At A Midpoint, Health Care Market Gets Mixed Reviews

By Amy Jeter |

The Virginian-Pilot

The Affordable Care Act's health insurance marketplaces offered nothing if not hope.

Hope spurred a Virginia Beach lawyer to jump on to HealthCare.gov minutes after the website went live at midnight Oct. 1. Hope guided a certified nurse's aide from Portsmouth to take time away from two jobs and sit through a speech and video clip that evening.

A 60-year-old Virginia Beach woman hoped to obtain health coverage after a decade without. A Portsmouth couple struggling from the effects of two layoffs hoped to go back to being insured.

Three months went by.

Now, it's halftime for the marketplaces - the government-run hubs where people can purchase private insurance plans on the individual or small-group markets.

The open enrollment period continues until March 31. Coverage began Wednesday for some.

For lower-income people, a major perk of the marketplace was supposed to be the opportunity to qualify for government assistance with premiums or out-of-pocket costs.

However, many ended up balancing potential benefits with the immediate frustrations of a broken website and flawed bureaucratic process; in the first two months, fewer than 5,000 Virginians selected a plan through the marketplace, out of hundreds of thousands who could have.

The number of enrollees is higher now, federal officials say.

The improved website saw a December surge, logging at least seven times as many enrollments for the federally run marketplace as in the previous two months. Virginia's numbers for December weren't available.

More people are contacting Virginia's specially trained helpers, too. More are completing applications. More are exploring their options.

With technical obstacles largely resolved, more people are closing in on an answer to their most pressing question:

Was my hope justified?

Ben Cohen says yes.

The self-employed Virginia Beach attorney, 45, logged on to HealthCare.gov four times before noon on Oct. 1 and was on hold 45 minutes before talking to a person on the marketplace's telephone hotline.

He completed an application in the first week but got hung up on identity verification. Over three months, Cohen visited the website more than 40 times. He completed the application several more times - first because the website wasn't working, then to modify family information.

Still, Cohen feels he's found a good deal.

For him and his three children, a marketplace policy would charge a monthly premium of $700 or less with a deductible around $4,500 and maximum out-of-pocket around $6,000.

Cohen currently pays $2,200 a month for the family's insurance. The deductible is $6,000, and the maximum out-of-pocket is around $8,000.

The main reason he hasn't bought a plan yet is that he wants bariatric surgery. He must decide whether to: find a marketplace plan that would cover the surgery, get the surgery under his current policy then switch, or switch now and forgo the surgery.

"In any way shape or form, I should be switched over by March," he said.

What about all that time on the website and the phone?

Cohen, a self-described liberal, said he was impressed at how quickly the government fixed severe problems with a large system launched under a tight deadline.

"I didn't mind being part of a social experiment," he said.

Larry Madden minded.

His wife, Teresa Madden, visited a marketplace helper three times - once for five hours - trying to figure out the system. They filled out an application on paper, got no response, then completed one online.

Then came a shock: The lowest-price plan for the Portsmouth couple charged $821 a month, with a $12,000 deductible.

It didn't come close to being affordable for them.

Larry Madden, 59, was laid off by the city of Chesapeake in 2009 and now works part time for a paint company. His wife, 56, was laid off in 2008 from a job as a nursing home receptionist and continues to look for work.

"If you take that premium and you subtract it from my monthly, I would only be bringing home $70 a month," Larry Madden said.

Am I doing something wrong? he wondered.

He made some phone calls and finally learned the answer from Katherine Taylor, an attorney who serves as a marketplace navigator: There was no mistake.

People with an income between one and four times the federal poverty standard - about $15,510 to $62,040 for a two-person household - can get government assistance, such as tax credits and subsidized coverage, through the marketplace.

People with incomes below the federal poverty level - like the Maddens - don't qualify for the assistance.

The Affordable Care Act had intended for them to receive coverage from Medicaid, the state-federal insurance program for some poor and some disabled people, under expanded eligibility rules. But the U.S. Supreme Court ruled in 2012 that states could opt out of the expansion. So far, Virginia has opted out.

The Maddens now plan to seek an exemption from the tax penalty for being uninsured this year. Otherwise, as far as health coverage is concerned, nothing will change for them.

Larry Madden never was a fan of the health care law, and this experience reinforced his opinion.

"I'm kind of numb," he said. "When they said affordable health care - in the state of Virginia, in my situation, it's not the fact."

Vickie Lynn Kershaw, 60, of Virginia Beach is starting to feel the same way.

Her husband, who is 71, is covered by Medicare and a supplemental policy, but Kershaw has gone without insurance since poor health forced her to leave a motel housekeeping job in 2003.

She showed up at the O.V. Medical and Dental Center in Norfolk the second week of October to get help signing up for a health plan. She didn't even mind doing a paper application - computers are not her thing.

What Kershaw minded was the confusion that followed.

"I haven't gotten anything in the mail," she said. "Nothing has been sent to me."

An insurance agent working with the health center gave her a quote for a couple of plans. One cost more than $1,400 a month with a $4,000 deductible, the other more than $600 a month with a $6,000 deductible.

"I said, 'Well, Donald Trump couldn't do that,'" Kershaw said. "That's as far as I got with them."

Now, she's considering signing up for insurance through a company that advertised on television.

"You wait so many years and years and years," she said. "It's very disappointing."

Cynthia Small feels like she won the lottery.

After her first informational session on Oct. 1, the certified nurse's aide went to another event at St. Mark Missionary Baptist Church in Portsmouth. Someone there signed her up for the marketplace, and her plan information already has arrived in the mail.

Although Small works two jobs, she logs too few hours to qualify for insurance through her employers and has sought health care at a free clinic. Now, she's looking forward to seeing specialists.

Asked if her plan is affordable, Small, 54, said, "Very." But she declined to quote an exact rate.

"I mean, cheap, cheap, cheap, cheap, cheap," she said. "Cheap!"

Amy Jeter, 757-446-2730, [email protected]

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