26, plans start at $213.
The federal law is expected to include subsidies, but only after you've spent a certain share of your income on premiums — 8 percent, for example, under the Senate bill for a single person earning $27,075, or $180.50 per month. How do you afford that if you're just scraping by?
Dr. Michael Fine, a Scituate family physician who retired last year to focus on advocacy, wants Congress to give Americans a second option: a subscription to a primary-care practice combined with high-deductible health insurance.
The model already exists in Rhode Island: It's called HealthAccessRI, and it has enrolled just under 700 patients who pay $25 to $30 a month to get care at one of 17 participating practices. Need to see a doctor? It'll just be a $5-to-$25 co-pay. And through partnerships with other local providers, Access members get discounts on imaging, lab tests and other services.
Combined with catastrophic coverage, this can meet most people's needs, Fine says – and at a much lower cost than comprehensive insurance. It also keeps people out of emergency rooms, and it helps doctors by providing steady revenue without insurers' constrictions.
Health care reform, as it's expected to pass, not only won't accomplish that much, Fine says, but it may raise insurance premiums dramatically. Yet without an exception for the HealthAccess model, reform could actually kill off that lower-cost alternative.
So for months, Fine has been lobbying to get that exception included in the final reform bill. The Senate bill already has the exception in place. But neither the House nor the Senate version fixes the nation's health care system or makes health care affordable for all, he says, so he hopes Congress will keep working on those problems and maybe learn from HealthAccess.
"From my sense of the world, something's better than nothing, but we've got a long way to go," he says. "This is just the first step."
Meanwhile, locally, the program has recently won new allies who are helping it reach its target audiences: people in that 200- to 400-percent-of-poverty range, especially creative types, freelancers and "young invincibles" — as well as hospitality industry workers and uninsured immigrants.
On the immigrant front, Dr. Pablo Rodriguez, co-founder of Latino Public Radio and a practicing ob/gyn, has now joined the program with his Pawtucket practice, Women's Care.
And in the creative and young-invincibles world, Fine now has the enthusiastic support of Stephanie Gerson, a social media consultant and founder of Pecha Kucha Providence, a monthly gathering that attracts scores of artists, designers, techies, and young professionals.