“It’s probably not the greatest health insurance,” says Pat a 64-year-old home health aide from West Toledo, “when I had my cataract surgery it paid most of it, but there’s still $400 left on the bill that I have to pay.”
Pat purchased insurance through the Ambetter Buckeye Health plan, via Healthcare.gov, the Obamacare marketplace which enables lower-income citizens to use tax credits to purchase reduced-cost health insurance.
“[President Obama] kept saying you can keep your own doctor,” Pat added, “I have not been able to keep any of my doctors, I had to change doctors, and hospitals. I see an endocrinologist for my thyroid, and the closest (one on my plan) is in Cleveland!”
The Affordable Care Act (ACA) commonly known as “Obamacare” has had its fair share of problems. In November 2016, only 43 percent of Americans had a favorable view of Obamacare, according to the Kaiser Family Foundation (KFF). Now our new President and Congress want to scrap it entirely. “Obamacare is a failure,” reads a statement issued by Republican Congressman Bob Latta, whose district includes Ottawa Hills, Sylvania, Maumee, and Perrysburg. “It has resulted in skyrocketing premiums, less access to care, and more money spent out-of-pocket for hardworking families. If nothing is done, marketplaces will continue to collapse, and Ohioans will continue to be forced to choose from fewer options.”
Republicans in the House of Representatives passed a law to repeal and replace Obamacare, but now the Senate is creating an entirely new bill. It’s not clear if a final bill, agreed on by both houses of Congress, will be available for the President’s signature.
The Affordable Care Act (Obamacare)
“[Obamacare] has some very good things in it,” says retired University of Toledo Professor of Public Policy Sunday Ubokudom, a health care reform expert. “For example, you can’t quarrel with keeping children on their parents plan until they are 26 [years old]. That’s a very popular aspect of the law.”
“The preventive services are very good,” he added. Obamacare requires that all plans provide for free preventive care like mammograms, immunizations, and colonoscopies. “The inability to refuse coverage for [people with] pre-existing conditions – that’s exemplary. There are lots of people that probably would have died because of a pre-existing condition who now have insurance.” And the mental health coverage, which is required as an ‘essential health benefit’ on marketplace plans? “You can’t beat that.”
Obamacare has brought health insurance to 866,000 Ohioans, and nearly 20 million Americans. That was done largely by Ohio, along with 31 other states and Washington D.C. expanding Medicaid. the Affordable Care Act (Obamacare) also provides government subsidies to make health insurance more affordable to people unable to obtain health insurance from their employer. Under the bill recently passed by the US House, those subsidies would be reduced for lower-income Americans.
Democrats, who made Obamacare the law 7 years ago, stand by it. “The Affordable Care Act is succeeding,” said Democrat Congresswoman Marcy Kaptur, in a statement. Her district includes most of Toledo and Oregon. “It has already saved thousands of lives. It is pro-life for all people. It has made it possible for ALL Americans to access health insurance. Yes, the Act still needs some improvements…but the Republican proposals would translate into even higher out of pocket costs, ending guaranteed coverage…We should repair [Obamacare], not repeal it.”
Professor Ubokudom agrees, “Ordinarily, what Congress would be expected to do…is to amend [Obamacare] to address the affordability problems,” he wrote in an email. “The President campaigned on covering everybody at lower costs. The American Health Care Act is the exact opposite of that campaign promise. We will continue with the dubious distinction of being the only advanced country without universal [health] coverage.”
High Out-of-Pocket Costs
High out-of -pocket costs are an issue under the Affordable Care Act. Gloria*, a 63-year old massage therapist and yoga instructor who lives in Perrysburg, has health insurance purchased through Healthcare.gov. “Last year I broke my wrist, and I had a ****load of bills afterward,” she said, “I had surgery and they put a plate in. I still have $1000-plus to pay on that.” That out of pocket cost is due to her health plan’s deductible, copays, and co-insurance. Gloria thinks her insurance should have picked up more of the cost, but “if you need something like surgery, I suppose it’s better than having to pay the whole thing.”
It’s not clear how the health care plan recently passed by the House will reduce those out of pocket costs.
Medicaid Expansion Helping Toledoans
A big piece of the Affordable Care Act is its expansion of Medicaid. 21% of Ohioans are now insured by Medicaid – that’s 2.9 million people – the partially federally-funded health insurance plan for the poor. Medicaid is great health insurance – it covers 100% of healthcare and drug costs, sometimes with a very low $3 copay, and also includes vision and dental coverage. Obamacare encouraged states to expand Medicaid to cover people with household income totals up to 138% of the poverty level ( which for a family of 3 is $20,420 per year), with the federal government paying for most of it. Governor John Kasich is one of 31 governors who agreed to expand Medicaid, which took effect in 2014. According to Rep. Kaptur, about 665,900 Ohioans have gained health insurance through the Medicaid expansion.
“Most of our folks have benefitted from the Medicaid expansion,” says Doni Miller, CEO of the Neighborhood Health Association (NHA) ( nhainc.org), a group of Toledo community health centers, including downtown Toledo’s recently opened Nexus Health Care at 1415 Jefferson Ave. “Most of the people we see are living at or below the poverty level. [Obamacare’s Medicaid expansion] has been a marvelous tool for some of our patients that’s allowed them to get control of their chronic diseases – hypertension, cardiac illnesses, diabetes – and get them access to medication, to become more fully-functional members of their families and neighborhoods. If you’re sick, it’s very difficult to be engaged in much.”
“There’s a significantly high rate of infant mortality for black babies” in Lucas County, Miller adds, “[Obamacare’s Medicaid expansion] gives women the opportunity to get their pregnancy health care paid for. It gives them…the best chance to have a successful pregnancy.”
“I feel that [the Medicaid expansion] has had a positive impact on people’s lives,” says Antionette Banks, who enrolls people in Medicaid for NHA, “for many people, it’s the first time in their lives that they’ve ever had [health] insurance. Some people have cried while holding up their health insurance card they’re so happy about it. Some of them have serious health conditions and now they can see the doctor and get their prescriptions. 34,000 people in Lucas County are covered now because [of The Affordable Care Act’s Medicaid Expansion]. So, I’m hoping the Medicaid expansion continues.”
The Congressional Budget Office estimates that if the AHCA becomes law, millions of Americans would lose Medicaid health insurance by 2026 due to the AHCA’s proposed changes. 34,000 people in Lucas County are covered now because [of The Affordable Care Act’s Medicaid Expansion].
Hospitals have also benefited from the Medicaid expansion. “Medicaid expansion has helped Ohio see the lowest uninsured rate on record, which has contributed to lower uncompensated care for [health care] providers,” Promedica said in a statement. Uncompensated care results when patients who cannot afford to pay receive care.. “The expansion of Medicaid has brought billions of dollars for health care to Ohio counties. Medicaid expansion reduces the burden on hospitals to care for people who
otherwise couldn’t pay,” Serena added.
The recent health plan passed by the House, the American Health Care Act (AHCA) would kill Obamacare’s Medicaid expansion.
Reduced, Or Free, Health Care Without Insurance
“I really haven’t looked into getting insurance to be honest,” says Alyssa* a 36-year old yoga instructor who lives in West Toledo, “I’m pretty healthy, luckily, and haven’t had the need to go to the doctor often.” However, Alyssa still went to the doctor, despite her not having health insurance. “I did go for a mammogram last year,” she said, “I received 2 bills. One from the office and one from (the care provider’s parent company). I had to make payments on the bill from the office, and send (the care provider’s parent company) copies of my paychecks so they could tell me how much my payments would be for the $1200 bill. I received a letter back about 5 months later – they waived the entire bill. I was pleasantly surprised.”
Years ago, Gloria contracted breast cancer, and at the time didn’t have any health insurance. “We had to enroll in HCAP (the Hospital Care Assurance Program), because of our income,“ she said, “They paid for everything, I was lucky.” Happily, she is a cancer survivor, now glad to have health insurance. “After going through cancer, and filling out those financial forms every 3 months, that was so stressful. So, I’m glad that I have something.” HCAP works with the Ohio Department of Medicaid to provide money to hospitals that provide uncompensated care.
NHA’s community health centers will also provide free health care services to patients without health insurance. However, a lot of people do not know this. “Without having medical coverage they’ll go without care,”
Health Care Act Changes
The recently-passed U.S. House of Representatives American Health Care Act (AHCA) is designed to replace the Affordable Care Act. After the U.S. Senate develops its own bill regarding health care coverage, the bills must then be reconciled, which will then need a vote by both Congressional chambers.
Most Toledoans who obtain health insurance through larger employers will probably not notice any changes. People who obtain health insurance through smaller employers may end up with health plans that are no longer mandated to cover health benefits as required by Obamacare.
Low-income people who purchase insurance on the individual market may see less in the way of government subsidies – the tax credit – to help them buy insurance. Medicaid expansion will likely be phased out and Medicaid is expected to return to only covering people with household incomes at or below the poverty level.
The AHCA would allow individual states to no longer guarantee standard-price health insurance for people with pre-existing medical conditions. These people may be charged more – even a lot more – for health insurance.
“[Obamacare] is so much better than not having insurance. It is a work in progress, “ says Kim, a 48-year-old from East Toledo. “I am afraid that the politicians are going to make it more difficult to get insurance, more difficult to use it, or wipe it out completely. It’s barely affordable now. I’m extremely anxious about the future of health insurance, because both my daughter and I have a lot of health issues.”
“I’m anxious [about the future of health insurance],” Gloria said. “I’m not getting any younger, who knows what’s going to happen. You have to have coverage” Gloria will soon be eligible to enroll in Medicare, when she turns 65. “If that’s still around,” she said, “do you think it will be?”
“I believe that everyone should have a right to access health care,” says Toledo Mayor Paula Hicks- Hudson, who believes Obamacare has been good for Toledoans. Under Obamacare “more folks have been able to be eligible for health care and to have the opportunity for folks not to be bankrupt because they did have this access to health care. Whether it’s single-payer or universal healthcare, I believe that folks need to be able to get the medical care that they need. But I also believe that we need to work on the side of preventive, and education.” And the Republicans’ new plan in Washington? “I am concerned that there is going to be a reduction in benefits, and people may have to pay more for coverage,” the Mayor said.
The Republicans’ repeal and replace bill is not popular. A new poll by the Kaiser Family Foundation shows that a mere 31% of Americans support the AHCA bill. The Senate is having difficulty agreeing on its own bill, and doubts remain as to whether the Senate can produce a health insurance bill before the end of the year.
In the meantime, Obamacare is still the law of the land. “[The Affordable Care Act] begins the critical journey,” Congresswoman Marcy Kaptur wrote, “to a health care system where healthy outcomes, not impoverishment, are the objective for all.”
Is The Obamacare Marketplace Collapsing?
Not in Toledo.
One of the big criticisms of Obamacare is that its health insurance marketplaces are collapsing – but that is not the case in Toledo, where 5 companies, Paramount, Ambetter Buckeye Health Plan, Medical Mutual of Ohio, CareSource, and Molina offer health insurance at reasonable prices, according to the Stride search tool.
However, according to KFF.org, 18 states currently have only one or two companies offering plans in the marketplaces established under the Affordable Care Act. Big insurance companies like Humana, Aetna, and UnitedHealth have claimed that they may be pulling out of the marketplaces entirely. Anthem left the Ohio marketplace on June 6.
Most People Get Health Insurance from
These Obamacare marketplaces, like Healthcare.gov, while a big to-do, only help a mere 5% of Ohioans to obtain health insurance– the individual health insurance market is a very small market compared to Ohioans who get their health insurance from an employer (52%), Medicare (15%), or Medicaid (21% with the expansion), according to KFF. Interestingly, members of the U.S. Congress buy their health insurance through the Obamacare
Health Insurance Plans:
Bronze, Silver, Gold, Platinum
A review of plan premiums via Stride shows Bronze plans for a non-smoking individual go for as little as $221 month, and if you qualify for a subsidy, can cost you as little as $135 per month. A Silver plan costs $329 per month, or around $243 per month with the subsidy. However, it depends on what state you live in – in some states premiums are rising more, according to the Kaiser Family Foundation (KFF), a health policy organization. Gold and Platinum health plans’ premiums are more expensive, with lower deductibles and better benefits.
According to the Commonwealth Fund, a health care advocacy organization, Ohio’s health plan premiums on Healthcare.gov only increased by 7% to 10% from 2015 to 2016. Certainly not “skyrocketing.” Also, health insurance premiums were already rising nationwide before Obamacare even became law: on average they increased between 9% and 11% from 2008 to 2010.
Doctors Who Are Accepting
New Patients Are Hard to Find
Penny Gentieu, a professional photographer in Toledo (gentieu.com), had to change health plans from a PPO to an HMO, because the company she went with, Medical Mutual of Ohio, quit offering a PPO plan on the individual market. This meant she had to find a new doctor. If you have HMO insurance you must find an in-network doctor, or your insurance will not pay any of the cost. Gentieu then embarked on a research project: calling all the doctors listed as accepting new patients, as published by all the Toledo health plans offered on Healthcare.gov. “I called them all, and found that on average only 20% [of the doctors listed] were actually accepting new patients.” she explained. The NY Times covered her research in a December 2016 article, “Insurers’ Flawed Directories Leave Patients Scrambling for InNetwork Doctors”.[nytimes.com/2016/12/03/us/inaccurate-doctor-directories-insurance-enrollment.html ] Mrs. Gentieu advocates on health care issues at her website Ohio Citizen Rate Review ohiocitizenratereview.info