Obamacare: Both good and bad

Dec. 13--The future of the Affordable Care Act may be uncertain -- but the deadline for getting coverage is not.

Open enrollment ends Friday.

As of Tuesday, 3.6 million individuals had enrolled for health insurance through the federal exchange, according to the Centers for Medicare and Medicaid Services. In 2017, 6.4 million people were covered under the ACA, also known as Obamacare. Including employer mandates, which requires most businesses to provide healthcare to workers employed 30 hours a week or more, and Medicaid expansion, which aids the elderly, disabled and poor, more than 20 million Americans received healthcare though the ACA since 2010.

Since the ACA was signed into law in 2010, Republican lawmakers have tried to both repeal and replace the law that provides healthcare coverage to all Americans -- and levies fines to those who do not sign up for health insurance.

GOP attempts to undo the ACA gained momentum with the November 2016 election of President Trump, who shortened the registration window for 2018 coverage. Senate Republicans have introduced a tax plan that includes ending the individual mandate requiring everyone to have health insurance.

Rep. Matt Gaetz, who represents Northwest Florida in the U.S. House of Representatives, favors ending the mandate, but would like to see Obamacare dismantled. If Gaetz eventually got his wish, he said those 20 million people won't be without health options. Instead, he said insurance companies would be "far more competitive." A repeal and replace plan passed in the House, but did not pass in the Senate.

"Right now, I hope we can get any repeal out of of the Senate," he said.

Three Panhandle residents recently shared their experiences -- some good, some bad -- with Affordable Care Act.

'There's no way I would've survived'

In 2012, David Wilcoxson was deployed in Afghanistan with the U.S. Army Reserve when he broke his back carrying hundreds of pounds of parts.

"I threw it over my back and it shifted my spine," he recalled. "It honestly did not hurt at the time ... I remember feeling a vibration, but I wouldn't take the pack off until we reached the destination."

When Wilcoxson's 11 years of service was up, so was his Tricare, which provides healthcare to active and retired military service members. But his back pain continued.

"My spine had shifted 4 millimeters, my wife had to help me out of bed," he said.

Wilcoxson signed up for insurance through healthcare.gov. At the time, he was living in Arkansas and was a full-time student with low income, so he qualified for a government subsidized, $150-a-month plan. Within a week, he saw a pain specialist and a mental health professional.

"The marriage didn't work, but the ACA helped us both tremendously," he said.

"If it was not for the Affordable Care Act, I really would have been another suicide statistic," he added. "There's no way I would have survived without help."

In August, Wilcoxson moved back to his native Florida. He's no longer a student and hasn't been able to apply for health insurance.

Florida is one of 19 states that did not expand Medicaid, which has made it harder for those making less money to receiving ACA subsidies. If you live under the poverty level -- the 2016 threshold for a one-person household is an annual income of $12,228 -- and you don't qualify for Medicaid, ACA plans may be unaffordable.

Wilcoxson said he just started a job at Walmart where he may be eligible for insurance in about a year. He manages the pain with prescription naproxen, an anti-inflammatory pain reliever.

"It hurts, but it's tolerable," he said.

The experience has made Wilcoxson rethink his opinions on the healthcare debate.

"Honestly, I was against it in the beginning," he said. "I think people have to experience what I did and not have that safety net. I've completely reversed my thinking.

"There's no need to throw it away."

'I'm done'

Caleb Smith, 30, said he was able to apply for health insurance for the first time through the Affordable Care Act.

But after his experience, the "hype" of Obamacare has ended.

"I'm done," he said. "I'd rather have no insurance."

Smith and his wife signed up for plans when the marketplace first opened in 2013. They found a monthly plan that covered both of them for $500 a month.

But when they filed their taxes later that year, they were hit with a big surprise. They had to pay back some of the subsidies. For the past two years they've been hit with penalties.

When enrolling in the ACA, applicants estimate their income for the upcoming year. If the estimated number is lower than the actual earned income, ACA subscribers will have to reimburse the government for a percentage of the subsidy they received.

Smith said it was more complicated than that.

"Our accountant couldn't even figure out why," he said.

According to a Kaiser Foundation Study in 2015, half of the households that received federal subsidies had to pay that money back. Annual penalties were an average of $794. On top of the penalties, the insurance coverage created more bills for the couple. When Caleb's wife tore her ACL during a skiing trip earlier this year, they still had to pay $10,000 out of pocket for her medical bills.

Smith said he started looking at plans for 2018. The monthly premium to cover both of them has risen to $1,300.

"It's outrageous," he said.

Next time he or his wife need medical attention, he said he's ready to just wait at the emergency room.

"I'll just not pay like everyone else," he said.

'It's not political'

When Debby's husband Mike (both declined to give last names) was laid off from his government contractor job in September last year, it was "a total nightmare," she said.

Mike was able to find some part-time work, but it didn't come with benefits. Yet at 61 years old and diagnosed with heart disease, Mike needed health insurance. He was able to find a plan on healthcare.gov that cost less than $100 a month.

"Thank God for the Affordable Care Act," Debby said. "We always had health insurance, this was a whole new experience. It's not political. You just don't know until it happens to you."

After two failed attempts to repeal and replace Obamacare, the Trump Administration has threatened to cut subsidies, creating market instability. In September, the Florida Office of Insurance Regulation announced there would be an average rate hike of 31 percent to premiums in the state. The increase is due to the potential elimination of the cost-sharing payments, the report said.

Mike went back to work at his government job in May. Debby said they wouldn't be able to afford health insurance if they had to pay the high premiums.

"We wouldn't have been able to keep our house," she said.

Working in the medical field, Debby said she knows how risky it can be to not be insured.

"You end up in the emergency room and it bounces things up," she said. "We're not lowlifes ... we just hit a bump in the road.

"I hope the ACA is still there for people who need it."

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