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Tampa Bay case studies of Obamacare's costs and benefits

With the election of Donald Trump and Republican majorities in the U.S. House and Senate, the future of the Affordable Care Act is suddenly uncertain.

The health law, often called Obamacare, became a key issue late in the race, when federal health officials said premiums had jumped an average of 25 percent nationwide. The average rate hike in Florida was 19 percent.

For critics, the rate hikes were but the latest strike against President Barack Obama's signature policy. Trump has vowed to dismantle the law, and with the support of Congress, could cut off funding to key provisions.

The House has already voted dozens of times to repeal it and Senate Majority Leader Mitch McConnell has signaled that the Senate would move swiftly to do so as well.

The shake-up comes amid the ACA's fourth open enrollment window, when consumers choose coverage for the upcoming year. The annual sign-up period began Nov. 1. and continues through Jan. 31.

Experts say consumers who buy insurance through the marketplace should continue to enroll.

Jodi Ray, of the Florida Covering Kids & Families program at the University of South Florida, said consumers will be protected from the rate increases. She pointed out that as premiums go up, so will the subsidies that help make plans affordable.

"The idea is to control the impact on the folks who need to buy the coverage," she said.

We asked consumers in the Tampa Bay area about their experience with the Affordable Care Act. Some said the health law put too much of a strain on their family budgets. But others said the law had helped them to get coverage they wouldn't have otherwise had.

Yusniel Diaz

Town 'N Country, security guard, 32

What he paid in 2016: About $100 a month

Comment: Insurance helped his father get diagnosed and treated for colon cancer.

Before the Affordable Care Act, Yusniel Diaz couldn't afford health insurance.

"I would go to the doctor and pay out of pocket for a regular visit or any prescriptions I needed," the 32-year-old security guard said.

Diaz remained relatively healthy — until 2013, when he started experiencing severe abdominal pain. He didn't see a gastroenterologist at first, he said. He had no way to pay for it.

But later that year, Diaz learned he was eligible for subsidized health insurance under the Affordable Care Act. He selected a silver plan from Humana that cost about him $100 a month.

That same week, Diaz scheduled an appointment with a specialist. The doctor found a polyp on his colon that had the potential to become cancerous, he said.

It cost about $700 to have it removed.

"It would have cost a lot more if I didn't have insurance," Diaz said.

After learning the condition was genetic, Diaz encouraged his father to enroll in a marketplace plan. Pedro Diaz, 64, took his son's advice — and soon learned he had a cancerous polyp.

The doctors removed it before chemotherapy was necessary.

"Thanks to Obamacare, he's been able to see those specialists," Yusniel Diaz said of his father. "If we didn't have it, I don't know what would have happened."

Diaz hasn't selected his 2017 plan yet, but he will likely pick something similar to what he currently has. He doesn't expect to pay more. He recently consulted with a health insurance navigator, who said his $100 subsidy is almost certain to increase.

Robert Lust

Holiday, small business owner, 60

What he paid in 2016: $1,872 a month

Comment: Not sure how he'll afford coverage for 2017.

Five years ago, small business owner Robert Lust and his wife, Michelle, decided to drop their health insurance. The $2,400 monthly premium was eating up nearly half their household income.

The couple couldn't wait for the launch of the Affordable Care Act.

"We saw relief coming," recalled Lust, now 60.

In 2014, the Lusts purchased a silver plan from UnitedHealth that cost about $1,000 per month. But they couldn't see any of their longtime doctors, and were assigned to a primary care facility that did little more than provide referrals, Lust said.

When the monthly premiums rose 40 percent, they decided to "bite the bullet" and buy a platinum plan from Florida Blue that gave them more choice in doctors. In 2016, with their $735 subsidy, the plan cost $1,872 a month.

"Add to that the $4,000 out-of-pocket expenses and all the other things that the plan does not pay for," Lust said.

"Take, for example, a trip to the emergency room. The hospital bill is covered, but the ER doctors are subcontractors and out of network."

If the premiums continue to rise like they have in years past, Lust fears his family will be "open to complete financial ruin."

He doesn't want to go without insurance. His wife has lung cancer and heart problems, and has already had several hospitalizations this year. But he's not sure how he'll afford it.

"My wife and I are hard-working, taxpaying citizens of this once great country," he said. "We never asked for anything for (free). Yet we are faced with some decisions that will affect our lives in a very substantial way."

Jules Stewart

Dunedin, physical therapy student, 46

What she paid in 2016: $774 a month

Comment: "We're literally siphoning through our savings to be protected."

As a state employee who advocated for teenagers in foster care, Jules Stewart had "stellar" benefits. But when she left the job in May to study physical therapy, she needed marketplace coverage.

Stewart and her husband, Kip Koelsch, a self-employed race director and endurance athlete, chose a silver plan from Humana. They were stunned by the $774 monthly premium, she said — especially because they had to meet a $12,000 deductible before most of the benefits kicked in.

"We're literally siphoning through our savings to be protected," she said.

She also had to change primary care physicians.

Stewart hopes her new part-time employer will offer her coverage for 2017. If that isn't an option, she and her husband will have to choose another marketplace plan.

They aren't looking forward to it.

"My husband and I are solidly middle class and wonder how folks living just below our level manage to afford Obamacare," she said. "It doesn't seem to benefit anyone I know."

Going without coverage isn't an option, she said.

"We're very fortunate to be in excellent health due mostly to our active lifestyles," she said. "But in our mid-40s and early 50s, we can't afford to take chances by not being covered."

Abby Schneller

Tampa, USF grad student, 23

What she will pay for 2017: $67 a month

Comment: "It's worth it, for sure."

Last year, Abby Schneller had health insurance through her mother's marketplace plan in Indiana. But when she moved to Tampa earlier this year to pursue a master's degree in women's and gender studies at the University of South Florida, she needed a plan of her own.

The 23-year-old grad student attended an on-campus enrollment event earlier this month. Finding a plan was easier than she thought it would be, she said after consulting with a health insurance navigator.

"We had a lot of options," she said.

She selected a plan from Ambetter with a low out-of-pocket maximum and no deductible. With her $196 monthly subsidy, she will pay $67 a month.

"It's worth it, for sure," said Schneller, adding that she has struggled with depression and attention issues, and had to go off her several medications while in between plans.

Schneller's mother, Heather Sutton, was relieved her daughter found affordable coverage. "I was concerned about the cost," Sutton said. "But I was more concerned about her not having coverage."

Sutton, a clinical social worker, has had her own positive experience with the ACA marketplace. Before its 2013 launch, she had trouble finding coverage due to cancer and lupus.

Now, both mother and daughter are insured.

"I have a deep appreciation for Obamacare," Sutton said.

Kiara Rosa

Lakeland, USF senior, 21

What she will pay in 2017: $4.47 a month

Comment: She is "incredibly happy."

Kiara Rosa lost her Medicaid coverage when she turned 21 in July.

The University of South Florida senior didn't think much of it — until she landed a competitive medical technology internship at St. Vincent's Medical Center in Jacksonville.

"One of the requirements is health insurance," Rosa said. She gathered her tax documents and made an appointment with a health insurance navigator last week.

At first, it seemed Rosa wouldn't be able to find a plan. She is a full-time student who doesn't earn enough income to quality for a subsidy. But the navigator realized Rosa's mother, who is uninsured and earns minimum wage at a produce packing job, might be eligible. And young adults can be on a parent's plan until age 26.

Rosa and her mother set up a joint account on healthcare.gov. They selected separate silver plans from Ambetter with special rates for low-income individuals. With their $580 subsidy, Rosa's plan costs $4.47 a month. Her mother's plan costs $6.47 a month.

Rosa had the option to select a plan that had no monthly premium, she said, but was concerned about the $8,000 deductible. The plan she bought has a $600 deductible.

Rosa said she was "incredibly happy" to find an affordable health insurance plan that met her needs. She was also happy she could help get coverage for her mom.

"Most jobs for her don't offer health insurance," Rosa said. "It wasn't even something she could think about."

Dave Beveridge

Tampa, temporary worker back from retirement, 63

What he will pay for in 2017: $1,267 a month

Comment: "The only reason I'm working is to pay the premiums."

After a decades-long career as an insurance claims adjustor, Dave Beveridge fulfilled his goal of retiring at 60.

He never imagined the cost of health insurance would drive him back into the workforce. But Beveridge, 63, had to take a temporary position with a Tampa insurance company, he said, because the monthly premium for his Affordable Care Act plan is so expensive.

"The only reason I'm working is to pay the premiums," he said.

In 2016, he and his wife Nancy paid $868 a month for a bronze plan from Humana. In 2017, the cheapest plan available to them is a $1,267-a-month bronze plan from Florida Blue, he said.

The deductible is $6,800.

Both Beveridge and his wife lead active lives. They eat healthy food. Neither smokes. He doesn't see why they should have to pay 20 percent of their household income for insurance they rarely use.

"We planned for (early retirement) financially since I was in my 20s," he said. "It bugs me to no end having to subsidize people who have not planned for health insurance."

Contact Kathleen McGrory at kmcgrory@tampabay.com or (727) 893-8330. Follow @kmcgrory.

Tampa Bay case studies of Obamacare's costs and benefits 11/11/16 [Last modified: Friday, November 11, 2016 2:03pm]
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