The impact of Obamacare in Berks County

March 30--Some walked away ecstatic. Others were furious.

Man or woman, Republican or Democrat, below the poverty level or slightly above it, it doesn't matter.

Some received federal health insurance. Some fell into a gap and got nothing.

After six months, hundreds of headlines and partisan angst, Monday marks the deadline for people to sign up for insurance through the Affordable Care Act. Those who started applications but were unable to finish them by the deadline have until mid-April to ask for an extension.

The law is one of President Barack Obama's landmark policies and is designed to make health insurance affordable for all.

But an anecdotal look at local people who signed up before the enrollment deadline tells a story that's not quite so universal.

Some in Berks County received life-changing, affordable federal health insurance. With help from the government, their premiums fell by hundreds of dollars or only cost a few.

Others fell outside the window for help and ended up paying more or are staring down big bills at the end of a year.

There are residents such as Karen Trimber, 55, of Spring Township: "When they told me I'd pay less than $5 a month (with tax credits) for an insurance premium, I said, 'Oh, my God, I can't believe it.' "

And residents such as David Hoffman, 52, of Sinking Spring: "It's people like me who bought insurance all our lives, and they say now you're going to lose yours. I'm really ticked off about it. It's the unknown. I don't know what's going to happen."

Tom Davenport, president of Blue Marsh Insurance Inc. in Birdsboro, said he has been seeing both ends of the spectrum since the federal health insurance website, HealthCare.gov, opened in the fall.

From October through February, about 160,000 Pennsylvanians signed up for insurance through the site. Thousands more were expected to sign up before Monday's deadline.

Across the country, 6 million had already enrolled with a few days left before the deadline. The nonpartisan Congressional Budget Office originally estimated 7 million would enroll by March 31.

"For us, we had a lot of people we helped who received coverage, and a lot of people who were not in a better position than they were before," Davenport said.

Glad to have help

Trimber, a part-time deli counter worker at Weis Markets, earns less than $16,000 a year. She suffers from a thyroid condition but has been without health insurance for the past five years.

"I think the navigator at Berks Encore could tell by the look on my face that I was near tears," she said of selecting an insurance plan.

Widowed for eight years and the mother of three adult children, Trimber used to work in the optical field before 2009 and typically earned less than $40,000. She had a $220 monthly insurance premium at the time.

"Economically, it's been a rough road for me during the past five years with the loss and changes in my jobs; I was getting depressed," Trimber said. "I rent a place now because my home went into foreclosure, but I am on the rebound now."

Now, she has comparable insurance in a silver-tier plan, but for only a few dollars a month.

"I'm a registered Republican and all my kids are Democrats, but I've always leaned toward Republican views and held values of self-sufficiency and trying to make it on my own effort," she said. "There was all this negativity about Obamacare, so I was hesitant. I really wasn't sure this health care option was going to help me.

"I think I've seen the light."

In the gap

Cynthia Heagy, 47, of Mohnton hasn't seen any light at the end of the federal marketplace insurance tunnel -- at least not yet.

"Oh, I was disappointed," said Heagy, a part-time pizza delivery driver, who showed up at a Berks Encore Super Saturday event designed to help low- and moderate-income people navigate the insurance marketplace.

"I thought anyone who has low-income would be helped by this program, but that's not the case," she said.

With a $13,000 annual income, Heagy, a single mother with a teenage daughter, said she made too much money to qualify for medical health assistance under Medicaid and not enough to qualify for the tax credits that are an integral part of the Affordable Care Act.

"I was told I fell into the gap," she said.

Helen Wooten, community outreach coordinator for the Berks Community Health Center, said she's consulting with others like Heagy who fell into the gap for assistance.

"I'm curious to know what the governor will do (if he will expand Medicaid)," Wooten said. "We are going to have a lot of folks who are falling through the cracks."

Gov. Tom Corbett has offered an alternative to Medicaid expansion as outlined under the Affordable Care Act. His plan would allow the uninsured to use federal subsidies to acquire private insurance, but it has faced heavy opposition because it included a work-search requirement.

Heagy suffers from high blood pressure, gallstones and a kidney ailment and needs health insurance. Corbett declined the federal Medicaid expansion as outlined in the law, which made Heagy's quest for health insurance a bit more problematic, she said.

But she was advised by insurance navigators that she would qualify for sliding-scale fees or for hospital charity programs to cover medical services. She also was advised that her first step for primary care would be to go to the federally supported Berks Community Health Center.

"I'm going to go through this process and see what happens, but they tell me I won't be penalized for not having this federal insurance," she said.

Young and invincible

At 23 and healthy, Griffin Macaulay is the type of person the government wants covered in the health insurance pool.

Macauley, a self-employed graphic and Web designer, signed up for new health insurance in March.

"I'm going to be walking around with almost $100 more a month in my pocket, which will help, especially after tax season," said Macaulay of Flying Hills.

He was paying $200 a month for insurance, but cancelled that plan after selecting a $150 policy on HealthCare.gov. He received a $40 subsidy for his insurance that brought his monthly premium down to $110.

"I'm a pretty healthy guy. I'm one of those twenty-something invincibles," he said. "Just in case something does happen, I have health insurance I can rely on."

Macaulay received help finding insurance from a navigator during a signup event at Berks Encore. He said he's been following the news about the health care law but believes it will ultimately help many people find insurance that had been out of their reach.

"There's so many acronyms and things to understand. It was really comforting to work with the adviser," he said. "It was a really good experience."

More out of his pocket

Last fall, Hoffman was among millions of Americans who received letters saying they would lose their insurance at the end of 2014 because it did not comply with the Affordable Care Act. He said he is worried what insurance rates will be like when he shops for a new policy later this year.

"I thought maybe my policy premiums were going to go up," he said. "I didn't expect to have mine canceled. I wanted to keep mine."

Steven Kunkle, 59, of Oley Township has a similar story. It has been years since Kunkle paid for an eye exam, but at the start of the year that all changed.

Kunkle, like Hoffman, received a cancellation notice. His insurance plan would have expired at the end of 2014, but he decided to select a new one after going through the exchange and calling a few different carriers.

His income was too high to qualify for subsidies. His new policy has a $525 premium, about $120 less than his cancelled one, but his deductible went from zero to $2,500.

"They are starting to dip into my pocket more," he said. "I just had to get a new sleep apnea machine. That was $1,600 out of my pocket.

"It's a disaster."

Big savings

Kathi Ember's doctors used to get on her about scheduling colonoscopies.

She wanted the screenings, but her insurance policy had a $5,000 deductible.

"That was what people don't understand," said Ember of Richmond Township. "I'm almost 60. A colonoscopy would cost me $2,000."

In December, Ember, 59, and her husband Alan "Breezy" Brintzenhoff, 61, found a policy on the exchange that will cost them $75 a month, with a $200 deductible. The whole process took 20 minutes.

The most the couple, both self-employed artists, will pay for health care this year is $1,500. It will cover colonoscopies.

Ember said she favors a single-payer system in which everyone contributes to one health plan, but the Affordable Care Act has worked for her family. With a hefty subsidy, she's saving $525 on her monthly premium, but might have to pay some of that back if her household income comes in higher than expected.

"It's not a perfect plan," she said. "I think they did the best they could. I'm sure it will evolve and change over time."

Both ends of spectrum

As a licensed Medicare specialist, it's Tom Smith's business to help people age 65 and older wade through health insurance options.

But recently he spent time helping his retired registered nurse wife, Karen, 62, and daughter, Marijo, 30, a preschool teacher, find health insurance under the Affordable Care Act.

"I am very happy with what I was able to get for my wife," said Smith, 63, of Mount Penn, who has eight years experience as a broker with 25 insurance companies. "At the end of April, she will be just getting off the COBRA plan, which we pay for ourselves and has a premium of $642.24 a month. It includes eye and dental."

Smith said he was able to get Karen a health plan in the federal marketplace, equal to or better than COBRA. Her new plan costs more than $100 less than what they had been paying.

"It is a gold plan, and it doesn't include dental or eye coverage, but we will pay those costs out of pocket," Smith said. Gold represents the third highest of the four available tiers.

Smith said his household income was too high for his wife to receive any tax credit to defray the monthly premium costs.

For his daughter, who has not had insurance for the past four years, Smith found a bronze plan, which carries a $151 monthly premium reduced to a month with the tax credit.

"I actually feel relieved," said Marijo of Stony Creek Mills, who was on her parents' insurance plan until she was 26 and then let her insurance drop.

Healthy and active, Marijo said she took her parents' advice that she should still have a basic insurance plan in case of emergency.

"Based on my daughter's age and health, I think this plan will be fine for her," Smith said.

"I could have had health insurance with my employer," Marijo said, "but it would have cost me more than $300 a month. They told me to try the marketplace. I'm satisfied."

More to come

Davenport said the winners and losers in the Affordable Care Act depended on income, current insurance and whether a person had pre-existing conditions; the new law helps those with pre-existing conditions, because it bars insurers from rejecting them.

He said the looming deadline is not the end of the story.

Enrollment on HealthCare.gov reopens Nov. 15, starting the process all over again. How much insurance will cost in November is a big unknown, but he said some will do better, and others will do worse.

"It's definitely not unilateral," he said. "You'll hear that it's the worst law ever and hurt everybody. But you'll also hear it's the best law ever and didn't hurt anybody."

Contact Bruce R. Posten: 610-371-5059 or [email protected].

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