Obamacare enrollees awaiting word on their health insurance

Dec. 04--NEWBURGH -- Nick Gross initially resented the Affordable Care Act, blaming the 2010 federal health law for the insurance hit he took at work. The small firm that employed him as an information technology specialist swapped his low-deductible health plan for a policy with a $1,500 deductible, and raised his monthly contribution to the premiums to $315 from $200.

But then he lost his job and his insurance with it, just as Lyme Disease inflicted pain on his joints, gave him daily headaches and saddled him with new medical expenses. Gross turned to New York's health exchange, created to oversee private health plans made available through the Affordable Care Act, and got coverage with federally subsidized premiums he could afford.

"I've been screwed by it, and I've been saved by it," Gross said of the law.

Roughly one in eight people in Orange, Ulster and Sullivan counties, or almost 77,000 residents, have gotten insurance through the health exchange since it was activated in 2013, according to a state count dating to Jan. 31 and released in August. For those like Gross, who got private insurance that would have been too expensive without the program dubbed Obamacare, and for others who became eligible for Medicaid as a result of the law, the future of their coverage suddenly has gotten murky. President-elect Donald Trump has vowed to make repealing Obamacare a priority when he takes office in January, although how and when he and Republicans in Congress go about dismantling the law and what they replace it with is not yet clear.

Majority enrolled in Medicaid

About two thirds of the people who signed up for coverage through the exchange in Orange, Ulster and Sullivan enrolled in Medicaid, the longstanding government insurance for the poor, funded jointly by the federal, state and county governments in New York. Most already qualified for the program under New York's broad eligibility guidelines, and are therefore not in danger of losing coverage if the Affordable Care Act is repealed. State officials say about 9 percent of people enrolled in Medicaid through the exchange -- 4,600 enrollees in Orange, Ulster and Sullivan -- became eligible as a result of the federal health law that Republicans may repeal.

More than 16,000 other people in those three counties got private health coverage through the exchange and could lose it. About half are enrolled in a new program New York created this year, known as Essential Plans, that makes insurance available for free or for only $20 a month for individuals and families whose incomes are just over the Medicaid eligibility limit and who earn up to twice the federal poverty level.

Among those receiving subsidized private coverage is Chris Brown, a 63-year-old carpenter from Newburgh who has deteriorating vertebrae and is unable to work as result. He got his coverage with the help of the Cornerstone Family Healthcare in Newburgh, which helps consumers understand their insurance options and enroll through the state exchange. Brown just renewed his insurance for the next year, and worries about potential changes that lie ahead.

"It's been good to me," he said. "This is the first time in my life that I've had insurance."

Cornerstone also helped 53-year-old Robin Brown, who had health insurance through her job at Macy's in New York City until she came down with lupus and had to leave the job. Now, she wakes at least once a month with swollen limbs and pain coursing through her bones. "It's just pure pain," said Brown, who is not related to Chris Brown. "The bone pain feels like a knife is stuck in there."

Brown, who lost her health coverage when she left Macy's, learned that the drugs she needs to slow the disease's progress would cost her more than $300 a month. A friend steered her to Cornerstone, and within days Brown was enrolled in Medicaid.

"A lot of people benefited from the Affordable Care Act," says Jose Santiago, coordinator of the Cornerstone program that helps consumers navigate the state health exchange. "There's a lot of concerns, and they're just waiting to see what's going to happen."

Budgetary implications with repeal

Repealing the law also has budgetary implications for New York. Bill Hammond, director of health policy at the Albany-based Empire Center for Public Policy, recently estimated the loss of additional Medicaid funding from Washington could punch a roughly $2.7 billion hole in the state budget, which totaled $155.6 billion this year. The state gets higher federal payments under the Affordable Care Act for providing Medicaid to people earning up to 138 percent of the federal poverty level -- a population New York already largely served before the law was passed.

Hammond said in an interview last week that none of the Republican proposals for replacing Obamacare have retained the Medicaid expansion, making it unlikely that enhanced funding would continue. That would leave New York with the choice between covering the expense on its own or discontinuing its own limited expansion of eligibility under the Affordable Care Act, a prospect he sees as unlikely. As a result of the law, the state expanded Medicaid eligibility to include single, childless adults with incomes between the federal poverty level and 138 percent of it.

"The practice in New York is not to take away benefits from the Medicaid population," Hammond said.

Paula Martino, a health and wellness coach who lives in New Windsor, pays $551 a month for a subsidized private plan offered through the state exchange, which was a godsend for her after she sold her longtime billing and consulting business last year and needed to get insurance. She has a rare liver disease that requires medication that costs almost $27,000 a month.

The coverage is not without flaws. Martino complained of difficulty with the exchange website, which recently told her -- incorrectly -- that she has no income and qualifies for Medicaid. And Martino is frustrated by the variations in how states are executing the Affordable Care Act, as well as the resistance she faced when seeking to see her out-of-state liver specialist. She wishes the program was more uniform across the country, like Medicare.

But she doesn't believe it can be taken away without an alternative in place. "They can't make it disappear, because they have to give people like me the ability to get insurance," she said.

Robert Quinlan, an independent life- and health-insurance agent and broker in New Windsor, said the Affordable Care Act has two major problems in its financial structure: a shortage of young, healthy people enrolling in exchange plans, despite the penalties the federal government makes them pay ($695 per adult this year); and a preponderance of enrollees who are older than 55 and have large medical bills.

One proposal likely to figure into any Republican "replacement" plan -- a future Trumpcare -- is letting people open health savings accounts, where they could deposit pretax income that could be spent later on deductibles, co-payments and other costs. Quinlan said coupling such accounts with high-deductible health plans, which offer employers and employees lower premiums, would be popular with large employers and workers with minimal medical needs -- the population that is still resisting Obamacare coverage.

Whether health savings accounts could simply be added to the Affordable Care Act without dismantling it is difficult to say, Quinlan said, given the complexity of the system. "There are so many moving parts to this thing," he said.

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