Obamacare leaves NJ consumers struggling to buy insurance as deadlines near

Nov. 29--Richard Brock couldn't remember his user name and password. Did he capitalize one of the letters? All of the letters? He thought he wrote it down somewhere. Did his wife throw out the paper with the information?

He clicked the prompt on the website, Healthcare.gov, to send him a new user name and password. It sent him a new user name. But not a new password.

New Jersey consumers trying to sign up for health insurance under what is popularly known as Obamacare have run into so much frustration that they have begun to wonder if a law designed to give more people access to health care instead will leave them without.

They have found, while trying to sign up, that there are more obstacles than a glitch-filled website and confusion over whether they can keep their old insurance. Namely, they are trying to fit their complicated, sometimes imperfect lives into an equally complicated law.

Each flare-up is a hit to a law regulating a health care industry whose economic model seems to be tied together by old shoelaces. But through it all, experts said it is too late to roll back the reforms. The state has already signed off on prices of insurance policies sold in 2014, said David Knowlton, president and chief executive officer of the New Jersey Health Care Quality Institute, a consumer advocacy group.

"This reform is going to move forward," Knowlton said. "The issue is not that you have unforeseen consequences. The issue is you react to it as a calamity instead of an opportunity to make it better."

Enacted in 2010, the Affordable Care Act is designed to cover more consumers, slow the rise in health care costs and help Americans live healthier lives. But the full impact is only reaching consumers now; beginning in 2014, most of them are required to have health insurance or pay a fee.

The biggest changes are in store for the nearly 1 million New Jerseyans who don't have insurance and 800,000 New Jerseyans who are covered by policies they bought from the individual market or their employer bought through the small employer market.

The rollout has come littered with minefields.

First, the federal government's website, Healthcare.gov, hasn't worked properly from day one, Oct. 1, delaying enrollment in New Jersey and 35 other states that didn't create a state-operated website. Just last week, the government said the site wouldn't be ready to accommodate small business sign-ups for another year.

Second, President Barack Obama told voters that if they liked their insurance, they could keep it -- a statement that turned out to be false when some consumers received notices that their policies wouldn't be renewed.

To quiet the political fallout, Obama let states decide if consumers could keep their expensive -- and less comprehensive -- policies. The move quickly elicited complaints from actuaries who said young and healthy consumers would take their old policies, leaving older and sicker consumers to choose from policies on the exchange. It was a recipe for higher premiums on the exchange.

New Jersey on Tuesday said it would be up to the insurance companies themselves to decide. Officially speaking, time is a factor. Open enrollment for the exchange lasts until March 31. Consumers who want policies to begin Jan. 1 need to purchase them by Dec. 23.

As a practical matter, little changed. Many insurers already have been letting customers renew their non-complaint policies early, even if those plans weren't scheduled to lapse until some time in 2014. The renewed policies still might be more expensive than the old ones, but it would give consumers another year before they need to go through the exercise again.

Yet it muddied the already muddy water. Horizon on Friday said it wanted to bring back one popular product, but it couldn't because it didn't meet federal requirements. The company said it was being blamed unfairly for the decision, even though its hands were tied by the federal government.

Hike in prices

The Asbury Park Press visited Richard Brock at his Marlboro home two weeks ago. Brock, 53, recently started a job selling medical devices for a small company that doesn't provide him insurance. His wife, Lianne, is covered through her employer, a private school.

Rather than go on his wife's policy, which would have been expensive, Brock last year found a plan from Horizon Blue Cross Blue Shield of New Jersey that covered himself and his three college-age children for $755 a month.

In October, Horizon sent Brock a letter saying the plan, called Horizon EPO Plus, wouldn't be renewed when it expires June 1, because it didn't meet the law's requirements.

It was a popular plan. More than 70 percent of New Jersey consumers who bought policies in the individual market -- about 94,000 policyholders -- had a version of that product.

With the lower price came restrictions that no longer are allowed. The plan, for example, capped the amount Horizon paid for diagnostic tests at $500 a year. It capped the amount it paid for diabetes benefits at $2,500 a year. It capped the amount it paid for wellness visits at $600 a year. It didn't cover ambulance service. And it didn't cover non-biological mental illness, said David Oscar, a benefits consultant with Altigro, a financial services firm in Fairfield.

Brock sat down at his computer and, without a working password, managed to at least browse the plans on HealthCare.gov. Up popped dozens of plans, many of which were comparable in price -- $833 for a gold plan that would cover 80 percent of what the government considers essential medical expenses such as hospitalization, laboratory services and wellness care, and $740 a month for a silver plan that would cover 70 percent of essential medical expenses.

But the site didn't ask for much personal information. And he couldn't find details about deductibles, co-pays and other out-of-pocket costs.

He then went to the Horizon site, which asked for more details, including the ages of his three children.

The premium for Horizon Advance EPO Silver was $1,303 a month. It included a preferred network of providers. It had a deductible of $1,500 for an individual and $3,000 for a family. It had a $30 co-pay. He would pay 30 percent of the bill after the deductible was met, at least up to the out-of-pocket limit of $5,000 for an individual and $10,000 for a family.

The cost of the policy was broken down by family member. His share was $568. His two sons' shares were $279 each. His daughter's share was $177. And a tax subsidy to offset the cost looked unlikely since he might have access to comprehensive insurance through his wife's employer.

Meantime, the insurance plan on Horizon's site came with a disclaimer: "Once you are enrolled, a complete list of details and exclusions will be provided."

How can you have somebody sign up if you don't know all of the details, he wondered.

Confusing choices

From Brock's home office, it was an example of the confusion consumers are encountering. It is difficult enough these days for consumers to remember their user names and passwords, much less trudge through the jargon of the insurance world and decipher premiums, deductibles, PPOs, EPOs and actuarial values.

The difference this year isn't that dramatic from before the Affordable Care Act. But now consumers, once shielded from the gritty details of insurance plans by their employers or brokers, are going to be on the hook for more of the cost. Just how much isn't clear. The website for <location value="LS/us.nj" idsrc="xmltag.org">New Jersey consumers doesn't work as it should.

"People change plans every year," said Wardell Sanders, president of the New Jersey Association of Health Plans, a trade group that represents insurers. "Deductibles, prescription drug coverage. There's always changes. That's always happened."

"What is important here on the individual side is for the marketplace to be working for folks to have access to plans and subsidies," he said. "We have to get that right."

Making the law work, even one as complicated as the Affordable Care Act, shouldn't be an insurmountable task. But David Oscar, the insurance broker, worries that politics are getting in the way of policy fixes.

"The only way (the law) can be fixed is if (politicians) get out of their own way," Oscar said. "They're talking to executives. They're not talking to people on the streets. Both sides of the aisle are afraid of each other and don't want anything to do with each other. Unless these people get out of, let's call it 'government world,' it can't be fixed."

Seeking short-term relief

Even with the exchange's balky website, Brock had options. He could go to HealthSherpa.com, which provides premium costs and subsidy information to consumers. He could join his wife's plan. Or he could see if Horizon would renew his policy before the end of the year since the new regulations only apply to policies being sold that go into effect Jan. 1.

The renewal still might be more expensive. But it would give him another 11 months before he would need to enroll again, said Linda Schwimmer, vice president of the New Jersey Health Care Quality Institute.

But one truth was beginning to emerge: He has found himself in the segment of consumers who likely will pay more both for insurance and for health care.

"Even if you're healthy, I've got to believe you're going to spend $2,000 to $4,000 a year, besides what you pay for (premiums)," he said. "With three kids, somebody is going to get sick or hurt."

Michael L. Diamond; 732-643-4038; [email protected]

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