How Obamacare Affects Young, Healthy Men: Jimmy Tomczak

Sophie Novack
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Sophie Novack
Sept. 26, 2013, 4:15 p.m.

Jimmy Tom­czak, 25, be­lieves there’s very little one needs to get out­side and live. After gradu­at­ing from the Uni­versity of Michigan, he star­ted his own com­pany based on this idea, cre­at­ing eco-friendly san­dals out of re­cycled bill­board vinyl. He re­cently spent a week at Burn­ing Man; he travels of­ten and says he needs only a laptop and cell phone to make money.

“The place I keep my stuff,” he says, is a du­plex in De­troit, in the apart­ment up­stairs from his mom and 13-year-old sis­ter, who are both on his moth­er’s em­ploy­ee health in­sur­ance plan. The Af­ford­able Care Act has al­lowed Tom­czak to get cov­er­age on that plan (it re­quires just a $20 co-pay for of­fice vis­its and cov­ers most pre­scrip­tions) so far, but when he turns 26 in April, he’ll be on his own. So he’ll shop on the ACA-cre­ated ex­changes with the help of a tax sub­sidy to cov­er the plan he chooses.

Jimmy’s age and good health might tempt him to pay the small pen­alty and forgo cov­er­age, but while some friends have chosen this op­tion, Jimmy wants the safety net. “The best cov­er­age is a hol­ist­ic ap­proach to sleep, eat­ing, ex­er­cise, main­tain­ing good re­la­tion­ships, and hav­ing a pos­it­ive im­pact,” he says. “But when everything else is chan­ging, and I’m in a dif­fer­ent city each day, I need to make sure [my health] is a sure thing.”¦ You’ve heard that young people think they’re in­vin­cible, but as an en­tre­pren­eur I take risks, and I would rather take big risks in busi­ness and build­ing my com­pany than with my health.”

Tom­czak’s in­come var­ies de­pend­ing on his busi­ness, which makes it dif­fi­cult to pre­dict what he’ll pay in premi­ums un­der the new law. His in­come range, which he de­clined to give on the re­cord, is near the cutoff for sub­sidy eli­gib­il­ity, so his cov­er­age could vary sig­ni­fic­antly with a re­l­at­ively small dif­fer­ence in earn­ings. If he earns more, he will need to pay around 5 per­cent of his an­nu­al in­come — or 33 per­cent of the over­all premi­um — for sil­ver-plan cov­er­age, with the re­mainder covered by a gov­ern­ment sub­sidy.

Be­cause Michigan op­ted in­to the Medi­caid ex­pan­sion, if Tom­czak’s in­come falls, he’ll be eli­gible for Medi­caid cov­er­age. Had the state op­ted out, his in­come would have been too high for ex­ist­ing Medi­caid and too low to qual­i­fy for sub­sidies; like sev­er­al mil­lion Amer­ic­ans in states that are not ex­pand­ing their Medi­caid pro­grams, he would be left without af­ford­able op­tions. In an­oth­er state, a lower in­come would have made his premi­um three times high­er than if he made a few thou­sand dol­lars more, be­cause he would have to pay 100 per­cent of the cost.

Al­though Tom­czak in­tends to pur­chase in­sur­ance on the ex­changes, he hasn’t re­searched his op­tions ex­tens­ively be­cause he’ll be on his mom’s plan un­til April. “Six months seems like an etern­ity in the busi­ness life cycle,” he says. “I can wait five months and be more edu­cated” — al­though the stand­ard en­roll­ment peri­od for 2014 will end March 31.

While a ma­jor­ity of young people are en­thu­si­ast­ic about the law, con­fu­sion is also com­mon. “They’re not do­ing a great job [mar­ket­ing the ACA],” Tom­czak says. “You’ll have two equally qual­i­fied ex­perts say totally dif­fer­ent things.” He says he’s de­term­ined to study his op­tions and make the best de­cision pos­sible. “An en­tre­pren­eur can only bend the rules so much.”

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