Insured with pre-existing woes could lose coverage

Nov. 21--The spotlight has shone brightly on Americans being kicked off cheaper private health insurance plans recently and forced to buy more expensive insurance through health-care exchanges established by the Affordable Care Act.

President Obama even reversed course last week and urged private insurance companies to keep offering cheaper, less comprehensive plans to consumers for one more year instead of canceling those plans.

But concern is mounting for another group of vulnerable consumers who were supposed to benefit most from the Affordable Care Act, also known as Obamacare.

Although the market reforms enacted by the health-care act will provide the poorest Americans with unrestricted access to private health insurance, many with chronic pre-existing conditions could find they cannot afford coverage if their incomes are too high to quality for government subsidies.

On Dec. 31, thousands of Ohio consumers with pre-existing conditions will be forced to move off a government-sponsored health-care plan that was meant to be a temporary fix for those considered high-risk by insurance companies.

Ruby Jean Stamper of Toledo is one of the 3,527 in Ohio who enrolled in what was originally called the Ohio High Risk Pool. She now must switch to new coverage next year as the federal government and states close down this special program for individuals with pre-existing conditions.

Mrs. Stamper, 63, had a freak accident in 2011 that left her with a herniated disk and chronic pain.

"I was going out to my car a couple of winters ago when it was like a sheet of ice. I went sliding on my butt and and it damaged a nerve. I always considered myself in good shape so I didn't think I needed it [health insurance], but accidents happen," Mrs. Stamper said.

Mrs. Stamper said suffering with the pain that went down her back and across her foot was "living hell." During this period that she called the worst time in her life, she did what she could to get by, but with no health insurance she sometimes resorted to buying pain medication on the black market.

Then she heard about the Ohio High Risk Pool. The federal government allocated $5 billion in funding to the states for the pools' creation, of which Ohio received $152 million to set up a safety net for people who have been denied or priced out of coverage.

Those enrolled in this program were later transferred to the federally run Pre-existing Condition Insurance Plan. It took Mrs. Stamper six months to enroll in the program, but she eventually found a health-care plan she could afford.

"That really saved me. I was able to sign up on Friday and I got the surgery the following Monday," she said.

She has been paying about $384 a month for coverage under the Pre-existing Condition Insurance Plan and about about $15 a month for prescriptions. But when the program terminates at the end of next month, Mrs. Stamper will have to buy coverage through the new health-care exchange.

Like many others, though, she had trouble gaining access to glitch-plagued healthcare.gov, so she turned to an independent insurance agent for help. With a Dec. 15 sign-up deadline looming, Mrs. Stamper anxiously contacted Rich Craig, an agent at the Pinnacle Health Group, and the price of the new coverage being offered was much higher than she expected.

Mr. Craig estimates Mrs. Stamper's cost for health care through the exchange will range from $525 a month for a "bronze"-rated plan with a $6,000 deductible to $994 a month for a premium "platinum" plan just a $500 deductible. She also would have to pay for pain medication out of pocket.

Mrs. Stamper, who runs a small day-care center out of her home, and her husband, who retired after being laid off from his job at Textileather in North Toledo, make too much money to qualify for federal subsidies for their premiums.

"I'm not rich. I make a decent living and I sure didn't expect that I would payer higher premiums than the Ohio High Risk Pool. I thought that would be in line with Obamacare."

The federal government has no plans to extend the Pre-existing Condition Insurance Plan past Dec. 31, Mr. Craig said. "But many people that are on the program do not qualify for subsidies and many of these people are looking at premiums that are outrageous," he said.

Just as Mrs. Stamper was about to give up and risk going without insurance again, while paying for prescriptions out of pocket, Mr. Craig found a temporary solution.

One of the cheap health plans slated to expire before the President made his announcement last week became available, Mr. Craig said. For at least one more year, Mrs. Stamper will be able to pay about the same health-care premium she had with the Pre-existing Condition Insurance Plan plan.

"I couldn't believe it. I'm so thankful," she said. "I still believe the President is on the right track, but they just have to work all this out."

Contact Marlene Harris-Taylor at: [email protected] or 419-724-6091.

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