Author: Paul Deaton

LAKE MACBRIDE— On Dec. 15, 2013 the person from the health insurance exchange with whom I spoke on Nov. 20 called back to say the website was fixed so that I could modify the income on our application. I deleted my old application, refiled, and we were qualified for a family policy on the exchange, with 30 different offerings to consider. We picked one, and are waiting for the payment to clear the bank to be assured that we are signed up. We canceled our current policy in anticipation of the new one. What changed? We can’t afford to turn down the tax credit which makes the policy affordable.

That is not to say the change was a perfect deal. The new policy cost is 28.5 percent more expensive than our current one would have been, and the coverage is less, with a higher deductible and maximum out of pocket. Without the government tax credit, we would have kept our current coverage for another year until Wellmark recalculated the cost of full compliance with the Affordable Care Act and raised their premium accordingly. Then we would participate in open enrollment to weigh our options.

In addition, the tax credit is based upon our projected income. If we generate more income than planned, we are required to report it, and that could trigger a change in our tax credit eligibility. Let’s say we are super successful and generate a lot of income in 2014. We will be stuck with a policy not as good as what we had, and paying more. Is it possible one of us could secure employment for a company with health insurance benefits? It is possible, but unlikely in the current low wage-no benefit job environment.

The saving grace is there is open enrollment each year in the health insurance exchange. I don’t like the idea of switching insurance companies every year, but at our age, we are filling the gap before Medicare kicks in at age 65. When one has lived as many years as we have, taking a one-year chance on a policy compliant with the Affordable Care Act is a controlled experiment in managing our health care costs, one with little downside if we pay attention to our income vis á vis the tax credit. The policy we picked includes our current doctors and health care providers, so operationally there is no change in care.

What bothers me about the situation is the benefit is more to the insurance providers than to citizens. We will pay more to an insurance company we would not normally have picked, with most of the money coming from the U.S. government.

This is the first time in my life outside the military to have participated in a government program, and I don’t like it. Why? It is a first step toward an inevitable dependency on government programs like Social Security and Medicare, and I have always tried to make my own way. When considering the points of entry I’ve had into the workplace— after military service, after graduate school, after a long career in transportation— there has never been an opportunity for a job that would have led to a different result. In the post-Reagan era the perquisites of working for a company have one-by-one been eliminated or diminished.

With the decision about health care made, this will be the last in the series of posts. It’s time to go on living, reminded again of how much we are on our own in a turbulent world. At least we have the quiet of winter and the solace it can provide to comfort us.

LAKE MACBRIDE— According to the Dec. 11, 2013 issue of the New York Times, “nearly 365,000 people picked a health insurance plan through state and federal exchanges established by the Affordable Care Act (ACA) through the end of November. While the pace of enrollment picked up last month, it is still a fraction of the 1.2 million target that the Obama administration had set for the first two months.” In Iowa, the target was 6,970 individuals enrolled with only 11 percent attainment (757 individuals). What’s going on?

In 2012, the American Community Survey,  found the number of uninsured people in Iowa was 254,275 uninsured, or 8.4 percent of our population. I’m not a statistician, but enrolling about 7,000 by Nov. 30 seems a reasonable target. Out of the whole, there are some, where household income exceeds $50,000 (91,073 uninsured), and non-citizens (28,901 uninsured), who would not be eligible. Nonetheless, enrolling only 757 individuals is an embarrassingly low number.

The enrollment period for coverage Jan. 1, 2014 was extended after the website trouble until Dec. 23, so some may have delayed to use this time. I submit, at its core, the problem is a cultural issue, rather than policy. Here are my thoughts:

People I know don’t understand health insurance is mandatory in 2014, and if they do, the perception is there is no reason to get it given the slight penalties.

Wellmark, the largest health insurance company in Iowa is not in the exchange, indicating that if one has insurance where the policy is grandfathered, it may be better to wait to change policies until Wellmark enters the exchange for the 2015 calendar year

The exchange requires some married couples to move from a joint policy to individual policies. That doesn’t seem right, and it was not explained well, if at all. Why change unless one understands this aspect of the ACA?

The folks at the exchange I spoke with were not prepared to deal with the idea that some people do not know how much income they will have in 2014, thus creating uncertainty about the amount of the tax credit, and how much will be paid out of pocket. Uncertainty for this and other reasons will be an obstacle to enrollment.

There have been success stories about people who have benefited from the Affordable Care Act, using expanded Medicaid and the insurance exchanges. On the ground level, the failure to attain targeted enrollments seems to be a failure on the part of government to recognize that enrolling in the exchange is not intuitive, and that people who may qualify for insurance may also need persuasion. This is particularly true given the all-out assault on the Affordable Care Act by some Iowans, including Rep. Steve King (R-Kiron).

Too, where is Organizing for Action? While enrolling people in the Affordable Care Act may not be their primary mission (Organizing for Action is the grassroots movement to pass legislation relating to the Obama administration’s agenda), failure to gain a better degree of compliance with the ACA will result in a policy failure for the administration, and hinder OFA’s progress going forward. OFA has a self interest in the success or failure of the ACA. Having missed identifying the need for persuasion, it seems doubtful anyone in the administration picked up the phone to call OFA.

With the deadline for Jan. 1 2014 coverage less than two weeks away, what’s a person to do?  For me, that means keeping the policy I have for another year, even if we qualify for a less expensive policy on the exchange. For the tens of thousands of Iowans who don’t have health insurance it remains to be seen. While the benefits of the ACA are pretty clear, even those who would be helped the most by the law are just not buying it.

Click on the links to read Part 1, Part 2, Part 3 and Part 4.