Why Obamacare, despite its flaws, works for me


A man looks over the Affordable Care Act (commonly known as Obamacare) signup page on the HealthCare.gov Website in New York in this Oct. 2, 2013 photo illustration. (Mike Segar/Reuters)

The attacks against Obamacare, or the Affordable Care Act, just won’t stop. The latest? A misrepresentation of a report from the Congressional Budget Office that the ACA would cause the loss of 2.5 million jobs by 2024.

Not exactly. The CBO report said 2.5 million workers would choose to leave the labor force.

I understand their decision. Had the ACA not become law, I would have considered a job as a “lunch lady” in one of the nearby elementary schools — just to get health insurance.

My inspiration was an out-of-work accountant I met at a social event a couple of years ago. When asked what he did for a living, he laughed and said, “lunch lady.” Then he explained that he’d been laid off during the recession, and though his wife worked at a job she loved, she had no benefits. So he took a job at his children’s school, working a few hours a day to qualify for health insurance for his family.

Two moms in my neighborhood do the same thing. One is married to a man in his 50s who took a buyout from his employer for early retirement. The other works as a para-professional, or teacher’s assistant, in a grade school so her husband could start his own business after being laid off twice. Two of their children have pre-existing conditions, and insurance, if they could have bought it, would have been exorbitantly priced.

Because of my own pre-existing condition, I couldn’t buy health insurance — at any price — before the ACA.

Fortunately, my husband had health insurance through his last job, but it was a contract position, and we knew it would end. My Plan B (before Obamacare): Trade the freelance business for a job as a lunch lady or para. I could be home on holidays and snow days with my kids, something I couldn’t do with a regular full-time position.

It comes down to having the freedom to choose, as Jason Furman, chairman of the President’s Council of Economic Advisers, explained in a White House news briefing on the CBO report Tuesday. “Somebody who used to be in a job they didn’t want to be in just because that was the only way of getting health insurance for their family may be able to be in a better job for them,” he said. “Maybe a spouse who wanted to be part-time so they could spend more time with their family, now is able to do that. Somebody else who wanted to start a business and become an entrepreneur, and was terrified of doing it because they’d lose their health insurance, is now able to do that too, and switch and take a chance on creating jobs and growing the overall economy.  So there’s a lot of new choices that this will facilitate.”

Doesn’t it make more sense for me to contribute to the labor force through my work as a freelance journalist, and let someone else take that job as a lunch lady? Or for the computer programmer to go ahead and retire at age 63, so someone else can take that coveted position? With the high rates of unemployment we’ve had, I don’t think those jobs will go unfilled.

As for the accusation that people will choose to work fewer hours just so they could receive a higher subsidy for their insurance premiums: Well, if you work less, you’ll make less, and will the subsidy really be worth the loss of income? And if you choose not to work at all, you won’t qualify for the ACA with an income of zero.

Let’s play with some numbers. A single person, age 50, in the state of Kansas would pay $3,406 for a silver policy through the marketplace. With an annual income of $20,000, there would be a tax subsidy of $2,384, making the annual premium $1,021. Let’s say the income goes up to $30,000. Then the tax subsidy drops to $894, and the premium goes up to $2,512. At $40,000, the tax subsidy drops to zero, and you pay the entire $3,406.

Do you honestly believe most people would choose to make $20,000 a year instead of $30,000 in order to save $1,491? Or to make $30,000 instead of $40,000 to save $894?

The Affordable Care Act meant when my husband’s job and benefits ended Dec. 31, we had the option of buying health insurance through the marketplace.

I’ll admit the computer system was a mess. I spent hours trying to enroll. It wasn’t until the Saturday before Christmas — around 3:30 a.m. — that I reached a human being on the 800 number.

He was wonderful. He walked me through the process. We hit a computer glitch — and had to start over, twice. He refused to abandon me until the form was submitted, and I received a confirmation that we were eligible to enroll.

By that time, it was 6:30, and the sun was coming up.

He wanted me to choose a plan, but I thought it best to get my husband’s input in that decision. We managed to get enrolled by 10:30 the night of Dec. 23, just in time for coverage to begin Jan. 1.

As it turns out, we would have been eligible to buy insurance even if my husband had stayed in his previous job because the premium for health insurance was 14.6 percent of his salary — well over the 9.5 percent limit set by the ACA.

Although I had checked to make sure my son’s pediatrician was in network for the plan we chose, I was too tired to look up our other physicians. After our coverage began, I started asking. My family physician’s receptionist told me they accepted Coventry, but when I explained it was a Coventry plan sold through the marketplace, she said bluntly, “We don’t take any plan sold by Obamacare.”

My daughter’s physician said the same thing, only in a nicer tone of voice. That doctor is associated with St. Luke’s Hospital, which has had a reputation in the past for playing tough with insurance companies.

As things turned out, my husband found another job by the end of January, one with health insurance, and we have our choice of four different plans through his employer. Only one has St. Luke’s as a network provider.

Which simply proves that not every doctor or medical facility will take every insurance plan. It’s always been that way, and blaming Obamacare for limiting your choice of physicians shows a lack of understanding of how insurance plans work.

The latest attack I’ve seen on the ACA has been a late-night television commercial featuring Emilie Lamb, a woman in Tennessee whose plan was canceled. Turns out Lamb, who suffers from lupus, was covered through a state program called CoverTN that had a $25,000 annual cap on benefits. That limit didn’t meet the standards of the Affordable Care Act. Rather than improve the coverage, the state ended the plan.

Her premiums had been just $57 a month, and her new plan, through the marketplace, cost “700 percent” as much — or $373 a month.

In an article for the New York Post, Lamb says she’ll spend more than $6,000 a year for her medical care than under her old plan. But her premiums add up to $4,476, and she bought a top-of-the-line platinum plan with an out-of-pocket maximum of $1,500. That adds up to $5,976 a year for her total cost.

Her previous plan sounds like buying a car insurance policy for a new Mercedes that was bargain-basement cheap, but it’ll only pay $5,000 if you total the car. It’s hard to believe that $25,000 a year would cover what many lupus patients spend.

Here’s what a friend of mine with lupus told me about her medical experiences since the first of the year: “I have had 18 doctors’ appointments, three X-rays, an MRI, a mammogram (I have to go back tomorrow for another digital mammogram and sonogram), six physical therapy appointments, at least 10 vials of blood and a urine analysis done this year. All of that since January.” She added, “What is unbelievable is that this is absolutely not abnormal for someone with active lupus.”

Blogger Erin Kotecki Vest, who also suffers from lupus, believes that Lamb could have found a less expensive policy through the marketplace, close to the price she’d been paying.

But she does agree that Lamb didn’t get to keep her old policy because of Obamacare.

“And I, for one, am glad,” Vest wrote. Lamb “now will be able to receive the expensive treatments to help with her medical problems. She won’t be discriminated against for her pre-existing condition.”

Diana Reese is a journalist in Overland Park, Kan. Follow her on Twitter at @dianareese.
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