Susan's Story

Northeast Pennsylvania.  Any traveler who explores down these windy mountainous roads can learn its history merely from the road signs directing you to nearby counties and towns.  Carbon County, Lock Haven, Minersville, Carbondale: a testament to a time when coal was king.  If the asphalt of the downtown business district of my first Pennsylvania stop could speak, it would tell you a tale of classic Pennsylvania Americana.  A coffee shop, a small eatery and a tuxedo rental shop occupy some of the windowed storefronts that are frequented by its loyal patrons, but many storefronts remain vacant.  The strip malls on the outskirts of town have been a temptation for businesses and patrons alike over the past couple decades.  The force of our ever-changing global economy even permeates a town that represents the pillar of American entrepreneurship and stability.

During the spring prom season and the summer wedding months, the tuxedo rental shop is alive with the starry-eyed teenagers and brides preparing for our culture’s joyous rites of passage.  Behind the counter stands Susan, a middle-aged lifelong northeast Pennsylvania resident and owner of the shop since 1986.  Susan is home grown.  She is a graduate of the local high school and like many women of her “baby boom” generation, received a business certificate from an area business school.  She spent 20 years employed in the business office of the local newspaper while working alongside her husband growing their shop on “Main Street”.  Following the purchase of the store in 1986, Susan and her husband have raised 2 children in their northeast Pennsylvania town and are living testaments to the perseverance of the American entrepreneurial spirit that has built small towns like this all over the United States.  They are illustrations of dedication that has given back to their community when others left.

Loyalty to the community they love has not come without its costs.  Keeping a small business has always meant a constant battle for health insurance and access to health care.  While the children had the security of CHIP, Susan and her husband purchased private insurance through Blue Cross.  This insurance cost $600 a month, a sizable portion of their take-home pay from a business that only yields roughly $30,000 a year.  By 2005, they could no longer afford spending almost 25% of their income on health insurance.  Fortunately they qualified for the state Adult Basic program which only cost them $36 a month.  Unfortunately the program was discontinued in February 2011.   Susan was now part of the 47 million Americans (16% of the population) that are uninsured[i].  The dismal reality became worse when they tried returning to the private insurance market only to find it would now cost $785 a month or 30% of their take-home pay; a financial impossibility. 

Susan and her family stood with one foot on each side of the fault line of our health insurance system.  As each plate slowly slid farther from the other they plummeted into the merciless abyss that lies below the crack in the system.   Lying at the bottom of this unforgiving pit, Susan felt abandoned by society.  A sense of solitude would have been tolerable if it weren’t for the laundry list of health issues she encountered over the years.  There was the lung disease diagnosed in 2005 and the vascular condition that resulted in chronic pain in her knee and wrists.  The thyroid condition that has left her with double vision and the perpetual feeling that sand is in her eyes served as the physical reminder of her uncertain state of health. 

Through the hazy and distorted visions Susan sees out her untreated eyes, there is a light.  Because of the Patient Protection and Affordable Care Act (PPACA) there is hope for Susan.  In 2014 a new market place called SHOP(Small Business Exchanges) will be set up.  A small business, like Susan's, will also be eligible for a small business tax credit.  Finally Susan can crawl out of her abyss of solitude she has endured in the crack of the system and unite with other small business owners like her in order to lower her costs.  Now insurance companies will have to compete for their business.   Susan also looks forward to knowing that she qualifies for premium credits and will ensure that her premiums will be capped at 4% of her income.  Gone are the days when 25% of her income went to health insurance and the days have arrived when this can now be reinvested into the business.  Finally, insurance companies will be held accountable to rate review instead of arbitrarily increasing premiums every year.  They will also need to adhere to the medical-loss ratio.  Susan has added security in knowing that the basic patient protections will also apply to her.

As I concluded my conversation with Susan, the humidity of the July day gave way to the choir of crickets and cicada bugs singing their celebratory tune in a rhythmic pattern.  Maybe they were singing because the fault line that Susan battled would finally be sealed.  Or maybe they were singing because Susan was now returning to the tuxedo shop with dignity and fulfill the American dream as she prepared the next bridal party for their joyous occasion.

[i]2006 Census Bureau Estimates