A year ago, as the Obama administration prepared to roll out its new health care marketplace, The Atlanta Journal-Constitution profiled 20 people on how the advent of Obamacare would affect them. Some were uninsured, some held individual-market policies, some were business owners considering whether to cover their employees. As the second open enrollment period commences, we’ve returned to several of those people to see what’s happened with them and their health care. We feature four today with wildly different experiences. Interviews by Virginia Anderson, for The Atlanta Journal-Constitution
Lives: Powder Springs
THE SITUATION: Janiga, who owns a franchise of the home care company Visiting Angels, didn’t offer coverage to her employees last year because she wanted to get a handle on costs. She is not required to offer it this year but has decided “to go ahead to get any kinks worked out.”
IMPACT OF ACA: Her biggest challenge will be how to handle the additional costs, which she had to wait to see until the marketplace opened Nov. 15. She is concerned about how to pay for it, balancing the costs to her customers, many of whom are on fixed incomes, with the costs to her employees and to the business. Any plan she offers will cost the company, and she needs to find a way to still operate the business at a profit.
JANIGA’S VIEW: You don’t actually have to offer until 2016, but if we find a plan for our employees that works, we’re pretty much gonna go ahead and do it and work the bugs out. We have a lot of wheels going because of the nature of our work, so where do we fall in this is the question. To give an example, (employees) can only be paying between $30 and $35 a week, and for us to be able to afford our share, well, if I say to clients, I’m gonna raise our fee 50 cents an hour, that would make them possibly have to miss a day (of service), because they are on fixed incomes. That’s the hardest part — when in a situation where the consumer can’t bear that cost. But, when I look at what my penalty would be, I can’t bear that, either. But if I offer insurance, that’s kind of catchy, too. I have to look out for my employees and clients but for the business, also. It takes a lot of investigating to keep tabs on everything — the expenses, the costs, the penalty. We could hold off, but if we can get it at a good rate this year, we’ll go ahead and do it. The penalty is based on how many people you employ who would be eligible, like $2,000 for a full time equivalent. That’s a big hit if you’re looking at 20 people. More importantly, though, I keep coming back to it’s just the right thing to do.
THE SITUATION: Wall works as a nanny for newborns, so her work is sporadic and she doesn’t have the same income each month. While Wall’s field is low-paying, she says she loves the work and wouldn’t trade it for anything. “I love it, I love the kids, and it takes a lot of patience and consistency.”
She was able to buy a policy during the first open enrollment period of Obamacare but, at $140 a month, it was too expensive for her.
IMPACT OF ACA: Wall was able to buy insurance through Blue Cross and Blue Shield of Georgia but could not afford it, so she dropped it. She also was confused about how insurance works and terms such as “co-payment” and “deductible.” She recently went through a brief illness that left her scared and untreated. Even when she was able to go back to work, she wasn’t operating at full speed.
WALL’S VIEW: The whole plan was a little confusing, and those cards. Everything is so small; I had to buy a magnifying glass. And I wasn’t sure with the deductible, if I paid off one doctor, how would that affect another doctor?
There are months when I don’t have a lot of work. A couple of weeks ago, I got a stomach virus. I called my doctor’s office, and they said they couldn’t see me because I don’t have insurance.
They told me to go to the ER. That made me cry because I didn’t have gas money, and how did I know they would treat me there? I was so sick I almost passed out, and I had to hold on to the walls to get to the bathroom. I just prayed and prayed.
If I had had health insurance, I probably would have called 911. It was very scary. I missed a week and a half of work. I tell you, coverage is everything. I had a heart attack in 2006. If I have chest pains, I get concerned.
There’s that horrible fear — am I going to be covered? I’m still kind of frustrated with the whole system.
THE SITUATION: Pirkle, a student, had to go off her parents’ insurance when she turned 27.
She considered the offerings in the marketplace but was able to find insurance through an employer. The job proved too much with her schoolwork at Kennesaw State University, though, so she quit to focus on her school work.
She hopes to graduate within a year but needs insurance in the meantime and hopes to find something affordable on the marketplace. Much of that will depend on costs. Doctors have told her that she may have fibromyalgia, which is characterized by widespread muscular and skeletal pain, fatigue and sleep problems. Such a diagnosis would mean she will need to see specialists for chronic pain and other issues.
Impact of ACA: Pirkle has options under the Affordable Care Act, but she is confused about them and also doesn’t know whether she will be able to afford the premiums. Because she lost her insurance when she quit her job, she likely would have been eligible to enroll during the special enrollment period but did not because of confusion about policies and the costs.
Pirkle’s view: (My former employer) offered me COBRA, but it was going to be so much more I couldn’t do it. So now I’m trying to find something. I looked the first go-around but then got a job. So now I have to balance out what I can afford. The only reason I haven’t jumped onto a catastrophic plan is that I have to see more. So now I need to find something.
Lives: Johns Creek
THE SITUATION: Shlora, an insurance agent, has shopped for and bought his own insurance for years. He went into the marketplace last year, but because of a glitch, he has never been able to see his application online. He obtained a policy from Humana, but it wasn’t the one he wanted. He would like to change this year.
IMPACT OF ACA: Because Shlora has never seen his policy online, he has been “frighteningly exasperated” by the ACA. Also, he was further frustrated when he received an email from Humana on Aug. 26 telling him that “the government has been trying to get in touch with you” regarding his enrollment. Unless “immediate action” was taken, Humana told him, he could lose his policy. Shlora estimates he has spent about 100 hours on the phone with marketplace and Humana reps over the past year.
SHLORA’S VIEW: I could see my profile but not my application. Laughably, my profile showed I had two wives named Paula and four sons named Raymond. They say every time I talk to them that the call may be recorded. I don’t think so, because they couldn’t let this go on if they did. I haven’t received anything from anyone, and the best I can figure is that I should get a renewal form by Nov. 15. I don’t dare try to change the plan, although I’d love to, because I can’t see my application. If the government would ever allow me to get online to see it, maybe I could. This renewal process … I think they’re flying by the seat of their pants. It’s really kind of unbelievable. The incompetence level has forced me into this corner.
Dr. Richard Wagner
Lives: Sandy Springs
THE SITUATION: Wagner, a solo-practice pediatrician in Atlanta for three decades, has bought his own health plans for years. With his wife now eligible for Medicare and their three children grown, Wagner needed a plan this year for just himself. He was paying $360 a month for a policy with a $5,000 deductible but went to the Health Insurance Marketplace just to compare prices.
IMPACT OF ACA: Wagner would have paid $150 more for a similar plan and deductible through the exchange, so he stuck with the plan he already had. This year, however, Wagner has learned that his old plan is being canceled because it doesn’t meet the new criteria under the Affordable Care Act. He is not eligible for a subsidy, so he plans to use the marketplace, at least to compare prices.
WAGNER’S VIEWS: Right now, I’m a little bit in limbo. I’m 64, but hopefully, I’ll be OK. I’ll probably re-check the (marketplace) when it opens. I tried Coventry (current insurer), but it’s not up and running. I got the message ‘call back after Nov. 15.’ I’m not panicking; I really only need insurance for 11 months, when I’ll be eligible for Medicare. But my wife’s Medicare Advantage plan doubled … so I don’t know. It’s a complicated business, and it’s not any less complicated because of the (marketplace). Why don’t we just do the Medicare model and be done with it? I do wish it had been done more efficiently. I don’t think they did a great job rolling it out. But anybody with any sense knew it was going to have problems the first time out. I’m not unhappy with the system in general. I think it’s ridiculous we’re not extending Medicaid. Bottom line, I wouldn’t be unhappy with a single-payer system.
THE SITUATION: Evans is director of living well at Southwire, a wire and cable manufacturer with close to 7,000 full-time employees. Workers pay about 15 percent of their insurance premiums, with Southwire covering the rest, more than some other companies, where workers might be responsible for 20 to 25 percent.
IMPACT OF ACA: This year, Southwire will face a fee, called a reinsurance fee, required under the Affordable Care Act: $63 per person for a total cost to Southwire of about $800,000.
EVANS’ VIEWS: There really wasn’t a lot changing for us this year except the reinsurance fee. This is new stuff for us. It’s just an expense that we have to book just like any other expense. I think we pretty much have it settled. It’s just one of those things, where costs keep going up. Some companies are actually passing it along as a surcharge, but we are not doing that. We will do what we need to do to be compliant and also to offer health care insurance to our employees.
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