Health & Wellness

Yellow Springers take a first look at Obamacare

Local contractor Chris Glaser is just the type of person that the Affordable Care Act was designed to help.

Glaser, a 60-year-old self-employed construction worker, hasn’t been able to find a more affordable health plan because of chronic neck and back injuries from 40 years on the job that insurance companies deemed a “pre-existing condition.” As the costs of his current Anthem Blue Cross plan grew in recent years — to $500 per month — he opted for less coverage to keep it affordable. Now it only covers 60 percent of medical costs after a $10,000 deductible.

“The scenario for the past five years was it would go up and I would drop my coverage so I could afford it,” Glaser said. “It feels like I’m pumping money out for nothing. I keep thinking, ‘What am I doing this for?’”

But as a part of President Barack Obama’s signature healthcare law, insurance companies can no longer deny coverage or charge more because of a pre-existing condition, a situation affecting more than five million Ohioans. And on Tuesday, Oct. 1, a newly-created healthcare marketplace opened with a slew of new private health plans for Glaser to choose from, along with government subsidies to make them affordable. From his initial research, Glaser could save a lot of money.

“I think I’ll be able to get twice the coverage for half the price,” he said.

Fifty-nine-year-old Leslie Lippert, who is currently unemployed, has been pleased with her individual insurance plan through Medical Mutual. In what some suspect is related to the overhaul of the healthcare system, her rate just jumped this year by 33 percent, to $400 per month. Though it’s a stretch for Lippert to afford the plan, she finds the new plans being offered on the federal health exchange have less coverage than she wants.

“What I have found is, there is no plan offered like my plan,” Lippert said. “My plan, once I meet my deductible, is 100 percent covered.”

Local resident Mark DeLozier, who has several part-time jobs, including as a piano tuner, is currently uninsured. DeLozier said he “isn’t too happy” about having to purchase health insurance or pay a fine. Because of the so-called “individual mandate,” DeLozier could face a penalty of $95 per year or 1 percent of his income, whichever is higher, if he doesn’t purchase insurance for 2014.

For some villagers who have been unable to afford or qualify for insurance, the new health insurance plans in the exchange as part of the Affordable Care Act are seen as a blessing. Others taking a wait-and-see approach to the new health insurance options are reluctant to drop their current plans, or would prefer to stay uninsured.

New health plans: what to expect

Those who are not already covered by their employer, Medicare or Medicaid, can now enroll in a new plan in the exchange for coverage beginning Jan. 1, 2014. In lieu of a state-run exchange, Ohioans can shop at the federal website www.healthcare.gov.

Those who are not currently insured must purchase insurance by March 31, 2014 or face penalties that grow to $695 per year or 2.5 percent of income, whichever is higher, by 2016. By comparison, the Congressional Budget Office estimates that by 2016 the least expensive health insurance plans in the marketplace will cost about $4,500 to $5,000 per person and $12,000 to $12,500 per family per year.

In Greene County, six insurance companies are offering 39 plans in a variety of price ranges, from the bronze plans, which have a low monthly cost but high deductible and co-pays, to mid-range silver plans and high-end gold and platinum plans, which are more expensive upfront but cover more healthcare services with fewer out-of-pocket expenses when getting care. In addition, those under 30 years of age or with very low income can qualify for “catastrophic” plans.

For many, government subsidies will defray the monthly cost of a premium. Those who make up to 400 percent of the federal poverty level, or up to $45,960 for an individual and $94,200 for a family of four, qualify for tax credits. Many villagers will likely qualify for such tax credits —the median household income in Yellow Springs was $59,537 in 2010.

According to a report from the Department of Health and Human Services, the lowest cost plan in Ohio for a 27-year-old who makes $25,000 per year is $177 per month and just $110 per month after tax credits. A mid-range premium for a family of four earning $50,000 in income would cost $768. After tax credits, the plan would cost $282. Under the new healthcare law, health premiums can only vary based on three factors — a person’s age, where they live, and whether they’re a smoker.

Those who make less than the federal poverty level and meet other requirements may qualify for Medicaid coverage and not need to purchase health insurance in the marketplace. In Yellow Springs in 2010, 13 percent of the population lived below the poverty level.

But since Ohio has not yet decided to expand Medicaid coverage in the state, some won’t qualify for either Medicaid, or premium subsidies. Local resident Alisha Stireman-Beyer makes too much to qualify for Medicaid, but not enough to qualify for subsidized insurance rates, she found out this week during a live chat with a healthcare expert at the federal website.

“I think that is so crazy,” Stireman-Beyer wrote this week. “Too poor to get help, but not poor enough to get help?”

While the new healthcare law initially expanded Medicaid nationwide to those making 138 percent of the federal poverty level, in June the U.S. Supreme Court said that states should decide. Ohio Governor John Kasich has proposed that Ohio expand Medicaid coverage, but the Ohio legislature has not approved the measure. If the legislature doesn’t take action, the question may end up on the ballot in November 2014.

Some less affected by law

The new healthcare law should have no impact on those on Medicare, according to Erica Mahle of the Yellow Springs Senior Center this week. About one-fifth of the local population is 65 and older and eligible for Medicare. Mahle said from the information she has received from county and state agencies, Medicare benefits are not changing. She is additionally warning local seniors to be wary of any phone calls they may receive soliciting health plans in the exchange. Those are scams, Mahle said.

“We’re telling senior citizens, ‘don’t go signing up for anything,’” Mahle said. “Wait until Oct. 15 to switch your plan.” Medicare enrollment is annually from Oct. 15 to Dec. 15.

The roughly half of all Ohioans that already have health insurance through their employers can keep their plan. But those plans must change to comply with new provisions in the Affordable Care Act that requires all plans to offer a slate of free preventative services — including colonoscopies, contraception and vaccines — without charging co-payments. In addition, in Ohio unmarried children can now remain on their parents’ policies until they are 28.

While all the health plans on the exchange (and Medicaid plans in 2014) must cover a set of essential benefits, including these preventative services along with prescription drugs, mental health services, maternity and newborn care and more, the plans still won’t likely cover many alternative therapies that many local residents rely on. Glaser, for one, plans to keep paying out of pocket for the combination of bodywork and alternative therapies that keep his chronic neck and back conditions in check, as he continues to work full-time doing home construction and remodeling. Glaser has turned to frequent neuro-muscular and traditional massage, acupuncture and the Alexander technique, which most likely won’t be covered by a new health plan.

Villagers question quality

Local resident Judith Ezekiel, 57, is also hoping the new healthcare law delivers on its promises of affordable coverage, but is skeptical that her health coverage will be good enough. Ezekiel is currently stuck with an insufficient high-deductible plan which she purchased before being diagnosed with diabetes, a pre-existing condition that has made it difficult to change carriers. So to her, “Obamacare is a life saver,” she said. At the same time, the plans in the healthcare marketplace will not provide her with good enough coverage, which she became used to while teaching in France for the last 35 years.

“If I have to pay between 20 and 40 percent [of my healthcare costs], that’s still a fortune,” Ezekiel said of the silver, bronze and gold health plans on the exchange.

A visiting professor of women’s studies at Wright State University with a permanent teaching position in France, Ezekiel has experienced the stark difference between the U.S. and French healthcare systems. Since she is still covered in France, Ezekiel returned there last summer for needed care. Over eight days, Ezekiel saw a dentist, rheumatologist, cardiologist and general practitioner and had a crown procedure, eight x-rays, a cortisone injection, a stress test and extensive blood work. The total out-of-pocket cost to her was just $200, for her dental crown, she said. Meanwhile, medications that would have cost her hundreds of dollars in the U.S. cost her the equivalent of $2 in France.

“I’m terribly disappointed that they gave up on a public option or a single-payer here,” Ezekiel said of the healthcare system available in most European countries. “But I’m very happy that the law made it through since it might — just might — make it possible for me to stay here if I want to.”

For now, Bettina and Scott Stolesenberg, who are both self-employed, are planning to stick with the plan they just purchased last year after going without insurance — Bettina for five years and Scott for two months. Bettina, a musician and contract copy editor and Scott, a photographer, have a plan through United Healthcare that costs just under $200 per month and covers 80 percent of medical expenses above a $10,000 deductible, along with many dental work and preventative care services.

“I have been happy with it so far,” Bettina Stolesenberg said. “In the past month, I have gotten caught up on all my long neglected preventative exams.”

United Health Care recently told them that if they switched to a plan in the new exchange, then wanted to come back to United Health Care, they would have to wait an entire year, which is another reason Stolsenberg said they’ll likely stay with their current plan. While the new healthcare marketplace is enticing, they’re not quite ready to take the leap.

Businesses unsure of benefits

Many local business owners are also wary or confused by the impact of the new law on their business. According to Yellow Springs Chamber of Commerce director Karen Wintrow, many businesses, as well as individual business owners, are staying with their current coverage.

“It appears that businesses and individuals with existing coverage are opting for early renewals to lock in a rate for 2014 because of the unknown,” she said.

The provision requiring companies with 50 or more full-time employees to provide insurance coverage (or face a penalty of up to $2,000 per employee after first 30) was delayed until 2015. Still that has Young’s Jersey Dairy owner Dan Young concerned about the amount of record keeping he’ll need to do to closely monitor the hours of his 300 mostly part-time and seasonal employees. Young’s has, for more than 30 years, offered health insurance coverage to its full-time employees, who number about 30. But the law in general makes it difficult for businesses to plan amidst uncertainty, he said.

“A problem from a business standpoint is [the law] is confusing and it seems there’s a new announcement every week,” Young said. “Businesses already live in a world of uncertainty and it’s hard when there’s more uncertainty injected.”

But most firms in the village are small businesses or sole proprietorships that don’t need to comply with the employee insurance mandate. They also don’t benefit from the group plans that large firms can offer. Nationally, almost half of America’s uninsured are small business owners, employees or their dependents. According to Wintrow, most downtown retail businesses rely heavily on part-time employees and simply can’t afford to offer insurance to their full-time employees. Many business owners even go without it themselves, she added.

Some downtown businesses that do offer insurance to their full-time employees include Current Cuisine, Peach’s Grill/The Import House, the Emporium, the Yellow Springs News and The Winds Cafe.

According to Current Cuisine owner Karen Current this week, while the group’s rate is forecast to jump by 30 percent this year, offering health insurance is still a priority.

“To be able to keep employees long term is an asset to our business and it seems pretty important,” Current said. “It has gotten extremely expensive and it’s extremely hard but it’s something we want to do.”

For more information, visit www.healthcare.gov .

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