Photo by Bulletin graphics
The sinking feeling.The feeling you get when you find out the cheapest catastrophic health insurance plan for your family is going to cost $1,900 per month this year.
That is the situation for a North Platte man, Rob Kittle, who posted his situation in an online facebook discussion forum, No Limits North Platte.
That puts Kittle’s cost of family health insurance more than twice an average house payment.
“Thank you Obama!” Kittle added.
The Kittles are far from alone in the quagmire. People who are not members of a group, recieving insurance through an employer, buy insurance from the government’s healthcare marketplace. They face a nightmare.
Dan Huebner, a farmer near Hershey, spent hours in November and December on the phone looking for healthcare coverage after premiums soared for his family of five children. He just about went ballistic.
Despite extensive efforts, the Huebners are still not sure if they are covered at this point.
Huebner’s troubles began in October, when Blue-Cross and Blue Shield stopped offering individual health coverage in Nebraska through the ACA marketplace.
Later, Coventry insurance company also pulled out.
Huebner went to a helpful website and found two companies still offering policies. He picked one and signed up, but the next week, he received cell phone messages telling him he had not signed up. When he went back to the website, he found he had no account.
He called the company, and was told to just go through and do it again. So he spent another two hours filling out the online application, but within another week, again received a call that there was no record of him signing up.
This time, Huebner called the marketplace directly.
“I actually spent five hours on the phone with a really nice guy from Tennessee who was trying to walk me through the process,” he said.
At the end of the conversation, Huebner was told he was enrolled in a “silver health savings account” that covered his entire family.
However, when he received the paperwork in the mail, he and his oldest daughter were the only ones covered.
So during Thanksgiving week, he spent more time on the phone. No one he talked with knew why his wife was not on the policy, but he was told his four minor children had been placed on Medicaid because his farm income was so low that he could not add his children to his silver plan.
Not only that, the Nebraska Health and Human Services started calling nearly every day and assigned him a caseworker.
He threw his hands up when healthcare.gov called and again said he did not have coverage.
“I’d had it,” he said. “I was done and wasn’t going to be nice to anyone.”
So, Huebner's wife intervened. She filled out the application again.
As of now, the family has an extension until February, but “we don’t know if we are covered,” Huebner told the Bulletin on Jan. 10.
At one point, he contacted Blue Cross Blue Shield and asked what it would cost to buy a policy directly from them, outside the government marketplace.
He found out it would cost $2,800 a month. Before Obamacare, health coverage for the family cost $800 a month, he said.
Huebner is considering a second job to get coverage, and he figures he’s not the only one in that kind of a mess.
Most everyone is waiting for something better, although people with very low incomes are grateful. They have health coverage at a very affordable price.
Due to a back injury, Tony Rasmussen of North Platte was out of work for about six months in 2016 and his income plummeted. Based on his income, he found coverage for less than $50 a month this year.
But those who earn more, pay more for insurance coverage.
It becomes discriminatory.
Buried deep in the Healthcare.gov website, John L. Podczerwinski found that family health insurance coverage gets worse as their income rises.
Podczerwinski retired in 2015. He was the president of a company that employed 1,000 people.
With an estimated yearly income of around $50,000 from investments, he entered the individual marketplace in 2016.
He patiently did his own shopping. He was shocked to find that he got less coverage if he earned more. He wrote about it for The Federalist, a conservative news magazine.
“Do people know that a family expecting to earn $51,000 in 2016 is not even allowed to buy the same coverage as a family that expects to earn $49,000?” Podczerwinski asked.
Nearly lost in the anguish is one of the basic promises of Obamacare, that no one would have to pay more than 9% of their annual income to buy health insurance. But that was before the new cooperative insurance companies went bankrupt and long-time, stable companies pulled out of the “marketplace.”
Today, you hardly hear about the 9% maximum. However, a health insurance shopper might be wise to ask some pointed questions. Some limits still apply.
“For 2017, your out-of-pocket maximum can be no more than $7,150 for an individual plan and $14,300 for a family plan, before marketplace subsidies,” according to the Obamacarefacts.com website.
Some people look forward to Trump’s presidency, hoping it will straighten out the mess.
“We used to have somewhat open market options before, so prices for private insurance were competitive,” said a responder to Kittle’s facebook post. “The competition is drying up, prices are on the rise. Remove the state territorial restrictions on private insurance, and heavily modify the healthcare plan, and prices will drop like a brick. Competition is a wonderful thing.”
A woman said she doesn’t want to be covered at all, even though individuals must pay a fine of around $800 this year for no coverage.
“I’d rather just pay the fine,” she said, “because I don't believe in western medicine anyways. I have no reason for health insurance. I don't go see a doctor. We eat healthy, build natural immunities and go see a chiropractor. I get a cash discount (at the chiropractor,) and would rather have that anyways."
Some people accuse medical and insurance companies of price gouging, even though companies have reasons to raise prices.
“They price gouge because government insurance doesn't pay them nearly what they ask for,” one man said, “so instead of actually getting paid a reasonable amount of money for their services, they have to charge 15 times the inflated rate just to get the normal payment for the service.”
“It really screws people who pay out of pocket,” he said.
Evertt Fidler, a retired North Platte teacher, said his rates are going up 12-fold from last year.
Fidler had Blue Cross / Blue Shield a year ago. This year, he's switched to Medica because BC/BS doesn't sell to individuals through the ACA marketplace anymore. Both the plans in this comparison are supposed to be silver level plans.
His premium per month for one adult and two children was $137.33 in 2016. This year, it is $1,631.20 a month, he said.
Fidler's deductibles, per individual and per family.
• 2016 - $250 / $500
• 2017 - $2,600 / $7,800
Groups of Nebraskans will visit the Nebraska offices of U.S. Sens. Deb Fischer and Ben Sasse to deliver personal letters and stories urging the senators not to repeal the Affordable Care Act until a system is in place that builds on its protections, not rolls them backwards, the Nebraska Appleseed advocacy group announced Monday.
(The bulk of this report was first published in the Bulletin's Jan. 11 print edition.)