The Washington PostDemocracy Dies in Darkness

Americans worry, cheer as Congress moves to upend the Affordable Care Act

Rick and Veda Woosley raise cattle and grow crops such as tobacco in Clark County, just outside Lexington, Ky. (Luke Sharrett/For The Washington Post)

A soon-to-be father whose wife is getting prenatal care through the Affordable Care Act . A woman whose mother would have been bankrupted by her cancer diagnosis had she not had ACA coverage. An older self-employed couple, insured under the law, who for "the first time in our lives" can afford to see doctors and buy medicines.

This month, they and nearly 1,200 other people responded when The Washington Post asked readers how they thought the health-care debate on Capitol Hill would affect them: "Do you or someone you know have health insurance through the Affordable Care Act? What do you think of the proposed changes by Congress? Are you concerned about a specific part of the plan? Share your story."

With the House poised to vote Thursday on the first potential changes, these replies offer a window on what’s at stake for many ­Americans.

The vast majority of people voiced anxiety, apprehension, even fear. Several doctors weighed in, warning that the country’s most vulnerable citizens would be put at risk by the House GOP’s legislation.

A question about the impact of the ACA and beyond elicits almost 1,200 answers

But a small fraction of people said they would be glad to see the law go. Some have watched their insurance premiums soar. Others have been staggered by their plans’ annual ­deductibles.

And there are those who still feel deceived, with one woman in Tennessee invoking President Barack Obama’s promise that people would be able to keep their plans and doctors going forward. “The first day of the ACA I was notified that my insurance was canceled,” she wrote.

Here are five of their stories.

When enrollment in the ACA’s insurance marketplaces opened in fall 2013, it had been two decades since Rick Woosley had seen a doctor. Not only did he feel pretty healthy, but as a tenant farmer raising cattle and growing crops such as corn, beans and tobacco, he also didn’t exactly have the money to buy health coverage.

Nevertheless, he signed up for his state's expansion of Medicaid under the ACA. He begrudgingly submitted to a physical and got a nasty shock: He had early-stage colon cancer. Surgery followed.

“I felt normal and didn’t really want to go take the physical, but if I hadn’t I don’t even know if I would be here now,” Woosley, 55, said late last week, talking by cellphone, surrounded by cows from one of his fields east of Lexington.

The story was similar for his wife, Veda, who went about 15 years without a doctor’s visit despite persistent breathing problems, he said. After getting on Medicaid, she was diagnosed with a chronic lung disease and put on a nebulizer.

“She sees the doctor now once every three months,” he said.

The relief the two felt soon gave way to nervousness as conservatives sharpened their attacks on the health law. In late 2015, a pro-ACA governor, Democrat Steve Beshear, left office and an anti-ACA governor, Republican Matt Bevin, succeeded him.

Five hundred Today, 500 miles away in Washington, Trump and House Republicans have proposed changing Medi­caid to curb federal spending on the program and give more flexibility to states. The result would be less generous for beneficiaries and could lead many states to kick people out.

Woosley and his wife would be affected.

The farmer, who earned $17,695 last year, suspects that he may not be able to hold on to his health care much longer. He thinks there’s little chance of affording insurance on his own — a particular concern for his wife, who continues to suffer from respiratory problems.

“There’s not anything you can do,” he said. “If they say no, it’s no. It’s the government.”

Travis Smith has spent much of his adult life without health insurance. That hasn’t really worried him over the years, and it doesn’t bother him now — even though, at 32, he has a wife and two small children.

“Maybe I’m a risk-tolerant person,” said Smith, a personal-injury attorney who decided to pay the ACA penalty for being ­uninsured.

When his first son was born two years ago, he and his wife paid cash for the prenatal expenses and birth — a total of about $12,000, he said. It struck him as a reasonable cost.

When their next boy arrived last year, the couple had health insurance purchased through the law’s federal exchange. Smith estimates he and his wife paid about $7,000 in premiums and $6,000 out of pocket for the actual birth. It was a wash financially, he thought, but in other ways it was worse. They had to change hospitals because the one they’d used for their first child would not accept their new insurance. They had to change pediatricians, too.

“It was sort of like we paid the same amount of money and had no choice,” Smith said. “What is the point of even having insurance absent a catastrophic thing?”

Smith says he would eagerly purchase a catastrophic health plan, which would offer low premiums in exchange for high deductibles. At one point, he found a private plan he liked that cost $400 monthly for a family of four, and included good disability coverage and a generous lump-sum payment in case of an emergency.

Yet the plan did not meet the ACA requirements, which include minimum coverage standards intended to ensure a baseline level of quality. So he would have faced paying a tax penalty — perhaps about $2,000, depending on how much he earns this year.

He decided not to sign up.

“We have better use for 10K every year than to blow it on premiums,” he wrote to The Post.

Shelley Powers remembers vividly the low-level fear that was always with her in the days before the ACA. Without health insurance, she worried that a slip or a car crash would send her to the emergency room and into bankruptcy because of the enormous bills.

“I was so afraid of making a misstep or breaking something or getting into an accident — just these sudden things that happen and suddenly your life is ruined,” said Powers, 62.

Initially, the problem wasn’t that she couldn’t afford coverage. She was a successful technology worker who spent time in Silicon Valley, starting her own consulting business after the 2000 dot-com bust. But she hesitated to apply for insurance on the individual market because she was overweight, which she thought could be viewed as a preexisting condition and disqualify her from getting covered again.

Eventually she lost the weight. But by then cost loomed as a barrier because, burned out on the tech field, she had retreated to a friend’s home in the St. Louis area to write computer books. Last year, Powers said, she made $4,000 for that work; the year before, she earned $22,000.

The health-care law not only got rid of the preexisting-condition hurdle but also granted Powers a subsidy that helped her afford her insurance premiums. Every year since, her coverage has gotten more affordable. This year, to her delight, she was able to sign up for a plan that costs $80 monthly with a $2,100 annual deductible.

She worries that the House GOP’s legislation will again render insurance unaffordable, in part because it would allow companies to charge older customers as much as five times more than younger ones.

With nearly three years to go before she becomes eligible for Medicare, Powers wonders if she’ll be able to maintain coverage. The House bill would give her a $4,000 insurance credit, nearly half her ACA subsidy.

Could she get another job? Powers wonders. Not in her field at her age, she figures.

“It’s not a good place to be,” she wrote in her reply to The Post’s query. “62 years old and without any health- care coverage.”

As a severe diabetic, health insurance is a must for Joe Blanchard. Indeed, his entire work career has been shaped by the need to find and keep good employer-sponsored health benefits.

So the 52-year-old computer programmer panicked a few years ago when his company downsized and he was let go.

The company let him keep his coverage until 2014, when the first ACA marketplace plans kicked in and the law’s insurance changes went into effect. Those included the rule that insurance companies could no longer deny a person insurance because of preexisting medical conditions such as diabetes.

The changes came just in time for Blanchard, who had started working independently as a consultant. It is a job that suits him, he says, but a career path that would not have been possible before the ACA.

“I really enjoy the freedom,” he said last week. “You have complete autonomy to do what you want to do.”

Blanchard earns about $100,000 a year and is paying $767 per month for his health plan. It covers insulin, which costs $285 per vial, but covers only part of the cost of his $9,000 insulin pump. He has paid $1,500 out of pocket this year for the pump and supplies.

In some ways, he may fare better under the House proposal, which would continue to require insurers to cover people with preexisting conditions. And although Blanchard’s high salary precludes him from qualifying for any premium subsidy under the ACA, he would get a modest tax credit under the GOP plan — about $500 a year.

Still, his age is a factor given the increased age differential in the Republican legislation. He also worries about lawmakers’ renewed interest in states forming “high-risk pools,” programs that save insurance companies the financial hardship of covering very costly care.

“This is all a guess at best,” said Blanchard, his anxieties kindling once again. “In my head I’m wondering, should I start making this transition . . . and try to find a full-time position solely for the health care?”

Andey Riffle doesn’t blame his employer. The small company was doing its best under difficult circumstances, he said, when the rising cost of insurance under the ACA finally led it to stop offering health benefits for its workers.

“Things were good until the health-care debacle stepped in and made them bad,” Riffle said.

The 44-year-old computer programmer and father of two was forced to turn to the federal marketplace, where he said he discovered that the cheapest plan for his family cost $900 a month and carried a $14,000 deductible. Given his family’s $71,000 salary — a sum he and his wife earn working four jobs — he opted to go without health insurance.

It’s a risky proposition for the Riffles, who live outside of Tulsa. He has a benign brain tumor that affects his hormones, and the medications he uses to keep the symptoms at bay can run $1,000 per month. He uses online coupons to cut the cost. That brings his charge down to about $500 when the coupons are particularly generous.

“If I had insurance, I could get [the tumor] removed and be done with it,” he said.

When his 8-year-old daughter had an ear infection last week, the family paid cash — $90 for the appointment and $50 for the medications.

Pricey for sure, but he and his wife have concluded that it’s cheaper than buying health insurance.

He is not particularly optimistic that the Republican plan to replace the 2010 law will be much better for him and his family. Until the raw costs of health care are brought down through regulation, he does not think anything will make coverage more affordable. Unless, of course, members of Congress are required to use the insurance exchanges themselves.

“If they were forced to participate in the system they created, they would make it work,” Riffle said.

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