Health insurance can be expensive, but the cost of not having it can be crippling.



Health insurance can be expensive, but the cost of not having it can be crippling. Local chef Jon Wise learned this the hard way when he was sent a bill for more than $62,000 after having his appendix removed last month.

“I was enraged. I had two choices: die or have surgery,” Wise said. “So I chose surgery.”

Wise is one of many Richmonders without health insurance. Almost one in five Richmond residents lacks health insurance – the highest uninsured rate among the more populous localities in Virginia, according to new data from the U.S. Census Bureau.

The bureau recently released 2014 findings from the American Community Survey for localities with populations greater than 65,000. The data tracks, among other things, how many people have health insurance coverage.

Many analysts had been eagerly awaiting the statistics to see if they would reflect the impact of the federal Affordable Care Act, which requires Americans to get health insurance or pay tax penalties.

For supporters of the law, often dubbed Obamacare, the data offered good news: Nationwide, the rate of uninsured people dropped from about 13 percent in 2013 to 10 percent in 2014.

However, Richmond saw only a dip in its uninsured rate: It fell from 19.1 percent in 2013 to 18 percent last year. The current uninsured rate is higher than the 16.6 percent reported in 2012.

The surrounding counties of Chesterfield and Henrico had uninsured rates of about 9 percent last year. Virginia as a whole was on par with the national average at about 10 percent.

Linda Wilkinson, CEO of the Virginia Association of Free and Charitable Clinics, said poverty is one of the main reasons why the uninsured rate is high in Richmond.

“If you have minimal education and are only skilled at a particular type of job – let’s say landscaping, which is a respectable job but most likely won’t offer seasonal workers benefits – then you’re not going to have insurance,” Wilkinson said.

Many of the unskilled jobs with benefits have moved as corporations shifted to the suburbs, and there’s no limited public transportation options for poor people living in the city to get there, she said.

Wilkinson said free clinics in Richmond are working with Enroll Virginia, a community outreach program focused on educating patients about the ACA Marketplace insurance options.

“People living in poverty aren’t engaged in policy matters and are unaware that Obamacare exists,” Wilkinson said. “Imagine multiple generations of your family have been living in poverty for 50, 60, 70 years and never had insurance and have no idea how it works.”

2014 was the first year tax penalties for not having health insurance were enforced under the ACA. H&R Block tax preparer Johanna Garg said she believes many people were unaware of the penalty last year.

“Almost everyone I did taxes for last year didn’t have health insurance unless their job provided it,” Garg said. “Most people didn’t realize the government was going to enforce the penalty, so they just ignored it.”

For the 2014 fiscal year, the penalty was 1 percent of a household’s income or a flat rate of $95, whichever amount was higher. The penalty will increase each year until 2016, when it will be either $695 or 2.5 percent.

Garg said she thinks many people haven’t taken the time to look into the ACA and don’t know about their insurance options.

“A lot of people can get quality insurance for $50 a month,” she said. “Technically it’s more than paying the penalty if your income is low and you’re only subject to the flat fee. But imagine if you really hurt yourself or got sick.”

Wise agreed that having insurance would have paid off when he had his appendix removed.

“It was life or death, and afterwards I still feel like I could have held out longer if I had known how expensive it would be,” Wise said. “I’ll probably never be able to pay my hospital bill off.”