Why Toby Overdorf can’t wait for Trump, Congress to replace ACA

Feb. 17--The Boyds think about Bill's triple bypass surgery and Deb's cystic fibrosis diagnosis when they hear Republicans' directive to repeal and replace their so-called "Obamacare."

"I don't want it to be shut down," said Deb Boyd of Fort Pierce.

But Toby Overdorf thinks about how much more he's paying for health insurance for his family and employees since the Affordable Care Act became effective.

"The system that's in place now is not working," said the Martin County GOP leader, who runs a small business in Port St. Lucie. "It was a first try, if you will, and I'm hoping the second time around we are able to hit it out of the ballpark."

The Boyds and Overdorfs are a microcosm of a nation divided over the issue, just two of countless stories Treasure Coast lawmakers may consider as Congress develops a new health care plan for the country. Many ideas have been circulating, but President Donald Trump and lawmakers haven't unveiled a specific plan yet.

It will be a politically daunting task for Congress members to decide which provisions of the 2010 law to keep and which ones to toss -- knowing some of their constituents might lose coverage. Nearly 48,000 Treasure Coast residents receive coverage through the law, according to the Kaiser Family Foundation, and countless others are affected by it -- for better or worse.

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"SO WHAT DO WE DO?"

The Boyds are a middle-class family. They raised two sons who now have families of their own. They live in a picturesque St. Lucie County subdivision west of Florida's Turnpike, where spacious single-family homes neighbor ranches and citrus groves.

They had good health insurance through Bill's job at Vision Research Inc., which builds high-speed cameras.

On Jan 21, 2016, Bill Boyd went to work and learned the firm's Stuart branch was closing because of declining profits. At 57, he was out of a job after 13 years working as an electronic technician there.

With their health insurance running out at the end of the month, the Boyds signed up for coverage through the Affordable Care Act -- the first time they've ever relied on government assistance for anything, they said. They pay $50 per month and receive $1,300 in federal tax credits to help them buy insurance, they said.

Five months later, Bill Boyd went to the doctor for a stress test after experiencing chest pain for about two months. His arteries were blocked and he underwent open heart surgery the next day at Martin Medical Center in Stuart. They said they paid $6,000 for the $168,000 procedure.

Soon after, Deb Boyd, 56, was diagnosed with cystic fibrosis, a genetic disease that causes mucus buildup in the lungs and other organs.

Her medication costs $3,000 a month, but because she has health insurance she qualifies for a grant that drops her co-pay to zero, she said. Without the grant, she would pay $947 a month through her Blue Cross Blue Shield of Florida policy.

Deb Boyd works 12 hours to 15 hours per week doing data entry for a local nonprofit. Bill Boyd is still looking for a job, but employment opportunities don't come easily for people his age, he said.

Without the tax credits, the Boyds couldn't afford health care, they said. They are afraid Congress will eliminate the Affordable Care Act provision that prohibits insurers from denying coverage to people with pre-existing conditions such as theirs. Trump and several Republicans have said they want to keep that provision, but haven't explained how they would do that.

The Boyds, who always had voted Republican, voted for Hillary Clinton and other Democrats last year because of Trump's campaign promise to repeal the health care law, they said.

"When I was working, I always had health care," Bill said. "But when you get laid off ... I look at it differently."

See the map below on mobile devices. Hover on any county to see how many insured and insurers it numbered in 2016 and 2017. Scroll down to read more of the story.

"IT'S NOT WORKING"

Overdorf said his monthly premium for a policy that covers him, his wife and his daughter has increased from about $850 five years ago to $1,790.

His family doesn't qualify for tax credits, which are awarded to those making between 100 percent and 400 percent of the federal poverty level. That means an annual income of $20,420 to $81,680 for a family of three.

Overdorf, the Martin County Republican Executive Committee's newly elected chairman, is vice president of EDC Inc., an engineering design and construction company. The law doesn't require him to provide health care coverage to his 26 employees, but he said he does to retain talent. Employers are required to provide insurance, or pay a fine, only when they have at least 50 full-time workers.

With soaring health care costs, his company went from subsidizing 100 percent of its workers' premiums in 2010 to less than 50 percent, depending on what kind of plan they choose, Overdorf said. His employees must choose between a high-deductible or a high-premium policy to make up for the company's increased costs. He said he has about five employees who find it cheaper to pay a federal penalty -- it varies by income -- imposed on those who waive coverage.

Whether it is correct to blame the Affordable Care Act for employers' higher costs is a much-debated issue with no definitive answer. The law has few provisions that significantly increase costs and statistics show premium increases have slowed in its wake, said Matthew Rae, an analyst at the Kaiser Family Foundation, a nonpartisan producer of healthcare policy facts and analysis. Employer-sponsored family premiums grew 20 percent from 2011 to 2016 compared to 31 percent from 2006 to 2011, according to Kaiser.

Still, most employers complained about soaring administrative costs associated with complying with the law, according to a 2015 survey by the International Foundation of Employee Benefit Plans.

Overdorf is one who has made up his mind: The law is costing his business. He said Congress should increase competition among providers, such as by allowing them to sell policies across state lines, while retaining the pre-existing condition provision.

The lack of competition is evident in the shrinking number of insurance companies providing coverage through the law. After UnitedHealthcare dropped out of the program, the number of insurers in Martin and St. Lucie counties declined from two to one and in Indian River from three to two.

"The challenge has been how do we continue to provide benefits for our employees ... while costs continue to rise," Overdorf said, "and there's nowhere that's more evident than within our health insurance."

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