Lack of Insurance Options Turns Many into Health Care Gamblers

This is the fifth article in a series about health care in the Virgin Islands.

Lieutenant Governor Tregenza Roach. (File photo)
Lieutenant Governor Tregenza Roach. (File photo)

Whether they like it or not, thousands of Virgin Islanders are living without the common protection of a health insurance policy.

Each time they – or their child – gets a fever, a rash, a sinus infection, they have a choice to make: Take cash out of the weekly budget or the savings account and head to the doctor, or tough it out without treatment and without prescription medication. A broken bone or even more serious condition may mean cleaning out that savings account, or taking out a loan.

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Exactly how many residents are in this position is not certain, but industry and government experts agree it is too many.

A recent study from a University of the Virgin Islands research team, the Community Needs Assessment, said 30 percent of the population is not covered by a job-related group plan and not eligible for either of the stopgap federal government plans: Medicare, for those over 65, or Medicaid for those with incomes below a specific level. The study cited a 2014 Virgin Islands Community Survey, which is a self-report survey as its source.

Lt. Gov. Tregenza Roach, whose position makes him the territory’s commissioner of Banking and Insurance, said his office doesn’t dispute the 30 percent estimate. He and the division’s director, Gwendolyn Hall Brady, spoke with the Source on Friday.

“That’s the same figure we’ve been using at the Legislature,” said Roach, a former senator.

Group insurance seems readily available. V.I. Equicare, the territory’s largest Preferred Provider Organization, has agreements with several insurers that offer group plans to V.I. companies, according to Dynel Soto, Equicare executive director.

But if you don’t work for a company offering a group plan, you are pretty much out of luck.

“If you’re not employer-based, I think it is almost impossible to get insurance,” said Steve Baker of Baker Magras Associates, Inc. which specializes in health insurance. “Quality and viable individual insurance is not available in the Virgin Islands.”

Baker said the 30 percent figure seems high to him, but regardless of exact numbers he does see a troubling gap in availability.

Director of Banking and Insurance Gwendolyn Hall Brady  (Photo by Barry Leerdam, V.I. Legislature)
Director of Banking and Insurance Gwendolyn Hall Brady (Photo by Barry Leerdam, V.I. Legislature)

“Insurance companies were never flocking to the Virgin Islands,” Baker said. “There was never great stuff” available in the individual market.

The small population and the territory’s distance from the mainland make it somewhat unattractive, he said. Besides, local regulations are off-putting.

Both Baker and Soto noted another factor that may cause insurers to hang back: the fact that so many of their potential clients are poor risks.

“Our people are not well” in general, Soto said.

What was always a bad situation got worse when the Virgin Islands was left out of major portions of health care reform, Baker said.

“I’m a huge fan of the Affordable Care Act,” Baker said, adding it is the “best thing ever.” But it only works if it is implemented in total.

The act contains a number of consumer enhancements, including guaranteed coverage despite pre-existing conditions, a prohibition on discrimination because of age or health condition, the elimination of co-payments for preventive check-ups, and coverage for birth control.

But in an effort to ensure viability for insurance carriers, the plan also established the “individual mandate,” requiring everyone to carry health insurance – arguably the most controversial part of the Act, and a part that does not apply in the Virgin Islands.

Without the mandate, ACA proponents – including Baker – argue the plan doesn’t work. Insurance companies don’t want to offer individual health insurance if they aren’t guaranteed a base of customers large enough that it includes low- as well as high-risk clients.

“The way around not having a national mandate is to have a territorial mandate,” Baker said.

But V.I. legislators and the previous administration were loath to impose one in the past, and there still appears no appetite for the move.

“I don’t think we can require people to maintain (individual) insurance” if there are no providers offering it, Roach said.

“You cannot have the mandate without the product,” Brady said.

Nor, Roach said, can the government offer subsidies to people who can’t afford insurance, another part of the federal plan that the territory is not included in.

However, they said the government is working with carriers to try to expand coverage and are currently in negotiations with one company that might offer individual health insurance. They did not give the company name or any details of the negotiations.

Enticements that the government might be able to offer could possibly include tax incentives and underwriting, or waiving restrictions on premium pricing or coverage restrictions due to health conditions.

“We routinely meet with companies,” Roach said.

In fact, Brady said she met Friday with an owner of Elan Insurance Co. to discuss its bid to expand its offerings, but she stressed that it is not currently contemplating offering full health care coverage.

Omar A. Andes, who said he is co-owner of Elan with his father, Omar Andes, said it was approved to offer air ambulance and catastrophic insurance in the V.I. in 2017.

“We have over 2,000 members in the Virgin Islands” and also do business in the British Virgin Islands, primarily Tortola, Andes said.

Brady said the company is seeking to expand its offerings to include emergency and urgent care coverage, generic prescription drug coverage and limited diagnostic and preventative care coverage.

While that is not the full health care coverage the office is hoping to work out with the other company Brady and Roach mentioned, it is “a good sign” that there is interest, they said.

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1 COMMENT

  1. Health insurance for basic care such as a “fever, a rash, a sinus infection” should be paid out of a family health care budget. Using an insurance company as a pass-through for such expected and typical health care needs creates more expense, due to their management and profit costs.

    Insurance is useful (and valuable to the consumer) for UNEXPECTED events. Thus, health insurance is valuable when insuring against less likely events like broken bones or serious illness.

    Just like food, clothing and shelter, responsible people should budget for basic and expectable health care needs.

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