July 26--For 10 years, Marcia Snell worked part time for a food-service company and was not offered health benefits.
That changed in May, when she was granted full-time status.
But the health-plan premiums were too expensive for the Hilltop woman, who qualifies for Medicaid during most years. So she passed on the benefits.
Snell has a history of heart issues and is supposed to take prescription medications to control her blood pressure and cholesterol. She also is supposed to take Plavix, a drug that can prevent strokes and heart attacks.
She said she stopped taking Plavix a few years ago because it had cost her $130 a month.
In July, she suffered chest pains and underwent triple-bypass heart surgery at Ohio State University Medical Center.
Employed, but uninsured, Snell qualified for a Medicaid program that pays hospitals for caring for indigent patients. Her surgery and hospital-stay tabs were picked up by taxpayers.
Open-heart surgeries in the United States can cost as much as $200,000.
Under health reform, situations such as Snell's could be avoided.
In 2014, Snell will have to have health insurance. And if she needs additional surgery, her employer will pay a portion of the costs.
"The goal with health reform is to ultimately reduce the number of people without insurance and provide new avenues of coverage," said Jennifer Tolbert, health policy expert at the Kaiser Family Foundation.
"In today's environment, the offering of employer health insurance is completely voluntary," she said.
In 2014, companies will face penalties if health premiums exceed 9.5 percent of a full-time worker's income. If an employee still can't afford coverage, he or she will be eligible for a subsidy through state health exchanges to help buy an affordable policy.
At that point, employers will face a penalty of $3,000 for each employee in the exchange or $2,000 for each full-time worker (excluding the first 30 employees), whichever is less, Tolbert said.
"This provision is designed to force employers who are currently providing coverage, but the coverage is not affordable, to think about how to structure these health-insurance plans so they're affordable to all workers," she said.
Snell, 58, has worked for Sodexo for a decade supervising volunteer groups who sell concessions at Ohio State's athletic facilities. Depending on the season, she said, she works 30 to 60 hours a week.
Sodexo, which has 120,000 employees in the United States, had considered her a seasonal worker until the spring.
Alfred King, a Sodexo spokesman, said the company offers workers several health plans with premiums that cost $6 to $105 a week.
"There are a range of options, and employees can choose what best meets their needs," King said.
He couldn't provide details such as co-pays, deductibles or co-insurance.
Snell said the out-of-pocket costs on plans with cheaper premiums were too high for her. And she said she couldn't afford $100 a week on her $280 weekly paycheck.
"It was Cadillac-priced insurance," she said. "It was cheaper to go to the doctor and pay my doctor."
King said that like most companies, Sodexo leaders aren't clear on how health reform will affect current employees' health benefits.
"One thing about the new federal reform is people won't just get hospital services, they'll get complete coverage," said Doug Anderson, chief policy officer at the Ohio Department of Insurance.
Snell, he said, will "have preventive care so she can stay on her meds and have continuous coverage. Managing your chronic conditions keeps you out of the hospital."
shoholik@dispatch.com
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