Government health care site provides headaches, then help
03/02/2014 8:01 AM
08/14/2014 3:20 PM
After taking early retirement from Spirit AeroSystems about two years ago, Ronald Gent was unable to afford health insurance
So he went without it.
“I knew I was running a risk,” he said. “I was hoping my health would hold. When your house payment is three-quarters of your pension and you dip into savings all the time, you have to make hard choices.”
“I needed shelter, food and a vehicle... Medical bills can bankrupt you so quickly depending on the seriousness of the condition. It’s a battle with which choice you’re making.”
Gent put off seeing specialists for his knees and cataracts. He still went to his family physician at GraceMed, who saw him for a reduced cost based on his income, but there was little the physician could do for him except put him on pain medication, he said.
Since getting insurance on Jan. 1, he has already scheduled the cataract and knee surgeries he needs.
“I’ll be a bionic guy with two new eye lenses and two new knees,” said Gent, who turns 60 later this month. “I’ll be glad to go walking in Sedgwick County Park again and walk without pain.”
Based on his income, Gent now pays less than $40 for his monthly health insurance premium through Coventry. A government subsidy determined by his income picks up the rest of the monthly cost, which is six or seven times that amount, he said.
But signing up wasn’t without its headaches.
Gent started trying to sign up on the first day of open enrollment Oct. 1. It took months before he was able to get past computer glitches with the help of a navigator at GraceMed.
Even after enrollment, he said it took awhile to get his plan information and his insurance card. It was frustrating, he said, but he was thankful for a navigator at GraceMed Clinic to step him through the process.
By the numbers
In the first month of open enrollment, a federal report showed that fewer than 400 Kansans had selected a plan on the federally-run site.
Nationwide, 846,184 people had completed applications, and 106,185 people were able to enroll and select an insurance plan in the first month – far below initial estimates by the White House.
After changes to the site, enrollment slowly improved.
Now, the national figures are much higher, but still lower than Democrats had hoped.
The most recent data, which includes enrollment figures through Feb. 1, shows that about 3.3 million people nationwide have enrolled in plans on the marketplace. In Kansas, 22,388 have selected a plan.
“The website has improved tremendously compared to where it was at the beginning of the enrollment process,” said Juven Nava, an Affordable Care Act navigator at GraceMed Clinic.
“There are still a couple of hiccups, but they’re things we know are going to be fixed. It’s much faster than before.”
The navigators are specially designated and undergo training for the position and can help educate people about the different plans.
Most people enroll themselves online, Nava said, but the navigators can lend a helping hand if there’s a question or a person needs assistance operating the website.
As of the end of January, Nava said, GraceMed navigators had met with 268 people and enrolled 143 into an insurance plan. The navigators also had held more than 20 educational events, speaking with more than 2,300 people.
The most popular plan in Kansas has been the silver plan, according to the federal report, with 56 percent of people choosing that plan, followed by gold (22 percent), bronze (17 percent), platinum (3 percent) and the catastrophic plan (2 percent). Silver also was the most popular plan on average nationwide.
The different plans on the new marketplace – bronze, silver, gold and platinum – have varying levels of premiums and out-of-pocket costs associated with them.
Donna Sweet, a professor and practitioner of internal medicine at the KU School of Medicine in Wichita and the president of the Medical Society of Sedgwick County, said she is concerned that some consumers may pick the plan that has the lowest monthly premium and get slammed with costs later on.
“It’s very tempting to pick the one with the lowest premium so that you have less out-of-pocket up front,” Sweet said. “The problem is if you have a very expensive condition, you’re going to pay big time.”
The least expensive plan requires people to pay up to 40 percent of the medical bills themselves.
For people with serious medical conditions, that can be a large bill.
“We’re educating the patients to pick the one that’s right for them as opposed to the cheapest and to make sure they understand what they’re buying.”
One major concern over the Affordable Care Act is that healthy young people – often referred to as “young invincibles” – won’t sign up for coverage to offset the costs of older and sick people who need more care.
About 28 percent of people who selected a plan in Kansas are between the ages of 18 and 34, which is slightly higher than the national average of 25 percent.
Tyler Sperry, 30, and Corinne Sperry, 31, of Towanda, who had a premature son in November, were able to sign up for coverage.
After some tussling with the HealthCare.gov website, the Sperrys ended up purchasing a silver plan with Blue Cross Blue Shield at the beginning of December.
The new plan, which was effective Jan. 1, costs about $200 a month, which is a $500-a-month savings from their old plan. The savings is especially helpful since Corinne Sperry is taking time off from work to care for their son.
“The savings were too good to pass up,” Tyler Sperry said.
“You always want to be able to provide your family whatever health care you can afford. Previously it was getting a little tight being able to pay for it, even while my wife was working. You never know when an emergency will happen and you’ll need health care or preventive services.”
Sperry takes blood pressure medication since he has a history of cardiovascular disease in his family, he said, and his wife has cancer in her family so it’s important she has screenings.
“Life happens, so we always need to be prepared for emergencies. It’s important to stay healthy.”
“We knew our costs were getting a little over the top and then our son came and we got some quotes and that’s what drove the action,” said Sperry, who works as an office manager for a dentist in Wichita and isn’t offered insurance through his employer.
“Financially, we couldn’t afford $6,000 (more) a year. It was unreasonable for our family.”
No Medicaid expansion
When Whitney Coulter gets sick, she puts off getting medical care as long as she can. Coulter, 24, hasn’t had health insurance for about five years.
“One year I had it really bad and I put it off so long that I ended up with pneumonia,” said Coulter, who works 20 to 25 hours a week as a hair stylist.
When she waits, she ends up in the emergency room and the hospital bills start to pile up, she said.
Her employer offers health insurance but the plan is too expensive and it doesn’t include lab work, she said. Her daughter is currently on Medicaid, the state and federal health insurance program for the poor.
Because the Affordable Care Act envisioned all states expanding Medicaid to provide insurance to people living in poverty, adults making less than the poverty level aren’t eligible to receive federal subsidies to buy health insurance.
Kansas, however, didn’t expand Medicaid.
Recently, Coulter spoke with a navigator from an area health clinic who informed her she was one of about 78,000 Kansans in the new Medicaid gap, making too much money to qualify for Medicaid, but not enough to qualify for subsidies on the new marketplace.
“That part just baffled me,” she said.
Adults with children who make between about $8,950 and $23,550 for a family of four are in the Medicaid gap, according to Kaiser Family Foundation.
Coulter said that if Kansas won’t expand Medicaid, she would favor a plan where those in the gap could make monthly payments toward part of the premium if it meant they could get affordable coverage.
Under the Affordable Care Act, nearly everyone is required to have health care coverage or face a tax penalty.
Originally, the health care law required all states to expand Medicaid coverage for the poor and disabled, but the Supreme Court ruled that the forced expansion as unconstitutional.
Kansas and 24 others states have so far chosen not to expand Medicaid.
“It’s a hole in the law,” Sweet said. “It needs to be fixed but since they won’t open the ACA to fix anything, it’s just there.”
“If you look at the business model, the model says Medicaid expansion is good for states. It creates jobs, it helps people be more employable, keeps them employed, keeps them out of the hospital. But getting our Legislature and our governor together on that is going to be tough.”
The open enrollment period ends on March 31 for people who want coverage this year.
The next open enrollment period will likely begin in November.