Care, cost and coverage: Kim’s experiences with health insurance volatility Kim, 36, moved to New York City as a teenager for “a fresh start.” During the pandemic, she lost her retail job and now supplements an irregular income from freelance graphic design by picking up oc- casional housekeeping work “to make sure that ends meet completely.” Her $1,300 rent is subsidized by the HIV/AIDS Services Administration (HASA), and covering it “gets tough sometimes, [but] it’s a lot easier than being homeless again,” as she was for about a year prior to securing her apartment. Born with HIV and managing a related chronic lung condition as well as mental health challenges, Kim chose not to enter the workforce full time because of difficulties not just with her health, but also with health insurance. She has Medicaid and a supplemental insurance, which cover most of her frequent doctors’ visits and daily medications, as well as the occasional health crises she experiences. Public insurance has been less precarious for Kim than the employer-based insurance she previously had: “Suddenly, [my employer] dropped my health insurance. I could only go and see my provider three times a year or two times a year without any emergency visits included. They, suddenly, didn’t cover my medications either, which was a huge deal because the medication cost about—outta pocket, it would be about $1,000 a month. I couldn’t afford that at all, and I still can’t. Suddenly, I didn’t have health insurance for six months. I couldn’t afford my medication for six months. With it be- ing a chronic illness, I, suddenly, got really sick really quickly. That’s why I’m really skittish about even trying that again, going through an employer [for insurance].” Kim left that job in order to get back on Medicaid, and her health did not stabilize for another year. High-need, economically disadvantaged New Yorkers have a stable and reliable option in public in- surance, as enrollment rates attest to, though this may come at the expense of pursuing a higher income. And although it is consistent, public insurance—like private coverage—guarantee neither timeliness nor affordability of care:
“It is difficult in that, when the doctor prescribes a certain treatment or medi- cation, [you] can’t get the medication right away, or you can’t get the treatment right away, even though you might need it right away. You have to go through the whole application system. Sometimes, you get denied, and then you have to appeal .... basically havin’ to plead with strangers that you are actually sick, even from a hospital bed.”
Kim delayed a needed jaw bone graft for almost three years for this reason, and when she eventually had the procedure, Medicaid only covered the appointments, while Kim was left with a $15,000 bill. She paid for this using a “Care Credit” card, which is interest-free as long as she pays the $1,000 an- nual minimum. She has missed payments in the past and used “the whole trick of maxing out other cards to pay [it]” and avoid accruing interest. Specialists within the hospital network can have long waitlists, but if the cost of care elsewhere is high, waiting months for an appointment is the only op-
PATTERNS OF DELAYED HEALTHCARE AMONG NEW YORKERS WITH HIGH HEALTHCARE NEED 14
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