Health coverage and peace of mind

The only thing riskier than opening a cafe/art gallery in a blue-collar, Maxwell House-coffee-drinking Port Richmond neighborhood is living without health insurance.

M.L. Simone has done both and is still around to talk about it.

A decade ago, the 46-year-old Delaware native wanted to open a small coffee bar that doubled as a gallery where local artists could display their work. The spillover from the Northern Liberties zip code had already pushed Fishtown rents out of her reach. So she moved her search upriver to Port Richmond.

"My first steps in this building were my first steps in Port Richmond," says Simone, who has a business degree from the University of Delaware and a master's in art administration from Drexel University, and calls herself "the most educated coffee pourer in Philadelphia."

With a lot of help from friends and family, "this building" became Hinge Cafe, a coffee shop where art would be the "hinge" point.

But her neighbors weren't impressed with lattes or the arts at that time. So a week after opening, Simone bought a two-burner hot plate and a bake oven and added six sandwiches to the menu of coffee specialties.

Over the years, the neighborhood has changed enough that Hinge has become a Port Richmond version of Cheers, where neighborhood regulars and loyal customers know Simone and her staff by name.

The cafe tucked away on Somerset Street - Indiana Jones would need a GPS to find Hinge - has gained enough buzz that Sunday brunch draws people from all over town for delights such as pecan apple pie oatmeal and cinnabun pancakes.

But getting the business to be self-sustaining has not been easy. Simone regularly works seven-day weeks and until a few years ago lived upstairs. And with slim profit margins, it has also meant going without necessities such as health insurance.

Coverage is "one thing that is easily moved down the priority list," Simone says. "A lot of independent business owners go without health insurance because they don't have the money."

But Simone "bit the bullet" four and a half years ago when her daughter, Cyam, arrived.

"I had to maintain good health insurance because I had a child," she says.

Back then, Simone bought Independence Blue Cross' Keystone Health Plan East and paid a $600 monthly premium. She stayed with the plan after the Affordable Care Act marketplace opened in late 2013, because she was too wrapped up in running the business and missed all three deadlines.

But Stanley Pliszka, Simone's chef - who interviewed for the job nine years ago by bringing in his crème brûlée - signed up for coverage on his own. Like his boss, he had been uninsured most of his life.

"I never really had any major illnesses or anything," says Pliszka, 43. "But it was like playing Russian roulette. When Obamacare came, I was able to find something more affordable for me."

The Port Richmond native bought an Independence gold-tier plan last year, paying $160 a month. The plan "was great," so he has decided to stick with it. He is adding dental coverage for $16 a month.

"I was finally able to get a routine checkup and take care of myself," he says. "It feels good when you can go and pick up a prescription and it costs $4."

This year, Simone is following her chef's lead. With the help of a navigator from the Pennsylvania Health Access Network, she took the time to sign up, settling on Independence's silver Proactive plan.

As of December 19, more than 6.3 million people - 30 percent new consumers - had selected plans like those for next year. To have coverage starting Feb. 1, people must sign up by Jan. 15. Open enrollment ends on Feb. 15, 2015.

The Proactive plan was Independence's best-selling plan last year. It is an HMO that relies on a tiered system to keep costs down. Proactive plan members can use any provider or hospital in the Blue Cross network.

But the tier the hospital and providers are on - more for academic hospitals and specialists and less for community hospitals and primary care doctors - determines how much you pay. The plan can become expensive if customers don't stick to tier 1 providers.

"I was able to keep my doctor" says Simone, who will pay $150 a month for coverage. "It's great."

She intends to invest the $450 a month she is saving in her daughter's education and, of course, the business.

"I love the idea of affordable health care," she says. "I don't like the idea of something for nothing. It doesn't fit with my ethics. I'm happy to pay. I didn't want free health care. I wanted affordable health insurance."

Health Federation of Philadelphia information:

215-977-7255

New Jersey - Center for Family Services

856-964-1990, Ext. 194

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