Obamacare repeal through the eyes of St. Louis area residents
The
People are still signing up for coverage this year. The deadline is Tuesday.
The Affordable Care Act required insurance companies to offer more robust plans with basic consumer protections. At the same time, most Americans were required to buy health insurance or pay a penalty, which was among the least popular provisions.
The idea was that requiring most Americans to obtain coverage would drive young healthy individuals to the online marketplaces to offset the costs of the older and sicker enrollees.
Some individuals were able to afford coverage by qualifying for financial help based on their household income. Some states decided to expand
Insurance companies complained that those who ended up enrolling in the online marketplaces were older and sicker and caused financial losses for the insurance companies.
Near the end of Obama's term, many insurers, particularly in
Now, there are signs that the marketplaces have stabilized. But consumers who don't qualify for financial help have experienced significant increases in premiums in some regions.
Most Americans receive health insurance through their employers, and the law required employer coverage to meet a minimum threshold of benefits, such as no lifetime limits on coverage and providing access to preventive service without copays.
The law required smaller employees with 50 full-time employees or more to offer insurance, which caused some to struggle with the increased costs.
Although the law has remained controversial, uninsured rates have fallen dramatically in a five-year period.
In
In the last figures released during Obama's time in office, 248,897 Missourians had picked a health insurance plan as of
A majority of them -- 59 percent -- had incomes between 100 percent and 200 percent of the federal poverty level.
Of the Missourians who enrolled in a plan for 2017, 48 percent picked a different plan. That is the highest percentage of any state, suggesting the insurance carrier dropouts were more acute in
A previous
Meanwhile, in
About 41 percent of
Forty-three percent of
Following are personal stories of people waiting to see what happens with the Affordable Care Act.
Bingheim said when the mandate went into effect in 2015, the restaurant used layoffs and reductions in employees' hours to avoid the mandate. "I told our insurance carrier that we need to do whatever we need to do to not get involved," Bingheim said. "It was going to be an extreme amount of money."
Though the restaurant avoided the costs, she feels the reduction added to a feeling of demise at the restaurant and banquet facility. Five years ago,
"I feel that everyone should have health care, but I don't know if it should the employers' responsibility all the time, especially if their employees are part time," said Bingheim, who did not want to say who she voted for. "We need to find some other way."
Valeria Sousza, 36,
At age 27, Valeria Sousza woke up to find her body completely numb from the waist down on her left side. She was diagnosed with multiple sclerosis, a disease in which the body's immune system attacks the protective lining in the brain and spinal cord, causing permanent damage to the central nervous system. Some eventually lose the ability to walk, write or swallow, but nearly 10 years later, Sousza is in relatively good health and works full time.
Insurance through her employer,
She fears she'll be forced to leave the city she has come to call home. "I've really grown to love it here ... and it would really break my heart, but I don't see how I'd be able to stay here (if the ACA is repealed)."
She found out one of her kidneys failed and caused a major systemic infection. The kidney was removed, and she has mostly healed. "Once I get over the financial shock, I will be much better."
She's worried about the repeal of the Affordable Care Act and again losing access to care. "It's a direct war on the people of this country who are too poor to afford health care," Deluca said. "I work very hard, and I've basically been told I'm not worth any help with health care."
Mahina Nightsage, 57,
After losing her job in July, Mahina Nightsage, a lifelong St. Louisan, turned to the online marketplace because she couldn't afford the COBRA plan her employer offered at the end of her employment. She doesn't have any serious health conditions, but at age 57, she said, "I'm at an age where it's risky to be without health insurance. If something serious happens to me, I'll be able to get care." She qualifies for financial help with her plan and pays about
Nightsage has a master's degree in public administration and policy and is working to get back in the nonprofit sector. "Those messages about who is more deserving of help colors our view of what is good public policy," she said.
She says the law has put small businesses at a disadvantage. "I don't have an HR department that can deal with this, so it's up to me." It's costing her more money each year, but she's reluctant to pass along those added costs to her clients. Pahde said she wishes there was more competition for her health insurance business like she sees when shopping for workers' compensation and liability insurance. This year she thought about incurring the financial penalty for not offering insurance. It would have been less costly to pay the penalty, she said. "But that's just not who we want to be."
The Affordable Care Act allowed Taylor to retire early as a custodian for
Taylor has worked since he was 13, but he has developed degenerative bone disease, scoliosis, spinal stenosis and severe arthritis, he said. "I couldn't have done it for much longer."
He retired last March and got insurance the following month through the health care exchange. Earning only disability, he qualified for assistance to help cover the cost. He paid
Taylor said he is prone to extremely painful intestinal obstructions that require expensive emergency care. An episode could occur at any time. He fears that he will not be able to afford insurance, and he could get hit with an emergency. When he suffered an obstruction last fall, the bill to insurance for a one-day hospital stay was
He also worries about keeping his diabetes and blood pressure under control, which he does with medication and regular doctor visits.
Taylor says he is conservative and has mostly voted Republican in the past but couldn't vote for either candidate in November. He said he thinks the
"You don't know how much it is going to be or what they are going to replace it with," he said. "They are so out of touch with people on the cost of things."
Kleindienst and her husband,
In the years preceding Obamacare, however, it was becoming more difficult, Kleindienst said. They could only afford to purchase a policy with a high deductible, which made accessing care very difficult for their workers.
"It was getting so expensive, it was a constant source of financial stress for us," she said. "We had hours of gut-wrenching number-crunching to figure out what we could do."
The legislation created a special insurance marketplace -- called the Small Business Health Options Program -- open only to businesses of this size. It provides small employers increased purchasing power to obtain better choices for coverage. Businesses purchasing coverage through the marketplace can also qualify for tax credits worth up to 50 percent.
"When we were able to access the Affordable Care Act, we were able to purchase insurance that could support our needs and is usable by our staff," said Kleindienst, a
Kleindienst fears her business will return to the prospect of increasingly expensive policies that cover fewer things for fewer people.
"There's more emphasis on wellness and preventive care, and that's just common sense," Kleindienst said. "I don't understand why a government would be hostile to the health of its citizens, and it's going to be more costly in the long run for our country."
"I'm freaking out. I own a small business," Heaton said. "Without an employer to put me on a plan, I'm completely terrified."
Three years ago, Heaton started her own marketing agency, called Undeniable. She fears her health coverage will be denied, however, without the ACA protecting her from being denied coverage or charged more because of her health status.
She has been able to get affordable insurance on the marketplace despite being self-employed, and despite treatment of depression, Hashimoto's disease, polycystic ovarian syndrome and fibroid tumors.
"It's not even about affording insurance, it's about being able to get insurance at all," said Heaton, who voted for
If replacement legislation doesn't offer the same cost protections, she will have to try to find a job at a big agency. She had dreamed of owning her own business, though. "I don't want to give up."
Freiderich watched her premiums rise and her coverage get worse under the ACA. She said she thinks it did nothing to control costs and improve access to care for middle-class workers.
Freiderich, who works as an insurance agent in a small office, has been getting health insurance on her own for nearly nine years, since her husband became eligible for
"Obamacare is wonderful for the people always getting everything for free, but it's not good for the blue-collar middle-class worker that is slapped with a monthly premium they struggle to have to pay," she said. "But you have to pay it, or they will penalize you on taxes, so now you're frustrated and your anxiety is so high because you are being pushed against a wall."
Last fall, Freiderich fell and fractured her leg. Then after the start of the new year, she discovered her nearby hospital and primary care doctor were no longer considered in-network under her plan. She must travel to
"Losing Obamacare in my estimation is not a big problem," she said. "It's put me in worse shape."
Freiderich, who did not want to say who she voted for, is anxious to learn details of a replacement plan, she said. "This is a terrible situation we are in; and we need to get it corrected, because for the middle class, it is just killing them."
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