Health on the Horizon: The Healthcare Serf

Published on
May 30, 2012
Image removed.

It was a Friday in mid April when I met Linda in a Central Pennsylvania coffee shop.  It was the end of a good week.  On Monday Linda had received her certification as a licensed massage therapist and hours before our meeting, she received a position at a facility in Leola.  An aura of relief surrounded her.  It had been a long year.

With a Master's Degree in public administration, Linda spent 17 years as a research project manager.  Her most recent job was at a large Central Pennsylvania Facility.  While her career had been a fulfilling one, the stress of this demanding profession began to take a toll on her health and wellbeing and it was time for a change.  After years of examining the practice of massage therapy, she saw this as her new calling.

At the age of 52, redefining yourself can be a frightening thing.  Leaving the security of a stable career that offers a good salary with benefits and going out on your own can often feel like walking a tightrope without a safety net.  Like Linda, many people can relate to reaching the point in their lives where it is time to change course and embrace independence, freedom and individualism.  After all, aren't those the core principle's America was founded on?

Not with our current healthcare system.

In 2008, nearly a quarter (23%) of Americans reported taking a job or staying at a job they no longer wanted to be at solely for healthcare benefits, according to the Kaiser Family Foundation.  Linda was one of them.  For months, Linda tried to balance school with her full-time job primarily to keep her healthcare benefits.  She explains that living without her salary for a time did not scare her, but the thought of not having health benefits was frightening.  She had never been without health insurance and she only stayed at her job because of them- she was a "serf" to her healthcare.

It was a grueling choice for her, but one that made her to engage in deep self reflection to explore the priorities in life:  personal happiness and living a life with meaning.  Eventually, Linda had to leave her job in order to finish her degree program. Unable to pay for a policy on the expensive individual market, she joined the ranks of the uninsured.  A recent study by the Commonwealth Fund found that individuals, like Linda, seeking policies on the individual market found it unaffordable and 45% went without a policy.  While she wasn't alone, she felt vulnerable and alone.  Linda recalls harboring a sense of shame for not having health insurance, as if society viewed her as somehow inferior.  However, the irony, doesn't our society celebrate personal independence?  

The United States is the only country in the industrialized world where individuals are left vulnerable when they leave their employer-based healthcare.  This makes me wonder that in a country that celebrates the ideas of "freedom" and "individualism", how truly free are we when we are strapped to our employers in order to meet our most basic human need? 

In 2014, the Patient Protection and Affordable Care Act calls on states to set up individual exchanges/marketplaces for people such as Linda.  These exchanges are designed for uninsured people (people who don't get insurance through their employer, people who are in between jobs or lost a job) to have a place to go for affordable healthcare.   The individual exchanges/marketplace will consist of a wide variety of private insurance plans where consumers "shop" on the internet.  By pooling many consumers together, it will be more affordable than going alone on the individual market.  Premium tax credits are also available for individuals up to 400% of poverty level.


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"Health on the Horizon" is a weekly blog about my travels around the state of Pennsylvania looking at how the Patient Protection and Affordable Care Act will impact individuals, groups and institutions.