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.”
There is still a family coverage gap. My wife’s work offers insurance but to add the rest of the family is over a thousand “affordable” dollars. So I can’t get us anything subsidized even though we fall nto the covered income range and to self pay a private plan is still over $500 a month for a crappy plan.
A bit of truth says
A word for Karen Buchanan: Under the ACA, the plan must provide several basic levels of coverage. First, routine / preventative care is covered 100%. Check it. Your annual Dr. visit and some other coverage is covered 100%, no deductible, no co-pay. Also, new this year, medication counts toward your deductible and out-of-pocket maximum. Previously, most plans counted medications separately, so medication costs did not count toward your deductible nor were they included in the out-of-pocket max. Now medication costs count as medical costs. Again, this last is new this year. Check your ACA plan.
The intent of this is to keep medical costs DOWN. It’s cheaper to get routine care, than wait for “major hospital bills” as Buchanan does. Also, the ACA helps alleviate other medical expenses that Buchanan mentioned: drug companies and hospitals writing off charge, and passing them to other patients.
Karen Buchanan says
I’m sure you are correct about the medication but as I stated $1300. per month toward medications until the deductible is met is not optional for a low income person. Also, I again checked my policy, it is Humana Bronz 6300 (I was a little incorrect on my deductible, it is $6300.00) It clearly states that for each category nothing is covered until the deductible is met. No where does it say routine or preventive care is covered.
The Truth says
Why are we still calling this Obamacare? If I wanted it called Obamacare, I would watch Fox News.
Tom Jacks says
Wow, a whopping 8% of the population under the age of 65. Private companies with results like this would be so proud.
Sherry Epley says
If you feel premiums are too high. . . please remember it was our governor, Rick Scott, who took away the power of our Insurance Commissioner to negotiate health insurance rates in Florida. He did this years ago as a “poison pill” to try and stop the ACA. . . simply as a political move of obstructing President Obama.
Our premiums could be lower, if our Insurance commissioner still had the power to negotiate in our behalf. Your complaints about high premiums should go to the governor’s office.
My health insurer’s monthly rates went up almost $150 from 2014 to 2015, from $461 to $590! Sure I have a credit, but just the thought of how expensive private health insurance companies have made health insurance for an individual is crazy and an outrage.
The numbers on Obama Care might have been impressive if people had a choice. You choice is get insurance, or face penalties or even jail time. Any numbers produced are just bs…. Some people have found that they are getting a reasonable rate, but that is not always the case. My family was told it would be over $12,000 a year for Obama Care. My father was making $36k, which would bring us all the way down to almost $20k a year, which is barely enough to live off of.
Nancy Nally says
There is no provision in the healthcare law under which you can be sent to jail for not buying health insurance. Whoever told you otherwise is spreading lies and hysteria.
At an income of $36,000/year your family easily qualifies for subsidies by purchasing insurance through the Federal heathcare exchange, healthcare.gov, that would allow you to purchase insurance at a much, much more affordable price than over $1,000/month.
Was to be expected…how come could anyone live without health care? Only in the poorest countries of the world and we are not supposed to be one of them!
Nancy Nally says
Karen – you need to check more carefully the fine print of your insurance policy. Under Federal law, every policy sold must cover a few items with no deductible or copay. This includes your annual physical/well woman visit and mammogram. Humana may not be telling you this in bold print because they don’t want you to take advantage of these services since they have to foot the whole bill, but they should be there.
Also, I think you are missing some information or options regarding your sons’ insurance. Are you working through Healthcare.gov or a private agent? Your reference to needing credit suggests that you were working with an agent, since the exchanges involve no credit check or qualification. I suggest you try the Federal government’s Healthcare.gov if you haven’t already, or find someone to help you navigate Healthcare.gov to get the best options out of it. Through that site, you can get monthly premium reductions and also reductions in your deductible and annual patient pay cap that you can’t get through an agent.
Just because your son has insurance does not mean that he can’t take part in a hospital’s patient assistance program, by the way. My daughter is on the patient assistance program at the Children’s Hospital that treats her despite having insurance. The program absorbs her copays and deductibles for her very expensive treatment until we hit her patient pay max for the year. Why would we want to pay for insurance when we are getting assistance with her treatment anyway? Several reasons. First, it guarantees us that we could still get her treatment if we lost access to the assistance program. Second, the hospital is not the only medical provider she sees, so she is covered for all of her treatment needs. Third, she is covered for emergencies. And lastly, an insurance card means that it is easier to access treatment of all kinds when you need it. Many places won’t take “patient pay” cases.
Tom Jacks – 8% of the population is actually a large amount to have purchased insurance through healthcare.gov when you consider that a large percentage of the population isn’t eligible to purchase ACA coverage because they are already eligible for coverage through an employer or Medicaid. Also healthcare.gov isn’t the only way to purchase ACA law coverage – it is also sold through private insurance agents. So when you consider those factors, the fact that 8% of the local under 65 population has purchased coverage directly through healthcare.gov shows how overwhelming the need was for this program.
There is no question that the ACA law can be improved. Other large government programs like social security and Medicare have been changed and improved over their lifetime as we’ve seen what works and what doesn’t and as the population’s needs have changed. The ACA program will too. It is unrealistic to expect a program this sweeping to roll out without some issues. Scrapping it because it wasn’t perfect right out of the box – and because some people don’t like its political creator – isn’t the answer. Fine tuning it is.
Sherry Epley says
Thank you for taking the time to assist those commenting here, Nancy Nally. . . and for your perspective, right on! Yes, the ACA is not perfect and of course needs fine tuning to make it better. We can make it better together. What is the alternative. . . going back to allowing insurance companies full rein to “cherry pick” only the most healthy to cover and then raising deductibles, co-pays and rates any time they felt like it?
Sure we could have and should have roll out something like Medicare for everyone, but the Republicans and some Democrats (who were heavily lobbied by the insurance companies and “Big Pharma”) simply wouldn’t even consider such a thing.
Let’s see the fabulous Republican plan for higher quality health care with no maximums, no deductibles, and no co-pays, for much cheaper premiums! We would all support that! What, you say. . . that’s not possible. . . yeah, I thought so!
Nancy Nally says
I am noticing a common thread in complaints here and elsewhere about the ACA law. It seems that the majority of complaints I am seeing are from low income people who are complaining that insurance is going to cost them thousands of dollars because they don’t understand how to get enrolled to take advantage of the subsidies and other benefits available through healthcare.gov.
It’s kind of like saying a recipe sucked because you didn’t read the directions carefully and made it wrong. It’s not actually the recipe’s fault – it’s your implementation of it that is the problem.
Tom Jacks says
Nancy Nally I bet you actually believe the unemployment rate is only 5.8% also.
Nancy Nally says
It depends on how you define “unemployment rate”. Is the statistical construct that the government calls “unemployment rate” currently calculated at 5.8%? Yes. However, depending on the circumstances that statistical construct is at times a more accurate reflection of the workforce than others. Currently, it is not a very accurate reflection as it doesn’t count the large numbers of people who have left the workforce through various means, giving up searching for work to stay at home with kids, retire, or continue their education instead.
Just because you don’t like what I have to say Tom doesn’t mean I don’t have a brain. I have a lot of education in social policy issues. I firmly believe that the ACA, while not perfect, is a strong move in the right direction for our country. The Republicans already proved it by conducting the trial run in Massachusetts. The results there have been impressive. But suddenly it was a horrible idea when President Obama wanted to do the same thing. I wonder why? Hmmm….
David B. says
I can’t believe that so many in this county have to depend on this plan. That should really send out the message that we have very few companies in our county that provide insurance plans, or the wages are so low that those who work for what companies there are can only afford insurance for themselves. To many are self employed and barely getting by.
0bamacare was sold based on lies, fraud and misconception. 85% of those enrolled are supplemented. It is nothing more than another failed entitlement program. It’s a way for leftists to say,”if you vote for him/her they’ll take away your healthcare”.
It was passed by one party…and “by the stupidity of the American (democrat) voter”, said Gruden. This debacle is a TRILLION dollar program…what’s the math per enrollee??? Yep…one day ignorant leftists may actually understand how a calculator works. Until that time, they’ll have to come to grips that we now have over 100 entitlement programs, have spent trillions and in 50 years….still have not lowered the poverty rate one single percentage point. It’s not about helping people, it’s about keeping people dependent…for a vote.