The Star-Telegram spoke with three residents about their plans under the Affordable Care Act as the health insurance exchanges, a key element in the landmark legislation, are set to open Tuesday.Tom Bainter, self-employed and self-insuredTom Bainter is a small investor whose commitment to self-insuring his family will not waver once the Affordable Care Act takes effect. “I believe in Obamacare, 100 percent,” he said. “But I won’t be buying it. It’s a terrible investment.” The 55-year-old Fort Worth resident said he would rather pay for his medical needs as they arise. Bainter and his wife have three children, the youngest of whom is 14. He said he has spent only $1,500 on healthcare since 1998, including $1,200 when his daughter broke an arm.But starting Jan. 1, Bainter will likely have to pay something. With limited exceptions, individuals and families that lack health insurance are subjected to penalties.Next year, the penalty is relatively small — either l percent of household income or $95 per adult and $47.50 per child under 18 (not to exceed $285), whichever is greater. Penalties increase in 2015 and in 2016, when an individual would pay $695 or 2.5 percent of household income, whichever is greater, and families would pay either 2.5 percent or $695 per adult and $347.50 per child (not to exceed $2,084).Bainter acknowledges the gamble he is taking but believes that he will be fine.“The chances are so slim” for a catastrophic incident, he said. And if it does happen? “I will go broke,” he said. “That is my personal decision.” Paul and Adri Smith, uninsured, with two childrenFor the Smith family of Fort Worth, the Health Insurance Marketplace, commonly called the exchange, has to work. “We have to have health insurance, and that’s where we are likely going to get it from,” said Adri Smith, 32. The Smiths and their children, Lilah, 1, and Elena, 8, were covered by the Mansfield school district’s health insurance plan, thanks to Adri Smith’s job as a teacher. But she left the district in May, and her family’s coverage ended in August.Paul Smith, 34, works three part-time jobs and does not qualify for insurance through any of his employers.In searching for coverage, Adri Smith has found private plans with premiums ranging from $500 to $800 a month, but none fit her family’s needs. All the plans had high deductibles, she said, and none of them covered, without extreme cost, the mental health needs of one of their daughters.The Affordable Care Act mandates that all individual and small-group plans —those sold through the Health Insurance Marketplace and those sold outside of it — provide mental health coverage. It’s one of the Essential Health Benefits mandated by the law.“I think it is very important to have mental health coverage for everyone. It’s one of the best things about the law,” Smith said. “With all of the recent gun violence, people are calling for more help with mental health, but we can’t get that if we can’t afford it.” Smith and her husband are optimistic about the exchange. They are waiting for the official costs to be released Tuesday before definitively choosing a route. “We really have to have healthcare,” she said. “I just really hope the exchange costs are what we need them to be.”Flora Brewer, business owner on COBRAIn December, Flora Brewer began organizing her work life around the Affordable Care Act. “I knew reform was coming, and I took it as an opportunity to no longer work two jobs,” said Brewer, of Fort Worth.She left her full-time position at a home health services company, which she says she took for the benefits alone, and focused solely on running Paulos Properties, her family’s real estate company.She qualified for COBRA, named for the 1985 federal law that allows many employees leaving a job with health benefits to continue those benefits for at least 18 months and as long as 36 months. There’s one catch: You have to pay the entire premium, since your former employer is no longer chipping in, plus a 2 percent administrative fee.Brewer’s COBRA plan costs her $1,950 a month. It covers her, her husband and their 22-year-old son. Prices like that are a big reason observers think the exchange is going to be popular with COBRA users.The Affordable Care Act allows Brewer, whose company has no other employees, to buy coverage through the exchange. “I have been looking at the websites, and I know that come Oct. 1, I certainly won’t be paying more,” Brewer said. She may see even more savings. Her son was recently hired as an hourly employee in Washington, D.C.He can enroll in his own health plan through the D.C. exchange and possibly qualify for a subsidy, further lowering his mother’s monthly premium.
Nick Dean, 817-390-7856 Twitter: @bynickdean