I recently had a conversation with a cousin. As we discussed our families, he told me proudly about his 27-year old daughter, a nurse. She was working in two interesting but part-time jobs, one at a community health clinic and the other with senior adults. “Great,” I said. “But wait. How does she get health insurance?” She was too old to be on her parents’ policy, a possibility for those under 26 since the adoption of the Affordable Care Act (aka Obamacare). The answer was simple. “No problem!” her father said. “She lives in Massachusetts!” Yes, all she needed to do was go to the health care exchange (called the Health Connector); enter a few basic facts, including age, income and ZIP code, and then choose among a number of policies, much as people in other states would compare car insurance policies. (Thanks, Governor Romney.)
By 2014, insurance exchanges similar to those in Massachusetts will be open for every state, with subsidies for those with modest incomes. The implications for all Americans will be profound, which becomes clear when we take a look on how this reform in health care might affect Jewish professionals and the organizations they work for.
First, there will be more possibilities for senior professionals under 65 (the age of eligibility for Medicare) to consider early or partial retirement. There is a very large group of baby boomers approaching the traditional age of retirement. While many are interested in continuing work in various settings, at least some might cut back on hours or consider a new position or career — if they were not to lose health insurance by doing so. By making these career moves, at least some positions would be open for others to move up the ladder. In addition, some new or smaller organizations or congregations would benefit from experienced but possibly part-time professional staff.
Second, younger people who have been avoiding a job move that might result in a loss, or even a gap, in health insurance coverage for themselves or their families, will no longer be in this position. This reform will give them options, even if they have preexisting conditions.
Some talented people will be more willing to consider such moves (professional or geographic) to seek creative opportunities or join start-ups. Large Jewish organizations typically have group health insurance policies for employees, which I hope will continue to be the norm. But smaller organizations, including small congregations with only one or two full-time employees (or none at all), have had great difficulty in offering or paying for health insurance for their staff. That will change in 2014, when small employers (including congregations and other nonprofit institutions) will be able to turn to a “small business” exchange to purchase health insurance policies for employees at reasonable costs.
With the ACA fully in place in 2014, even people with relatively midlevel incomes will be able to take advantage of financial subsidies for health insurance. And out-of-pocket costs, though still possibly substantial, will be capped.
For example, according to the Kaiser Family Foundation, using a “silver” (midrange) plan, a 35-year old single person earning $35,000 in 2014 would pay a maximum of $3,325 a year for health insurance with a government subsidy of $637. Additional out-of-pocket expenses would be capped at $4,137. Jeff Gelles, a consumer writer for the Philadelphia Inquirer, offers this example: “Coverage through the exchanges will be subsidized for people earning up to 400 percent of the poverty level — close to $90,000 a year for a family of four, though subsidies shrink as income rises.”
The combination of access and subsidies will not solve all the problems Jewish professionals face in finding employment and getting affordable health care. However, the changes due in 2014 will have a positive effect on the number of full-time and part-time Jewish communal jobs available and on the flexibility of people to accept them. Our community will be enriched by these professionals, who can finally focus on their own contribution to the Jewish future without fearing for their health and the well being of themselves and their families in the present.
Robert Tabak is a staff chaplain at the Hospital of the University of Pennsylvania, in Philadelphia.