Florida is leading the nation in enrollment and re-enrollment in the Affordable Care Act, with 1.3 million people signed up as of Jan. 23. Enrollment has been brisk in Flagler County, too.
A federal database that breaks down enrollment by zip code shows that in Palm Coast’s two zips, 4,481 people have enrolled through healthcare.gov, the federal marketplace. (Florida’s GOP-led Legislature, with Gov. Rick Scott’s support, refused to establish a state-based marketplace.) In Flagler Beach, 466 people enrolled, and in Bunnell and the unincorporated portion of the county, another 378 people enrolled.
The southeastern part of the county is brushed by another zip code, most of which covers Ormond Beach. An estimated 600 people in that zip code live on the Flagler side of the county line. In all, some 6,000 people in Flagler County have enrolled, a sizeable proportion in a county of almost 100,000, where 27,000 people are 65 or over, and covered by Medicare.
The number of people enrolled in Obamacare is expected to grow in the coming days, ahead of the Feb. 15 deadline. But while getting on healthcare.gov has become a lot smoother compared to its disastrous roll-out, the system continues to polarize people, either because they object to its mandate that every individual must be covered, or because they discover particulars about it that they find objectionable—not least of which it costs, depending on where individuals fall on the income scale.
“As an agent I see positives and negatives,” says Lorraine Hayes, an agent with Palm Coast-based Berlin and Denys and an independent contractor for Florida Blue and Florida Health Care. As soon as she starts talking health care reform, the polarizing discussions around her follow.
But this year, Hayes said, many people have gone directly to the healthcare.gov website, now that it’s working more smoothly, not realizing that going through an agent doesn’t cost additional dollars—and gets many answers to questions the website doesn’t answer readily. Some people don’t even realize that I’m here to help, they don’t realize they can go through an agent,” Hayes said.
Clients tend to be most worried about their network of doctors, wanting to make sure that the plan they choose includes the doctors they want. They worry about their out of pocket maximums, which can vary greatly depending on the plan they choose. And they have to estimate their coming year’s income correctly, which for the self-employed can be difficult. If the estimate is off, the federal government may add to the client’s tax subsidies. But if it’s an under-estimate, the federal government will demand additional payments. And for individuals or families that fall outside the tax credit windows, “these plans are expensive,” Hayes said.
Subsidies are available, but—taking a couple as an example—only for those making a combined minimum of $15,730 to a maximum of $62,920. Above that, people have to pay their own way. Below that in Florida, poorer people fall in the so-called Medicaid gap: the state was supposed to extend Medicaid coverage at the poorer end, with the federal government picking up almost the entire tab. The Legislature and the governor refused to do so, leaving almost 1 million Floridians in the gap, too poor to afford coverage but not eligible for Medicaid.
Many people are opting to skip coverage altogether and pay the penalty. That penalty was not expensive in the first year of the Affordable Care Act: $95 or 1 percent of income, whichever was greater. This year, the penalty rises to $325 or 2 percent of income. And next year it rises to 2.5 percent or $695.
“I am ASTOUNDED at the HIGH penalties if you have no coverage in 2015 and beyond,” Jan Reeger, a Bunnell resident and Realtor, said in comments FlaglerLive solicited about the Affordable Care Act on Facebook.
“This is just a smoke and mirrors to offset the climbing cost of Welfare,” Diane Strachan, a Palm Coast resident, wrote. “Hard working people who pay their own medical bills, now HAVE to get Osamacare or get fined. But yet welfare takers still abuse the system by going to the ER for a toothache and get free care.”
Since the whole system is based on providing coverage to the maximum number of people, including those suffering severe illnesses who were previously uninsured—because insurers refused to sell them policies—the system depends on a broad enrollment pool, and on the money those premiums generate. Those not enrolled must compensate for their absence with dollars through penalties, thus ensuring that the pool remains funded. Otherwise, the system would collapse.
Hayes points out that the system has also made matters much easier for many. She’s been an insurance agent since 2007. In the past, one of the hardest part of her job was having to tell certain applicants who had diabetes or cancer or other illnesses that they could not get health insurance coverage, as insurers could legally refuse it. The Affordable Care Act made that illegal: insurers not only are not allowed to turn down applicants, whatever their pre-existing conditions. They must also provide a minimum level of coverage, including, for example, a level of prescription drugs coverage—contraception, for example, must be covered—and maternity care, both of which were previously excluded from many plans.
That’s where Obamacare has made a major difference for people like Nancy Nally, a Palm Coast resident, and her family.
Nally, who is self-employed as the publisher and editor of Scrapbook Update, has had lupus since she was 18—she was not diagnosed until she was 30—but couldn’t buy insurance at any price because insurers refused her.
“My husband and I have basically spent our entire life, our entire adult life, planning our major decisions about our careers and everything else around how to maintain employer-provided health insurance.” For many years, Nally could depend on her husband’s work-provided health insurance. But in 2010 he lost his job. “When his Cobra went out,” Nally said, referring to the provision in law that requires employers to continue providing ex-employees health coverage for up to 18 months in most cases, but at a steep price, “I was screwed. I spent two plus years without insurance until the Act went into effect, paying out of pocket for everything. I was paying at least $200 a month just for my prescription drugs, then of course there was doctor’s visits, any time I needed blood work, things like that, I was having to pay out of pocket. Any advanced testing was completely out of the question.”
The couple went into bankruptcy. Then the Affordable Care Act kicked in. “Last year because we got coverage, we ended up on an ACA subsidized plan through the local Florida Health Care HMO,” Nally said. “In calendar year 2014, between my husband and I, we had three surgeries, which would have been completely not possible, and they were all for acute situations.”
“We would have been up a serious creek if the Affordable Care law had not been in effect, giving us insurance.” And that doesn’t take into account the couple’s 11-year-old daughter, who has rheumatoid arthritis and needed treatment that cost around $15,000 a month. She had been on a private plan, not Nally’s husband’s work-provided plan, so she did not lose coverage when he did. But that only created anxiety of a different sort before the Obamacare days. “Until, the ACA law went into effect we were holding our breath constantly wondering if they were going to cancel us,” Nally said. “The ACA gives us security going forward.”
The family needs the security: Nally’s daughter is autistic and will have challenges ahead, but with the law in place, it gives the family some assurance that there’ll be options for her treatments regardless.
That’s assuming the U.S. Supreme Court does not rule the subsidies provided families like Nally’s, and most people enrolled under Obamacare, illegal The court is hearing arguments in a case next month where states, including Florida, are challenging the federal government’s authority to provide subsidies to residents of states that have refused to have state-based marketplaces. If the court rules against the subsidies, the system will be financially unsustainable, as fewer people will be able to afford it, including most of the now close to 8 million people enrolled.
For Karen Buchanan, however, Obamacare “has turned into a complete nightmare” for her and her family. She has two young adult sons, each of whom has had his difficulties. One of them needs monthly prescriptions. His deductible, without a monthly premium, would be $6,350. He is able to get his medication for $7 a month through a special program enabled by the medication’s manufacturer. Under Obamacare, Buchanan says, the medication would run $1,300 per month, which must be paid until the deductible is met. If he had this amount of money laying around he would be on a decent insurance plan in the first place,” Buchanan said. “He won’t be signing up for this insurance any time soon. Doing it this way is worth way more than a penalty on a tax refund.”
Her other son’s navigation of the insurance maze hasn’t been easier, with the system keeping him from enrolling because he had no credit. He was recently hospitalized. Had he bee under Obamacare, he would not have been able to afford his deductible, and his bills would have gone to a collection agency, Buchanan said. Instead, the hospital wiped out his bill after he filled out documentation showing his low income. “Why would any low income person sign up to be responsible for a huge deductible when the hospitals have these programs in place? Surely this is worth paying a penalty on a tax refund,” Buchanan said.
She describes her own health plan as out of control: “Last year my insurance was $341 per month with a $4,500 deductible. For 2015 that same policy went up to $440. I had no choice but to up my deductible which is now $6,550, for $375 per month, all I can afford. I can’t afford to pay this monthly amount and the deductible so I haven’t seen a doctor in seven years. I have insurance simply for major hospital bills.” In sum, she says, the new system is a boon to insurers, not a help to individuals, let alone the poor.
Nally concedes that the paperwork can be burdensome. “It’s a government program. It’s brand new. Hopefully over time they will streamline some of the paperwork,” Nally says. “But to me the paperwork is far less painful than not having insurance.”
Nally stresses the difference between the days before Obamacare and since, and looks past some of the damaging, often inaccurate stereotypes about the new law. “I work hard, I pay my taxes, but because of my health situation I couldn’t buy insurance,” she said. “So I’m happy to tell people that side of the story, so they understand there are good people out there and kids that need this law desperately.”