Middle-Class Family Feels The ACA Pinch

Nov. 13--There were days when Mike Merkel's health insurance plan drove him to the edge of a breakdown.

It began after President Barack Obama signed the Affordable Care Act in 2010. Merkel saw his private insurance premiums jump from $585 a month to $1,400 for a family of four. He investigated switching but was told by Covered California, the state's health plan exchange, he was ineligible for tax credits because his family earned just above $97,000. But he could pay $1,200 a month if he put his two children on Medi-Cal. He switched to a new private plan for he and his wife that had lower premiums, but he later learned his wife, Nina, a breast cancer survivor, could no longer see her doctor at City of Hope for checkups. The family was then mistakenly dropped from the plan after his son joined the U.S. Marines. Earlier this year, when Nina Merkel was diagnosed with angiosarcoma, a form of cancer, their insurance carrier could not tell them which medical provider to go to for PET scans or surgeries.

After two years of letters, phone calls, doctors who fought on his family's behalf and frustration, Merkel said he's been able to sort through most of the issues with his Anthem Blue Shield policy, but he's stuck with high deductibles, the cost of a PET scan, and his wife sees three different doctors at three different medical centers across Los Angeles County.

"It's hurt me more than anything because it raised the cost of my insurance to begin with," Merkel said of the Affordable Care Act. "And it more than tripled in less than five years. The cost of my deductibles have skyrocketed. I don't understand how that's affordable."

Merkel, a West Covina resident, is among many Americans in the middle whose household income is too high to qualify for government subsidies but not enough to shed worries over how to pay their medical bills to receive quality care. For Merkel and many Americans getting ready to renew health insurance policies this month, they say the Affordable Care Act belies its intention.

Results of a Gallup poll released in April back up Merkel's assessment.

--Of the more than 2,000 people contacted by telephone, half still disapprove of the now 5-year-old Affordable Care Act.

--Among those such as Merkel whose household income is higher than $90,000, 27 percent said the ACA hurt their family, while 55 percent in that group said it neither helped nor hindered them.

--On the flip side, 23 percent of those with incomes below $24,000 a year say the ACA has helped their health care situation.

In California, there are 3.8 million people who remain uninsured. But of those, almost 400,000 make too much money, or more than $97,000 for a family of four, to receive government subsidies, according to figures released this year by the Kaiser Family Foundation.

When Covered California launched in the fall of 2013, the exchange helped sign up 2 million people, and most of them qualified for a tax credit. But since then, 700,000 people have left the exchange for various reasons. And at least 4 million were enrolled into Medi-Cal, the state's version of Medicaid, as a result of the Affordable Care Act.

An email request to speak with Peter Lee, the executive director for Covered California, went unanswered. In an October interview with the , Lee said the Affordable Care Act fulfilled at least one goal.

"What the Affordable Care Act did was bring health care to millions," Lee said. "It did not make health care cheap."

Covered California began its third enrollment period on Nov. 1. and it ends on Jan. 31. Early on, many said if the Affordable Care Act was a success in California, it would be a success nationwide. Health policy consultant Robert Laszewski said the Golden State can't claim success yet.

"The ACA is working well for those buying insurance on the exchanges who are low income," Laszewski said. "In states that have expanded Medicaid, those people at least have a Medicaid plan. But that's what makes the Affordable Care Act so problematic. The biggest problem is that those making more than 200 percent of the poverty level are still finding the plans expensive (after subsidies) and the deductibles and co-pays high."

He said more people who buy plans on the exchanges will see their premiums and deductibles increase and even narrower provider networks.

"The quality of care depends upon whether you can get a plan that makes going to a good provider affordable after the higher deductibles and provider access limitations," Laszewski said.

Merkel said he can only offer some advice to those who plan to enroll or renew their health policy plans whether they buy it through Covered California or not: Do lots of research, weigh the positives and negatives of high premiums and deductibles, and record all conversations when on the telephone with customer service, he said.

The most important advice: "Don't get sick," Merkel said. "If you're not sick, it's not a problem, but if you're sick, it's a problem."

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