The state decides how much health insurance you can afford — not you

Lauren and Nick Destito had a wonderful life in Plainville. They paid their bills and raised two sons in a lovely four-bedroom colonial that they were just eight years away from owning outright.

But the economy collapsed in 2008 and soon crushed the small tree and landscaping business the couple had run since 1984.

Now, the state of Massachusetts is grinding the Destitos into the dirt. The reason: the health insurance the Destitos bought, paid $750 monthly premiums on and repeatedly used at doctor visits apparently does not pass muster with the state’s mandatory universal health insurance law. Now the Destitos, both 50 and already on the brink of financial ruin, are facing a $3,000 state fine.

“The stress will kill me before anything else,” Lauren Destito joked nervously yesterday just before her appeal hearing with the state’s Health Connector. She was so worried she asked her state representative, Dan Winslow, to listen in on the conference call. With hearing officer Irene Herman’s knowledge, I listened in, too.

“I would just like to say that we did make the effort and purchased a plan,” Destito told Herman. “I don’t understand why we’re in this situation at all.”

Because, Herman explained, the state must establish if her family could afford other, better insurance, and that affordability is determined “not, unfortunately, from your perspective but from the state agency’s view.”

In other words, the state decides how much health insurance you can afford — not you.

After that stunner, Herman asked Destito detailed questions about her income and expenses right down to costs of clothing, heat, food, phones. She also said the state would need documentation on her mortgage and medical bill arrears as well as what her insurance does and does not covers.

“This is outrageous,” Winslow interjected. “Bankruptcy isn’t enough? Unemployment isn’t enough? Buying insurance isn’t enough when it’s bought from a licensed broker in Massachusetts? They should go after the broker, not the people.”

Lauren Destito said her family’s financial reverses have been devastating.

During bankruptcy proceedings on the tree business, which employed both her and her husband, the bank auctioned off all their heavy equipment and then tacked its remaining losses onto the couple’s mortgage, which zoomed from $2,000 to $3,200 a month. They now owe $385,000 on a home they bought for $193,000, and efforts to restructure payments were rebuffed.

Now Lauren is back working part-time as a nurse and Nick is working as an equipment operator. The family is insured through his union. “But it’s hard to dig out when the hole is so deep,” she said, “even though my husband works six and seven days a week. It’s really very sad.”

A decision is expected in a month on the Destitos’ fine, which stems from 2010, when unemployment forced them to find cheaper insurance. That same year taxpayers paid $35.7 million in Massachusetts to cover free emergency room visits for illegal immigrants.

Something is very, very wrong with this picture.

Article URL: http://www.bostonherald.com/news/columnists/view.bg?articleid=1374144