John Donahue of Mechanicsburg has a beaming smile in the wedding photo. He has a wife and four children and added a son-in-law in the spring.
He counts his blessings. He enjoys jet skiing in Ocean City, Maryland. He loves working for himself as a private contractor in IT.
But that is both a blessing and a curse.
“I choose to be self-employed, but I didn’t really expect one of my battles to be for me to spend two to three times for health insurance versus someone who is an employee,” Donahue said.
Donahue purchases health insurance for himself, his wife, and two dependent children. He has been a Highmark customer with premiums that have gone sky high.
In 2015, it cost $15,638 a year.
In 2016, it rose to $19,315 a year.
In 2017, it rose again to $33,563.
And the projected cost for next year is $43,800. That’s $3,650 a month.
“That doesn’t include any dental, it doesn’t include any vision, and I still am at risk for an additional $14,700 out-of-pocket expenses,” Donahue said, adding that he had no co-pays in 2014 but they, too, have increased each year.
John makes a good income. He works hard. He pays his taxes. He gets no help.
“I make enough that I don’t get any assistance for anything. I’m proud of that. But I’m reaching a point where any extra is disappearing with things other folks aren’t faced with,” he said.
It is happening, confirms Pennsylvania Acting Insurance Commissioner Jessica Altman.
“This is the population I worry about the most because they are gonna see these costs, it is going to hit their bank account and their pocketbooks,” she said.
Altman explains that only five percent of Pennsylvanians buy health insurance on the exchanges. Of those, four in five get subsidies because of their income. Statistically, only one to two percent are like Donahue, making more than $96,000 a year.
Donahue is frustrated that his taxes go, in part, to help others get subsidies but he’s hit with a whopping bill. Altman understands the frustration.
“Call your congressman,” she said. “Call your representative. Ask them what they are doing also to help this population because you do matter and you are seeing these huge cost increases, and somebody should be thinking about that. I am,” Altman said.
The Insurance commissioner feels for Donahue. So does Highmark. But there’s little either can do for him. He’s a cancer survivor. He has the picture of a tiny mole that turned into a life-threatening skin cancer. He survived physically but financially is still a question.
“I have no options right now,” he said in a defeated tone. “I have to have health insurance, not because the federal government mandates it but because I care about my family. Having had cancer, I know what can happen. I had one month of treatments and it cost $200,000. I know that could bankrupt me as well and I don’t want to be in that situation either. I have no choice about having insurance but have no viable alternative.”
So why has Highmark jacked the rates year over year, nearly 300 percent in five years?
“Our rates reflect what the true cost of care is for these ACA members,” the insurer said in a statement. “Over time, we have learned that this group is sicker compared to our commercial customers and use more health care services.”
It’s maddening to Donahue that he could be just as sick but working for an employer with group coverage and pay a fraction of the cost. He would, in fact, get much more and pay much less. It seems to him that somebody forgot about the self-employed when they were creating the system.
“I guess I feel like I’m being left with an anvil in the ocean,” he said.