Some Win, Some Lose, A Year Into ACA Reforms
One year after the first health insurance marketplaces opened across the country,
As a result of the 2010 Affordable Care Act, some people have health insurance for the first time. But others feel they are worse off since the legislation -- dubbed Obamacare both drolly and derisively -- went into effect.
Given how the system works, that's hardly surprising, insurance experts say. Under the reform, people whose income is up to 400 percent of the poverty level may receive a tax credit or other incentives that put insurance within their financial reach.
About 78 percent of those who enrolled in the Marketplace by
But that's only part of the story.
Many of those who make over 400 percent of the federal poverty level have seen their rates increase, said
"It's kind of a redistribution of who pays the premiums," he said. "It's 50-50. It affects some people really well.... The downside is the people who hadn't planned on having their premiums increase so much. I think it was sold as that it would help a lot of people, but not that the premiums would go up so much."
Here's how it played out among some Hoosier, some winners, some not:
Insurance subsidy helps woman with heart trouble
Her husband has worked on and off for the past four years and not had employer-based insurance. But when work is scarce, they have been eligible for
Last year, her husband earned enough that they were no longer eligible for
And the Southeastside resident needs insurance. Hawkins -- a stay-at-home mother of five, three of whom are still at home -- suffers from heart failure and osteoarthritis.
"It's probably been a year since I have gone to the doctor," Hawkins said. "The fear is that I have a problem and have to go to the hospital, and right now I wouldn't be able to pay for it and wouldn't have insurance."
Whenever she knows she's going to go through a period without insurance, she stocks up on her medicine to make sure she has it. She's also been extra careful about what she eats to help keep her disease in check.
But last year, she started counting the days until the open enrollment period began in November. And now, some of her worries are about to go away.
Starting in March, she and her husband will both have health insurance once more, paying about
Cobbling together insurance was not easy for Hawkins. She made one trip in December to see an
"It's better than having nothing," she said. "This definitely gives me peace of mind. We need something."
'This really is a tax on us'
Insurers, including Anthem which had insured the family for nearly 30 years, declined to cover Funke, who went through what she describes as "minor breast cancer" in 2006.
The rest of her family -- her husband and three daughters -- purchased individual coverage. But Funke had to enter the state's high risk pool, paying about
Knowing that her plan would be offered only through
First of all, she did not want to deal with healthcare.gov. Besides she knew that her family's income would not qualify her for a subsidy.
One plan off the marketplace that she looked at would cost about
Meanwhile, the rest of her family has already seen their costs skyrocket. Last year her husband and two daughters had been paying about
Instead, the best they could find was about
"That's
Funke knows firsthand what it feels like to be turned down for a pre-existing condition, something that under health-care reform insurance companies can no longer do.
Still, she questions whether the current system is the best one.
"I'm sympathetic to people; I got turned down for insurance too. There certainly were problems with the way it used to work," she said. "But I do feel like there surely would have been a better way to fix it where it would not have had these effects on individuals who are seeing these huge premium increases. I wish there were more of a marketplace approach to it."
'I would not have been able to afford it'
For about a decade,
Campbell, now 64, knew what it was like to have insurance, though. Until she left a job at Quaker Oats in 2000, she was on her employer's plan.
But when she switched to a retail position, the cost of the plan her employer offered exceeded her budget and she had no insurance at all.
"If I had a need to go to the doctor, I had to pay out of pocket," she said.
In 2011, the Westside resident retired and started counting the years until she turned 65 and
She made a "drastic" change, cutting most carbs and sugar from her diet and losing about 40 pounds.
As soon as she could, she enrolled for insurance through the Affordable Care Act, opting for an Anthem/
"If it had not been for the tax credit I would not have been able to afford it," she said.
Once her insurance started, Campbell went to catch up on many tests she had put off when she lacked insurance -- basic preventive measures such as a mammogram, Pap smear, blood work.
This year, she returned to the navigator at the
"Some people are against Obamacare, but I'm not," Campbell said. "I'm one of those that really appreciate it. Anything could have happened, which it probably still can, but at least I know now that I'm covered. ... It's been a blessing I haven't had a major illness."
'Those that make the money, pay the money'
Nothing in the Affordable Care Act has had a direct impact on
Retired from Lucent Technologies in 2001, Rodenberg had health coverage in his retirement plan. At first, he was asked only to make small contributions.
Then a few years ago the costs started to soar. He and his wife switched to a high-deductible plan to try to keep the payments low but the deductible kept rising.
This year, Rodenburg, 64, received a letter telling him he would have to pay the full cost --
While both he and his wife still work, neither of their employers offers them insurance. So he turned to Walker, the
The couple's income level prevented them from qualifying for any subsidies, so Walker recommended they look off the marketplace and buy separate insurance policies. Rodenburg stayed with Lucent's plan. They're now paying
"This could have happened if health-care reform had not passed," he said, "but I have the suspicion that the cost is going so high that's why (Lucent) wanted out of it. Obviously there's a reason that they had to drop it, and the reason had to be that the price kept going up and they couldn't afford it either."
Although Rodenburg has less than a year until he turns 65 and is eligible for
The whole experience has left him bitter.
"Like anything else, those that make the money, pay the money, those that don't collect the benefits," he said. "I don't mind paying my fair share, but lord..."
Call Star reporter
___
(c)2015 The Indianapolis Star
Visit The Indianapolis Star at www.IndyStar.com
Distributed by Tribune Content Agency, LLC
Advisor News
Annuity News
Health/Employee Benefits News
Life Insurance News