James Schultz said he first beat cancer when he was 25.
He beat cancer a second time when was 28.
And now, at 58, the Kenmore man has no health insurance. He could sign up for a plan offered under the Affordable Care Act, commonly referred to as Obamacare. But Schultz said he’d rather go without.
“I don’t want the government telling me what I need to do,” Schultz said last week at the Kenmore branch of the Akron-Summit County Public Library. “The government are dummies. Make sure you put that in there. This is not partisan. They’re just dummies.”
Schultz is not alone in Kenmore. It’s not clear why, but only about 14 percent of the uninsured who qualify for federally subsidized health insurance in the 44314 ZIP code have signed up, according to a new study released by a Cleveland nonprofit group.
The study — which looked at enrollment in ZIP codes in seven Northeast Ohio counties — showed that people who live in urban neighborhoods like Kenmore tend to sign up at a far lower rate than their counterparts who live in the suburbs and beyond.
In Summit County, Akron’s Kenmore, Lane-Wooster and North Hill neighborhoods had some of the lowest sign-up rates even though they had the largest eligible populations. Only about 1,029 out of 6,691 eligible people who live in those three ZIP codes signed up, the study showed.
Yet every eligible adult in the Hudson and Peninsula areas — about 667 people — took advantage of the subsidized insurance, the study said.
And no one in Lakemore or an area stretching from the University of Akron to just north of Glenwood Avenue signed up even though 319 people could have.
The ‘how’ of the study
The Center for Medicaid Policy and the Center for Health Affairs collaborated on the study, combining income information from the U.S. census with the number of people who signed up for insurance under the Affordable Care Act.
The numbers aren’t perfect because the data represent slightly different snapshots in time. In Hudson, for example, 41 more people signed up for the insurance than census numbers showed eligible.
But the people behind the study say the ZIP code map accurately reflects trends that outreach workers can use as they prepare for the 2017 open enrollment period, which begins Nov. 1.
To qualify for reduced health insurance premiums through the Affordable Care Act, people must earn too much to qualify for Medicaid, but less than 400 percent of the poverty level set by the federal government.
The ZIP code study only looked at who was signing up — or not signing up — but did not investigate why.
The ‘why’ of choices
But Tina Wood and Olivia Oldfield, who work at AxessPointe Community Health Center, see what happens. The women help low-income residents in Summit County apply for the insurance and then choose what options are available.
“A lot of people need help navigating the system,” Wood said. “If you are not used to it, there’s so much lingo and so many changes that continue happening, it can be overwhelming.”
The initial meeting with someone who wants to sign up can easily take two hours, although Wood said she tries to limit it to 90 minutes during open enrollment because so many need help.
Once people find out how much they’ll have to pay — the price slides based on income and the type of insurance chosen — many decide they can’t afford it.
“For people, especially on the lower end, it’s cutting into their other expenses, like how much they spend on food,” Oldfield said.
Some opt to pay the annual fine — $695 for an adult, or 2.5 percent of annual household income, whichever is greater — because they say it’s cheaper than the monthly insurance payments, she said.
But Oldfield said those same people come back and want to sign up at income tax time because, instead of getting the tax refund they depended on, the IRS eats it as a health insurance penalty.
The women don’t know yet how they can use the new study to reach out to people in Summit County who may not know how the Affordable Care Act works.
They already visit farmers markets, women’s shelters and places they know they’re needed. In recent weeks, they spoke to Parker Hannifin employees who were losing their jobs at the Home Avenue factory. Employees were shocked, they said, by how much the plans cost.
“When it’s part of your paycheck, you don’t think about it as much,” Wood said. “When in comes out of your own pocket, it hurts more.”
The solution for some
Not everyone, however, feels pain using the sliding-scale insurance offered under the government plan.
Lori Prentice, 56, who owns the Prentice Funeral Home in Kenmore, said the health insurance has been a lifesaver.
As small-business owners, the Prentice family had always paid for its own health insurance. But in the 2000s, the rate for Prentice, her husband and their youngest child jumped to $2,800 per month.
The Prentices couldn’t afford it, so she took a second job at Buehler’s grocery in Wadsworth where, she said, employees who worked at least 20 hours a week had access to a health care plan.
For seven years, Prentice loaded groceries in and out of people’s cars. All but a few dollars of her check went toward health care, but it provided insurance for her family until July 2014, when Prentice’s husband was diagnosed with a rare and aggressive type of cancer. He died two weeks later.
Prentice said she was terrified. Her family is the fourth generation of Prentices to run the funeral home, and she didn’t want to sell it. But she didn’t know how she could work at Buehler’s for insurance and run the funeral business alone.
A friend told her about the Affordable Care Act, and she signed up for health insurance online. Consumers at all income levels can use the federal marketplace to find coverage. Those not on Medicaid who earn up to 400 percent of the federal poverty level receive tax credits which lower the monthly premium.
“I had so many people tell me this was all too good to be true, that I would owe big on my taxes for the health care,” Prentice said. “But truly, it saved our lives. And, as long as you’re honest about your income, there are no surprises.”
The way to reach out
Organizations like the Robert Wood Johnson Foundation and the Urban Institute are trying to figure out new strategies to reach the uninsured who may not know how they could benefit, too, particularly young adults who often don’t see the value of having insurance.
Nationwide, just over half of low-income people eligible live in families that have at least one person getting a public benefit not related to health.
So the groups have suggested states reach out to families enrolled in nutrition programs. Likewise, the organizations suggest federal agencies reach out to those receiving the Earned Income Tax Credit.
None of that would matter to James Schultz, the uninsured Kenmore man who wants the government out of his life.
“At some point, I know the government is going to come after me on [health insurance],” Schultz said. “But for now, I’ll take the penalty. God healed me before, so I’m going on faith.”
Amanda Garrett can be reached at 330-996-3725 or agarrett@thebeaconjournal.com.