For those who count on Obamacare, fear, frustration mount as they await Trump’s move

Nov. 25--Mike Berry of Kansas City listened to President-elect Donald Trump call the Affordable Care Act a "total disaster" that he swore he would move to repeal on the first day of his presidency and then replace with something better.

Berry's take:

"I would be doomed," said the 62-year-old former music teacher, who has a bad heart, diabetes and brittle bones and thinks he's only alive with the help of 27 expensive prescription medications. "I feel like a political piñata at this point. They literally have my life in their hands."

Berry spoke recently at the Samuel U. Rodgers Health Center, sitting alongside his wife, Colleen, as he signed up for insurance through the marketplace that first opened up in 2013 under the Affordable Care Act.

Some 20 million people who were once uninsured now have coverage under the law, enacted in 2010 and commonly called Obamacare. The percentage of uninsured non-elderly citizens has likewise dropped to a historic low of 10 percent from 16.6 percent in 2014.

Nationwide, advisers like those at Rodgers say they are being inundated by anger and worry in the run-up to Inauguration Day. The fate of the Affordable Care Act is just one of the issues Trump campaigned on that Americans are watching with anticipation or dread.

As for Obamacare: "It's life and death to some people. I mean, this is not a game," said Jim Torres, the program manager at Rodgers who helps clients sign on. "It gets back to their health, their well-being, their ability to work, to attend school -- to just live. We're talking about people and their lives. This is real."

So, too, is the pitch and frustration in Penny Ward-Bledsoe's voice.

At 63, the Kansas City hairdresser is healthy and has been for years.

"I've never been sickly," she said. "I've been blessed. No diabetes. No high blood pressure."

Self-employed, she signed up for Obamacare at Swope Health Services and is hardly shy about describing herself as poor.

"Oh, my God, yes!" Ward-Bledsoe said. She lauded the Affordable Care Act simply for the peace of mind it has given her. For years, before its availability, Ward-Bledsoe gambled with her health, going without insurance. It wasn't because she wanted to.

"It was just not affordable," she said. "Even back in the '90s, for me to call around to try to get some health insurance, it was damned near as much as my mortgage, plus a $1,000 deductible ...

"For them (politicians) to try to tamper with it, to take people like me back damned near 20 to 30 years -- to have nothing again, which is going to cause people to have to file bankruptcies, to fall back due to health bills and hospitalizations -- that is not helping 'we the people.' "

As a taxpayer, it angers her that repeal will come at the hands of lawmakers who get their health care paid for by taxpayers.

"Let them go without it!" Ward-Bledsoe said. "Congress, the Senate -- all of them that are getting health care that my tax dollars are paying for. I'm helping to pay for their health insurance, but I can't have coverage? I'm part of the 99 percent that can't?"

For Ward-Bledsoe and others with Obamacare coverage, two big questions loom: If Trump and Congress repeal or partially repeal portions of the Affordable Care Act, what kind of health plan would replace it, and when that might happen?

Congress has voted more than 60 times to repeal the ACA. Ideas have been floated, such as supporting health savings accounts. But no detailed replacement plan has been presented.

Numerous experts have opined that repealing the ACA without replacing it would foment political uproar, as it would effectively kick 20 million people off insurance rolls.

A slight majority of Americans -- 51 percent -- favor repealing Obamacare, according to a Gallup poll last month. And many small companies dislike the law, advocates say, for its increasing premiums, its employer mandate -- forcing businesses with 50 or more workers to offer coverage or pay penalties -- and the complexity of meeting its reporting requirements.

But the plans remain popular with people who have them; a Kaiser Family Foundation survey this year found that 68 percent of those using Obamacare rate their coverage as either "excellent" or "good."

Sharon Pace of Kansas City, Kan., counts herself in that number.

She said she has no admiration for Trump. Nor is she convinced that the president-elect will adhere to his recent statement that whatever new health insurance plan that he and a Republican-controlled Congress might devise will keep the part of Obamacare that prevents insurance companies from denying coverage to people with pre-existing conditions.

"Let me tell you," Pace said. "If they did remove (coverage for) pre-existing conditions, I'm not buying your health insurance. You can fine me all you want. When I go the hospital, your ass can pay for it. I have no money. You can't come after me."

Pace, 61, worked for 15 years for AT&T before retiring early two years ago. For those two years, she drew a small income by tapping into her 401k. She paid for her own health insurance, about $500 a month.

Now, as soon as she turns 62 in December, she will draw her income exclusively from Social Security: $1,154 per month, or $13,848 a year, only about $2,000 more than the $11,880 federal poverty line for a single adult.

"I knew that when I left (my job) I had to have health care," said Pace, who takes medications to manage conditions that include arthritis and bipolar disorder. "I knew that if I couldn't get it under the Affordable Care Act, I would be pretty much screwed because of pre-existing conditions -- besides the fact that it is so expensive.

"Social Security is $1,154 a month. If I had to pay $800 (for coverage), what would a girl live on? Air?"

Under Obamacare, Pace received a tax credit to offset the cost of what otherwise would have been several hundred dollars in monthly premiums.

Her monthly premium: $23.41.

"Coverage is excellent!" Pace said. "There is almost no deductible. It is better coverage than I've had the last two years."

Popular benefits

Under the Affordable Care Act, insurance plans are required to include the same set of guaranteed essential benefits.

The most popular include coverage for pre-existing conditions; prescription drug coverage; and oral health and vision coverage for children. Also required is the provision that dependents be covered under their parents' plans up to age 26.

Trump, post-election, also indicated that the age 26 benefit would remain.

Yet, in the last two years, criticism of Obamacare has mounted as a number of insurance carriers that once offered coverage in the HealthCare.gov marketplace have now abandoned it, finding that they are losing money.

Older, sicker Americans signed up for Obamacare, but younger, healthier clients did not enroll in the numbers expected. Choices on policies have narrowed, and premiums increased.

About 75 percent of people using Obamacare in 2017 are still expected to be able to get policies for less than about $100 per month. But premiums for mid-level health plans for people making too much to qualify for federal tax credits were expected to increase by an average of 25 percent for 2017.

The Kaiser survey found that while 68 percent were satisfied with their premiums in 2014, that number dropped to 59 percent in 2016.

'It would be devastating'

Berry, the music teacher with 27 prescriptions, cataloged his illnesses during his visit to Rodgers Health Center.

A 20-year history of ulcerative colitis led to him taking the drug Prednisone, which caused him to gain weight.

"I ended up putting on 150 pounds," Berry said. "I came down with diabetes, high blood pressure...a degenerative bone disease."

His bones are so brittle, a high school student where he taught in Colorado cracked his sternum when she accidentally hit him in the chest.

"I've had five operations on this arm," he said, touching his right. "I've had both knees. I've had a double hip repair."

His right eye has been repaired with wire mesh. On top of that, Berry suffers pericarditis, swelling of the tissues around his heart.

"There are more medications than I can keep track of," he said.

His wife has kept track. Age 66, Colleen Berry is already insured through a Medicare Advantage plan. Her job, working at the Sprouts Farmers Market, also provides health insurance. Because she's already receiving Medicare, she's not forced to take it, nor is Mike.

They have done the math. Her employer-sponsored health insurance, Colleen Berry said, would cost the couple more than $400 per month before their deductible. At their current income, she said, that would leave the couple a remaining $400 for all other bills, including gas, groceries and prescriptions, beyond basic rent and utilities.

"It would be devastating," Colleen Berry said.

Logged on to HealthCare.gov, Torres, the counselor, called up a number of plans. Based on income, Mike Berry qualified for a $565 monthly tax credit to put toward a premium.

He settled on a Cigna plan. Cost: $214 per month after the tax credit.

The deductible would be $2,700, after which the plan would pick up more than 90 percent of costs. It offered co-pays of $25 for primary care physicians and $75 for specialists.

"That's the one I want," Berry said.

Until Republican leaders produce a detailed plan for replacing Obamacare, Torres said, he can only tell clients so much about the future after they sign up for coverage to begin Jan. 1.

"They're worried," he said. "People say, 'Am I going to have insurance next year?' I tell them I think that next year you're probably OK. The federal government has already signed agreements with insurance companies for 2017. They're going to start before the new president takes office.

"That being said, I'm sure they'll make changes. How they happen, when they happen, we have no idea."

Eric Adler: 816-234-4431, @eadler

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