Today I met Gary Cloutier, a self-employed auto-body shop owner. He’s uninsured, and hopping mad. With a salary of about $41,000, he doesn’t qualify for Commonwealth Care (the limit for eligibility is around $31,000). He’s been looking into private health insurance, but feels completely hamstrung. With his business down 40 percent because of the economy, he can’t afford any of the private plans, and he very much resents having to pay a $900 penalty as a result.

While I was there, he got a call from one insurance agent, who eagerly tried to sell him a health policy that was $166 a month…..which is just about affordable to him. Until the agent explained that this policy includes a $7500 hospital deductible….plus high co-pays for just about everything….and THEN, the kicker: it doesn’t even qualify as a “minimum creditable plan” under Massachusetts’ health reform. (The agent only admitted this under pressure.) So after all that, the shop owner would still be breaking the law. The only plan offered by this company that DOES qualify under Mass law would cost more than $400 a month, which he vows he absolutely cannot afford. So he’s going without insurance.

He’s so angry, that he’s been calling lawyers all over town to see if there’s a class action lawsuit to join. “They’re ramming this down our throats, and now I’m being penalized because I can’t afford to buy health insurance!” He even called the Attorney General’s office for help, but they told him, if there WERE a lawsuit, their office would be defending the state.

I mentioned to him that he might be able to get a waiver from the penalty if he can show that there’s no affordable plan offered to him. He was unaware that a waiver was even a possibility, and he didn’t know where to go for advice.

Meanwhile, his fiancee did just qualify for Commonwealth Care, although not before she incurred a $700 hospital bill for a bronchitis ER visit. (It was the financial officer at Noble Hospital who told her she’d likely qualify for Comm Care.) She’s still waiting for the Comm Care paperwork to come through. When it does, she’s expecting to pay a monthly $39 premium. I suggested that was a fairly reasonable premium for health coverage, but she says it’s too much for her to afford as a single mother of three teenagers. I pointed out that paying out of pocket for health expenses would likely be much more expensive, but she still didn’t feel the mandate was fair. (She still has bronchitis, by the way. She doesn’t want to see a doctor again until she’s sure she’s covered.)

I also met a happy Comm Care recipient today — a fine artist named Xylor Jane who lives in a warehouse in Holyoke. With a salary of about $15K a year, she qualified easily for the state plan — just in time to pay for an emergency historectomy she needed this past Fall. She says she feels very grateful for the coverage. “I only paid $5 for the whole thing. That’s amazing.” I told her about the conversation I had with the auto body shop owner, and how upset he was, and she could see why. “It’s strange,” she said, “that this is one of the rare cases where being a poor artist is actually an advantage.”