Health Care Law
Providing Relief and Frustration
Travis
Dove for The New York Times
Kay and Mike Horrigan
of Charlotte, N.C. He was in a high-risk insurance pool, and her policy was
canceled under the law.
Published: December 6, 2013
CHARLOTTE,
N.C. — Mike Horrigan is a lifelong Democrat with heart problems who supports
President Obama’s health care law because he expects it will help many people
obtain better insurance, including himself.
But under
the new law, the Affordable Care Act, Mr.
Horrigan’s coverage by a state high-risk
insurance program was eliminated, then replaced by a more expensive plan.
His wife’s individual plan was canceled for being substandard, then suddenly
renewed — also at a higher price.
So while Mr.
Horrigan, 59, believes the law will improve health care in the long run, its
short-term effect has been chaotic and trying for him and his wife, Kay. “It’s
more stressful than it needed to be,” he said.
For a
measure of the tumult that has accompanied the arrival of the federal health
care overhaul, there may be no better place to look than in the politically
mixed state of North Carolina, where both the anxiety and the promise of
revamping the health insurance system has left hundreds of thousands of people
struggling to sort out their options.
Many will
end up with better coverage than they had, and may get help paying for it.
Others will see their costs rise and are wondering if the change is worth it.
And some, like the Horrigans, may find themselves falling into both camps.
The
agitation has been building for months. This fall, insurers notified about
260,000 North Carolinians that their individual health plans no longer complied
with the law’s more stringent requirements, and many learned that the plans
they were being offered as replacements would cost hundreds of dollars more per
month. Then, after Mr. Obama said on Nov. 14 that insurers would be allowed to
renew their plans for one year, Blue Cross and Blue Shield of North Carolina
announced that 230,000 of its customers in the state could keep their own plans
— but at prices that rose 16 percent to 24 percent.
Kathleen
LaFleur, a broker who works with people who have individual plans at Employee
Benefit Advisors, an insurance agency here, said many of the callers to her
office had two things in common: confusion and anger. “They are confused before
they call,” she said. “After they call, they’re not confused anymore. They’re
angry.”
Travis Dove for The
New York Times
Kathleen LaFleur, an
insurance broker, said callers are initially confused, then angry. With help,
she said, they calm down.
Adding to
the confusion is the fact that many consumers have been unable to fully
evaluate their options because the federal health care website, which serves
residents of North Carolina and 35 other states, did not work very well until
recently. Those who qualify for subsidies must sign up through the federal
marketplace. Consumers have until Dec. 23 to sign up for coverage beginning in
January.
“It has
obviously been extremely frustrating for individual policyholders who have
received cancellation notices at a time when there’s such a short window for
them to decide what their coverage options will be,” said Wayne Goodwin, North
Carolina’s insurance commissioner, an elected Democrat.
Still, for
some, the new law is working well. Rachel Bryant, a small-business owner who
lives just outside Winston-Salem, felt unlucky when she received a notice from
Blue Cross saying that her plan was being canceled and that the replacement
would raise her monthly bill to $675 from $408.
But when Ms.
Bryant, a single mother of two young children who earns about
$30,000 through her legal services business, finally succeeded after many tries
to log onto the online marketplace, HealthCare.gov, she learned she was
eligible for subsidies that would bring down her premiums to just $150 a month.
“I’m
extremely happy,” said Ms. Bryant, 36. “I’m not going to go bankrupt because of
medical bills. I’m looking forward to it, and I’ll put up with the frustration
and the bother.”
About half
of those buying individual insurance in the existing market will be eligible
for a subsidy, according to a national study by the Kaiser Family Foundation.
That does not include an additional one million people who buy individual
insurance now but, under the provisions of the health law, will be eligible for
Medicaid beginning in 2014, according to the study.
For others,
like the Horrigans, the transition is proving uncomfortable.
Ms. Horrigan,
61, is a former psychiatric social worker; Mr. Horrigan is a former corporate
human resources expert who started a consulting business in Charlotte after
atrial fibrillation required two heart surgeries. Because of his heart problem,
he was denied insurance and found coverage through North Carolina’s high-risk
insurance pool.
So they
understood, Mr. Horrigan said, why the Affordable Care Act was necessary. The
new law was designed to fix flaws in the old market in which people with
existing medical conditions, like Mr. Horrigan, could find themselves
uninsurable and without limits on out-of-pocket costs — people for whom serious
illness often meant financial ruin. Under the new law, such people cannot be
turned away or be charged more by insurers, and subsidies are available to
those whose incomes fall below a certain level.
“I was a
poster child for why folks should have this opportunity,” Mr. Horrigan said.
Then
realities set in. Because of the law, the state eliminated the high-risk pool
that provided his coverage, for which he paid about $400 a month. Then Ms.
Horrigan learned that her insurer, Blue Cross, was discontinuing her plan —
which was deemed substandard under the new law — and replacing it with one that
would cost $620 a month, up from $325, with a higher deductible as well.
Obama
Recalls an Aide to Guide Health Care Law (December 7, 2013) Now, after Mr. Obama’s
reversal, Blue Cross says it will extend her policy, though at a higher cost:
She will get a one-year rate of $402, an increase of 23.6 percent, she said.
After all the confusion, she will renew — and her husband has selected a
midlevel plan through Blue Cross that will cost about $670 per month.
Calling the
increases “unreasonable,” Ms. Horrigan acknowledged that they may be necessary
to make the new system work.
“I
appreciate the irony of complaining about my premiums being increased when it
protects somebody like my husband,” she said. “I reluctantly say we will
probably be better off even though it hits us hard in the pocket.”
Prices are
rising for several reasons, including the law’s higher standards for coverage,
and fees and taxes associated with it, said Barbara Morales Burke, vice
president for health policy at Blue Cross in North Carolina. But she said the
sticker shock some are feeling also has another cause: For years, insurers
could charge people different prices based on factors like their health or
gender. Now that the law prohibits such practices, some who benefited from the
old system will be asked to pay more, while those who had been at a
disadvantage will see some relief.
“This is a
disruption to the marketplace,” she said, and estimated that about a third of
Blue Cross’s individual insurance customers would see a significant increase in
their rates.
Dr. David
Naftolowitz, a psychiatrist in Durham, is among them. He was offered a
replacement plan that would raise his monthly cost to $410 from $199. His
deductible would rise to $5,500 from $5,000. He plans to extend his existing
policies for a year, but said the extension was “like a teaser” that “takes the
heat” off the president for the moment.
“You’re
going to be hit a year from now,” he said.
Ms. LaFleur,
the broker, said that once her clients have been through the process and make
their choices, they tend to calm down. “They can exert some control, and that
makes them feel better,” she said.
There is one
silver lining in the tumult: Suzy K. Johnson, Ms. LaFleur’s boss, says she
plans to expand. “I’m growing my team,” she said. “This is an opportunity —
they need us more than ever.”
----------------------------------------------------THE
END----------------------------------------------
The article
related to the new health law, the Affordable Care Act (ACA).
The Affordable
Care Act is the federal statute signed into law by President Barack Obama on March 23, 2010.
The ACA includes many changes to insurance standards.
Many people will pay higher price for insurance than before.
Like Mr. Horrigan, his coverage by a state high-risk
insurance program was eliminated, then replaced by a more expensive plan.
However for others, like Ms. Bryant, they will save a large
money for their insurance.
For my opinion, I support the new law, because it will help real
poor people to get out of their trouble.
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