Love In The Time Of Repeal And Replace

Mar 14, 2017
Originally published on March 14, 2017 5:57 pm

"This is a first for me," says Rabbi Andy Dubin, as he sits down on a collapsible chair opposite Ann Justi and Don Boyer.

The three of them are in the compact living room of Boyer's apartment in Yonkers, N.Y., standing between the sofa, TV and writing desk. Dubin is in his socks, having shed his snow-caked boots out in the hallway.

Boyer and Justi are getting married. Never mind the blizzard-like conditions that kept one set of friends home, and a bad cold that waylaid another. They're determined to tie the knot this afternoon. So they recruited their landlord from downstairs and a public radio reporter to be witnesses.

Why the rush? Boyer and Justi have been listening to the news. They were planning to get married in the fall, but it occurred to them that there's no knowing what could happen to health insurance if the Trump administration and congressional Republicans dismantle the Affordable Care Act.

Justi has several preexisting conditions — osteoporosis, asthma, allergies and Vitamin B-12 malabsorption — and the insurance she carried over from her previous job will expire this summer. She had employer-based insurance for more than a decade, but was laid off last year.

Justi and Boyer knew they could wait until the spring to get married, and she then could go on the health plan he receives as a concierge for a residential building — it's a union job, and the health insurance is good. But Boyer worries about Republicans unspooling crucial Obamacare safeguards.

"There's so much uncertainty as far as what's going to be law tomorrow, what's going to be law next month," he says. "Nobody really knows, unfortunately."

Much of the focus in the "repeal and replace" debate has been on the 20 million Americans who have received coverage via state and federal health insurance exchanges and Medicaid expansion. But most Americans still get coverage from employers, and their plans now have protections that could also be rolled back.

Under the Affordable Care Act, private insurers can no longer reject people with preexisting conditions, or charge them more for their insurance. As of now, the GOP bill in front of Congress also has language requiring that people with preexisting conditions be able to get health insurance.

But there are other factors that could make that insurance much more expensive — such as the applicant's age and the lack of a mandate, under the GOP plan, that everyone have health insurance. If you get rid of the mandate, many health care analysts say, it's likely that the people buying that insurance would mostly be sick — further driving up the cost of the insurance, and driving out of the insurance pool the healthy, younger people who tend to bring down the cost of the insurance.

Justi's current situation of having temporary insurance with an expiration date — instead of being on a stable health plan that can't kick her off — takes her back to an earlier, uglier time in her life.

"I went from one employer to another, and the new employer's insurance didn't cover my preexisting conditions for a year and that nearly bankrupted me," she says.

So Justi and Boyer decided to get legally married as soon as possible, and have a more ceremonial, celebratory wedding in the fall. They found Rabbi Andy Dubin online, on a list of licensed local wedding officiants. They warmed to his profile, even though neither is Jewish.

The service in their living room is casual but formal. Dubin wears a suit, and both bride and groom are fashionably attired in black. Boyer sports a white rose boutonnière. Justi holds a bouquet wrapped in silk. Dubin talks about marriage and commitment and faith. And he nods to their need to protect themselves.

"Every marriage is important — but it's also important because you are living in times, as we all are, when sometimes we have to take things into our own hands to make sure we come out all right on the other side," he says.

For about 20 minutes, they discuss the journey behind the couple and the one ahead. Boyer and Justi read vows they've written to each other, and then give each other rings. Dubin declares, "By the authority vested me by state of NY, I now pronounce you, Don and Ann, husband and wife."

They kiss, then sign some paperwork, raise a toast of sparkling water, take some smartphone pictures and embrace the rabbi.

They're beaming like newlyweds — albeit very practical newlyweds who are planning for the future.

"As quickly as possible, I want to get you and this form down to the union headquarters tomorrow," Boyer says.

And that's it. The landlord heads back downstairs. The rabbi and I head out into the snow. And Justi and Boyer bundle up for a one-night honeymoon in a White Plains, N.Y, hotel. They say they're prepared to face whatever comes next together –- in sickness and in health.

This story is part of NPR's reporting partnership with WNYC and Kaiser Health News. Fred Mogul has been covering health care and medicine for WNYC since 2002.

Copyright 2017 WNYC Radio. To see more, visit WNYC Radio.

ROBERT SIEGEL, HOST:

Uncertainty over the future of health care in America is affecting consumers now. From member station WNYC, Fred Mogul met up with one couple who are not taking any chances.

FRED MOGUL, BYLINE: In the middle of a blizzard a few weeks ago, Ann Justi and Don Boyer sat down in the living room of their apartment in Yonkers to tie the knot.

DONALD BOYER: I, Donald Matthew Boyer, vow to you, Ann Lorraine Justi...

MOGUL: The couple met last year, quickly fell in love and had been planning a wedding for next fall. But they sped up wedding plans, opting for an intimate ceremony with just themselves, a rabbi and two witnesses - their landlord from downstairs and me, pinch hitting for friends who got snowed in. Why the accelerated timeline - health insurance.

BOYER: There's so much uncertainty as far as what's going to be law tomorrow, what's going to be law next month. Nobody really knows unfortunately.

MOGUL: Boyer has a good union health plan from his work as a concierge. But Justi only has temporary insurance from the employer who laid her off last year after more than a decade on the job. They don't know what will be available when that runs out.

BOYER: We know that there are plans to remove a lot of what's already in place. We don't know what's going to replace it.

MOGUL: Justi eats well and exercises every day. But she says she is 53, and she has some longstanding health issues.

ANN JUSTI: I've got B-12 malabsorption disease. I have GERD. I have mastocytosis, which is an allergy. I have asthma.

MOGUL: None of these are life-threatening, but they do require expensive drugs and monitoring tests.

JUSTI: If I don't have my prescriptions, then things will get really unmanageable.

MOGUL: Having insurance with an expiration date instead of being on a stable health plan that can't kick her off takes Justi back to an earlier, uglier time in her life.

JUSTI: In 1988, I went from one employer to another. And the new employer then - their insurance didn't cover my preexisting conditions for a year, and that nearly bankrupt me.

MOGUL: They still plan to have a real wedding in the fall with friends and family. But for this time, they didn't just want to go to city hall, so they found Rabbi Andy Dubin in an online list of officiants even though neither of them is Jewish.

BOYER: I can't thank you enough for making it in this lousy weather.

JUSTI: Yeah.

ANDY DUBIN: You know, there's certain things that I just wouldn't miss.

MOGUL: Dubin talks to them about marriage, commitment, faith and resourcefulness.

DUBIN: You are living in times, as we all are, where sometimes we have to take things into our own hands to make sure that we come out all right on the other side.

MOGUL: He speaks about the couple's personal journey. They read vows they wrote and put rings on each other's fingers.

DUBIN: By the authority vested in me by the state of New York, I now pronounce you Don and Ann, husband and wife. And now we clap.

(APPLAUSE)

DUBIN: Woo-hoo (ph).

MOGUL: Boyer and Justi are beaming like newlyweds but very practical newlyweds. Boyer is mapping out the next step.

BOYER: I want to get you and this form down to my union's headquarters to get you on my insurance.

DUBIN: Oh, that makes sense.

JUSTI: Yeah, yeah, yeah.

DUBIN: So then maybe you should just bring it on tomorrow.

MOGUL: And that's it. The landlord heads back downstairs. The rabbi and I head out into the snow. And Justi and Boyer bundle up for a one-night honeymoon in a nearby hotel. They say they're prepared to face whatever comes next together, in sickness and in health. For NPR News, I'm Fred Mogul in New York.

SIEGEL: And that story is part of a reporting partnership of NPR, WNYC and Kaiser Health News.

(SOUNDBITE OF DIRTY ART CLUB SONG, "JUST A MEMORY") Transcript provided by NPR, Copyright NPR.