My Experience with the Affordable Care Act

I’ve had health insurance since my first “real job” in Gillette, Wyoming back when Sen. Ted Kennedy was touting universal health care and had Richard Nixon not screwed up with Watergate, would have joined forces with Kennedy and we wouldn’t be having this Obamacare fight today.

Nonetheless, back in 2010, I received a letter from my insurance carrier – Kaiser Permanente – that since I had coverage before ACA went into effect, my policy was “grandfathered” and could keep it or change it with no repercussions from any “pre-existing conditions” that I had or may develop in the future.

I just heard several thousand Kaiser Permanente policy holders got their pink slips that their coverage doesn’t meet the minimum requirements of ACA? What kind of coverage is that? Like a barbecue grill warranty at Walmart? The ACA naysayers have been finding stories about us self employed people who have had their policies handled. What’s the big deal? For the past 10 years, my plan has been cancelled like clockwork on December 31st. If I want to reup, the policies are similar, but the price has always gone up. I’ve had to increase my deductible over the years to keep a reasonable price. ACA or not, my carrier will be cancelling my policy December 14, 2014 as usual and every year after. But at least they can’t kick me out for some medical reason.

When ACA was in its infancy, my premium price dropped, not a lot, but a few bucks. Meanwhile, there was no national health care exchange, but many private ones out there. Since I couldn’t be denied coverage, I did shop around on a private exchange and ended up finding a less expensive plan that had a little better coverage from my existing carrier – it’s a medium deductible co-pay plan – and the plan I’ve had for three years or so. Over the past couple years, my prescription prices dropped to grocery store levels ($5 or buy 2 get one free).

Private healthcare exchanges

On October 1, I signed up with the Colorado healthcare exchange. On day one, I had a few problems getting my account set up – I was bumped off the site a few times, timed out a few times, but eventually was able to get a good connection. After all that and to my surprise, there were no plans offered with coverage even close to what I purchased on the private market.  They all had very high deductibles and premiums that were nearly double what I was currently paying. Apparently, the income-based tax credits would lower the costs dramatically, but the coverage is still terrible, at best. The Connect for Colorado Health support has been great. I’ve been called a couple times to help me get finally through the process which has been goo.

I imagine it has something to do with the actuarial tables that show that low-income people tend to have bigger health problems than the general population, which is why all sorts of people are necessary in the risk pool. These “low-end” policies end up costing less with the tax credits applied. If you’ve been denied coverage all these years, this type of policy is probably considered “gold”. The premiums are likely based on the probability that mostly uninsured, ergo unhealthy, and low income folks will be the ones who apply. I also surmise that places like Wyoming that chose to opt out of the Medicaid expansion plopped all those “high risk” people into the general risk pool, which was a contributing factor to higher premiums.

The Mississippi experience

Rural areas lack competition

There are dental plans offered, but none from my current dentist, which is one of the publicly-traded dentists, Perfect Teeth. I may switch over to Delta Dental if after comparing my Perfect Teeth discount program, it turns out to be way better. Kaiser doesn’t offer dental coverage.

I looked around on the Kaiser Permanente site for plans and found one that had a lower deductible than I currently have and the cost was a third less and called about it and found out that I could switch over, but it would expire for me at the end of 2013 and if i kept it, the price would jump up to the Colorado Health Exchange price, which was over double what I currently spend.

The Kaiser Permanente member service representative on the phone said that they figure out ACA tax credit eligibility too. They have an entire staff designated to Medicaid and Medicare paperwork and I would imagine is very good at working through each state to figure out any ACA red tape.

The upshot?

In my case:

– ACA saves me a few bucks on premiums and lots of bucks on prescriptions

– ACA gives me peace of mind about the future because my insurance won’t get cancelled

– ACA covers a whole bunch of people who won’t be using the emergency room staff as their primary care physicians which, in the long, run will keep my premiums lower by putting their risk in their own pool and not mine.

ACA has caught on and will only improve as more people previously uninsured participate. I think that the national health care exchange is good if you don’t already have coverage and income eligible for tax credits. I heard the dead-beat states that let the federal government run their exchanges are missing the boat and the can-do states that tailored their own are having pretty good success.

State run exchanges more successful

Most people have coverage and If you do, I suggest sticking with learning information from your carrier and not mess around with the national exchange. If you’re in the market or curious as to what choices are out there, also check out the private health care exchanges. You’ll be asked for the same personal information as the Obamacare website asks. Like all other internet commerce, be careful!

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