Last summer Ellen Holzman and Meredith Vezina, a married gay couple in San Diego County, got kicked off their long-term Kaiser health plan, for which they’d been paying more than $1,300 a month. The cause wasn’t the Affordable Care Act, as far as they knew. They’d been living outside Kaiser’s service area, and the health plan had decided to tighten its rules.
That’s when they discovered the chilly hazards of dependence on the individual health insurance market. When they applied for a replacement policy with Anthem Blue Cross of California, Ellen, 59, disclosed that she might have carpal tunnel syndrome. She wasn’t sure--her condition was still being diagnosed by Kaiser when her coverage ended. But the possibility was enough to scare Anthem. “They said, ‘We will not insure you because you have a pre-existing condition,’” Holzman recalls.
But they were lucky, thanks to Obamacare. Through Covered California, the state’s individual insurance marketplace, they’ve found a plan through Sharp Healthcare that will cover them both for a total premium of $142 a month, after a government subsidy based on their income. They’ll have a higher deductible than Kaiser’s but lower co-pays. But their possible savings will be impressive.
More important than that was knowing that they couldn’t be turned down for coverage come Jan. 1. “We felt we didn’t have to panic, or worry,” Holzman says. “If not for the Affordable Care Act, our ability to get insurance would be very limited, if we could get it at all.”
Holzman and Vezina are exactly the type of people Obamacare is designed to help--indeed, rescue from the cold, hard world of individual health insurance of the past. That was a world where even an undiagnosed condition might render you uninsurable. Where your insurance could be canceled after you got sick or had an accident. Where your financial health was at risk as much as your physical well-being.
These are the stories you’re not hearing amid the pumped-up panic over canceled individual policies and premium shocks--many of which stories are certainly true, but the noise being made about them leads people to think they’re more common than they are.
We’ve compiled several alternative examples for this post. They’re anecdotes, sure, just like the anecdotes you’ve been seeing and reading about people learning they’ll be paying more for coverage next year.
The difference is that Americans learning that they’ll be eligible for coverage perhaps for the first time, or at sharply lower cost, are far more typical of the individual insurance market. Two-thirds of the 30 million Americans who will be eligible for individual coverage next year are uninsured today, whether because they can’t afford it now or because they’re barred by pre-existing condition limitations, which will no longer be legal. And more than three-quarters will be eligible for subsidies that will cut their premium costs and even co-pays and deductibles substantially.
Let’s hear from a few more of them.
David Shevlino, 51, is an artist in Delaware. Between the COBRA policy that extends the coverage his wife, Kathy, received at a former job and the bare-bones policy that covers himself and their 15-year-old son, they’ve been laying out $1,000 a month in premiums. Next year they’ll pay $650 a month, after the government subsidy, for a plan through Blue Cross of Delaware that covers the entire family and provides many services that have been excluded up to now.
That makes a big difference, especially for Kathy, who is still dealing with injuries she suffered in a cycling accident and that would have made her uninsurable once her COBRA ran out less than a year from now. “She had already been turned down by Aetna and Blue Cross, the very company that will now insure her,” Shevlino says. “This is a really significant thing--to me, the fact that insurance companies could turn you down didn’t make sense in terms of what healthcare is supposed to be for.”
And Judith Silverstein, 49, a Californian who was diagnosed with multiple sclerosis in 2007. Her family helps her pay the $750 monthly cost of her existing plan--which she only had because of federal law requiring that insurers who provide employer-based insurance continue to offer coverage if the employer goes out of business, as hers did. Next year she’ll get a subsidy that will get her a good “silver” level plan for $50.
For Silverstein that coverage is indispensable. Her case is relatively mild, but MS is a progressive condition that typically has made its sufferers pariahs of the individual insurance market in the past. “I researched the options,” she says. “Nobody’s going to sell you insurance in the individual market if you have MS.” But these customers can’t be excluded or saddled with big premium markups any more.
It’s not only recipients of subsidies who are benefiting. Jason Noble, 44, who has his own property management firm in Southern California, found a gold plan that will cover his wife and their three children--a daughter, 9, and 5-year-old twins--for a little less than $1,300 a month. That’s slightly more than they’d be paying next year for their existing Blue Shield plan, but the benefits are much greater, including pediatric dental coverage. Their family deductible will fall from $3,400 to zero. Last year, the family had a health scare that ran them $1,800 in out-of-pocket expenses; a similar event next year would cost them nothing. “It’s definitely a good deal,” Noble says.
It’s fair to observe that not all these people are enamored with their enrollment experience. Ellen Holzman found Covered California’s website “definitely clunky,” and she and Vezina are still awaiting enrollment documents from Sharp that they say are well overdue.
Brian Sheppard, 58, a self-employed Southern California attorney, says he spent five to seven hours on the website before determining that he could upgrade from the existing Kaiser plan covering him and his wife for an additional $100 a month, but with lower deductibles and prescription costs. He’s still waiting to hear whether he’ll be eligible for a subsidy that would slash his expenses significantly.
“I’m persistent, I’m a lawyer, and I found it very difficult to work through that system,” he says. But for him it was worth the effort. “In 2010, when people were being canceled because they got sick, there was all this outrage,” he observes. “People have forgotten that.”
The difficulties of the federal government’s healthcare.gov and some state enrollment websites are real, and have kept hundreds of thousands of Americans, even millions, from enrolling. But many of those who understand the benefits of the Affordable Care Act know that obsessing about the technical glitches is like mistaking the scoreboard for the game.
Political opportunists (like House Speaker John Boehner), exploit near-term difficulties to obscure the tangible benefits the Affordable Care Act will bring to tens of millions of their constituents. When they say “this law has to go,” as Boehner’s spokesman did this weekend, they’re talking about returning people to the era of exclusions for pre-existing conditions. To people learning they’re uninsurable because of injuries from accidents, or chronic diseases, or the sheer bloody-mindedness of insurance company bureaucrats.
Let’s hear Boehner and his people explain to Holzman and Vezina, the Shevlinos, the Nobles, the Sheppards, and Silverstein--and to 20-30 million other Americans like them who might be locked out of the individual insurance market without the law they ridicule as “Obamacare"--how they’d be better off that way.