Sara Foss's Thinking It Through
by Sara Foss

Thinking It Through

A Daily Gazette life blog
Her column and blog rolled into one
 

Obamacare: Local effects a mixed bag

By Sara Foss
Saturday, November 2, 2013

Over the past couple of weeks, I’ve received a number of interesting emails from readers who have purchased, or are attempting to purchase, health insurance through the new state exchange.
And here’s what I can tell you: Thus far, Obamacare is a mixed bag.
Some people will save money, while others will pay more for health insurance. The process of signing up is complicated and has been marred by glitches and misinformation in the early going. Every story I heard made me grateful that I receive health insurance through my employer and don’t have to spend hours researching my health plan choices, comparing costs and trying to anticipate what health problems I might or might not have in the coming year.
Plans offered through the state’s health plan marketplace — officially known as the NY State of Health — fall into four categories: platinum, gold, silver and bronze. The platinum plans are most expensive, but come with lower out-of-pocket costs, while the bronze plans are least expensive, but have higher deductibles. Subsidies to help defray costs are available to lower-income customers, many of whom might discover that they are now eligible for Medicaid.
It’s all pretty complicated, and many of the people I heard from are still researching and trying to understand their options. Here’s a sampling of my responses.
One reader, who described herself as “a 60-year-old recent widow who does not get insurance through my employer,” told me that “my best option pre-Obamacare is a COBRA policy from my late husband’s employer (SUNY Albany) which costs over $1,500/month for my 23-year-old daughter and myself.” On the exchange, she signed up for “an unsubsidized bronze policy from CDPHP that will cost $626/month. It is a very good deal for us.”
But others said they were experiencing a bit of sticker shock.
One 45-year-old man told me that “the Affordable Care Act is not exactly affordable.”
“The bronze plan might work for me, but it’s something like $331 per month with a $2,000 deductible for individual coverage,” wrote the man, who recently became an independent insurance agent after a stint working at Stewart’s. “As long as you don’t get sick or visit doctors often, the bronze is best. Like all insurance (I work in the field), you’re paying for security and you hope you don’t have to use it.”
“I knew health care wasn’t going to be cheap, but this is tough for a guy like me,” the man said. “I’m just starting a new career and will rely on commissions to make my living.”
In general, I’ve been a supporter of Obamacare, because I believe it makes some necessary improvements to a lousy system.
For instance, it makes it illegal to deny health insurance to people because they have a pre-existing medical condition, and bans lifetime caps on the dollar amount of coverage people can receive.
But it’s also clear that Obamacare has some flaws, and that its implementation has been a mess.
The administration had three years to create a functioning website, and failed to do it. This is inexcusable. And President Barack Obama never should have promised that people could keep their health insurance if they liked it. Many of the people whose plans are now being canceled will probably receive better insurance in the long run, but this was an obvious lie that never should have been uttered.
I also have serious misgivings about how Obamacare reinforces the notion that health care is a consumer good. At one point or another, everybody gets sick or hurt, and the idea that we should pay through the nose for medical care and treatment is absurd. Our health care system is unwieldy, complicated and overly expensive, and this isn’t going to change anytime soon. But I expect that New York’s exchange will ultimately be a success, because the state is committed to making it work.
A Saratoga County woman told me she began researching her options under Obamacare after she learned that her Healthy NY plan would be discontinued at the end of the year, forcing her to buy insurance through the exchange. At first, the website frustrated her; due to a glitch that has since been straightened out, she was initially informed that she wasn’t eligible to purchase a health plan on NY State of Health.
The woman, who is 51, said she and her husband both work part time and make about $30,000. Right now, she pays $333 a month for Healthy NY, a state program that provides affordable insurance to individuals and small businesses in partnership with HMOs. Her husband, who is a quadriplegic, receives Medicare and a supplemental plan that costs $357 per month; the couple’s 8-year-old son is insured for $15 a month through Child Health Plus, a state program.
After doing a bit of research, the woman has learned that under Obamacare she qualifies for a $191 subsidy as well as a cost-share reduction plan, which comes with lower out-of-pocket costs. “I wouldn’t say it is a win-win since I was happy with my other plan, but at least I finally figured out that it will end up costing me less than I’m currently paying per month,” she said.
One Schoharie County woman said Obamacare will be a much better deal for her family.
Right now, she and her husband, who has Type I diabetes, pay $8,000 a year for a catastrophic health insurance plan and spend another $5,000 on dentists, eye doctors and other health-related expenses. The couple has two children, and earn about $30,000 farming; under the Affordable Care Act, they are Medicaid-eligible. The woman said signing up for health insurance through the state exchange “was a piece of cake. The trouble I faced is the vitriol from folks who resent that someone like me is now Medicaid eligible.”
“Farmers don’t get benefits packages,” she said.

 

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