Editor's note: On Jan. 6, the Star-Telegram published a column by Executive Editor Jim Witt headlined "Star-Telegram report on Affordable Care Act left out key information," namely, that the subjects of this report are affiliated with the Tea Party. Read that update here. Whitney Johnson, an Arlington 26-year-old with multiple sclerosis, can’t afford to go without health insurance. Her life depends on it.
She gave birth to her first child Sept. 2 after undergoing a series of rigorous steroid treatments, surgeries and a plasma exchange that saved her life. She pays $325 a month for an individual insurance plan — a drop in the bucket compared with the cost of her plasma protein replacement therapy, which runs $40,000 a pop. She undergoes treatment every five weeks.
But now, with the Affordable Care Act in full swing, Johnson’s insurance is under threat. She recently received a letter that said her insurance plan will be canceled Jan. 1 because it does not comply with the federal healthcare law, also known as Obamacare.
The insurance company told her that it was pulling out of Texas. She said she can’t afford to go on her husband’s plan because it would triple the family’s monthly premium. And she has been unable to access the federal health exchange website, which has been hampered by technical problems.
“I’m scared to death to stop these treatments,” she said. “If I lose my treatments, I don’t know what my health will be like. Before I got on the treatments, I could not function. It was really scary.”
Johnson is among thousands of Texans in limbo after being told that their insurance plans will be canceled under provisions of the healthcare law. More than a dozen states have agreed to let consumers keep their plans for another year, at the urging of President Barack Obama. But in Texas, the state’s health insurance regulator says it has no authority to require insurance companies to follow suit.
The Affordable Care Act is making “winners” and “losers” of Texans all over the state, said Stacey Pogue, senior policy analyst at the Center for Public Policy Priorities, an Austin organization that is evaluating how the law is affecting Texans.
“It depends on who you are, male or female, where you live,” Pogue said. “It’s a very individual experience, whether you have options that are more or less expensive. So there’s nothing you can say in ‘general’ about the Affordable Care Act across the board.”
Many Texans have coverage through their employers and likely won’t be hit with cancellation letters. But hundreds of thousands of others, like Johnson, must seek new policies because the independent insurance they bought before 2010 doesn’t comply with the Affordable Care Act.
Thousands of others with chronic illnesses who have participated in the Texas Health Insurance Pool must also find new plans because the pool is expected to be terminated Jan. 1.
Gov. Rick Perry is working with the Texas Department of Insurance, which oversees the program, to “determine what action needs to be taken,” spokeswoman Lucy Nashed said Tuesday.
On Friday, the Obama administration said it’s making progress on fixing the federal exchange, which it hopes will be operating well by the end of the month. It also extended the deadline for enrolling through the exchange until Dec. 23 for coverage to start Jan. 1.
Frustrated by website
Wayne Hoelscher, whose wife is a participant in the insurance pool, got a cancellation letter months ago and has been looking for alternatives. He can buy insurance in the private marketplace or use the federal exchange, where he is likely to qualify for a subsidy, he said. The Hoelschers are in their early 60s.
On Nov. 2, the Keller retiree went to the federal HealthCare.gov site to try to establish an account and shop the exchange, he said. “It said, ‘select a state,’ but there was no entry to select a state, no drop-down for me to select,” Hoelscher said.
After a few failed attempts, he called an 800 number to try to apply. After he provided personal information about himself and his wife, he was told that a packet would arrive in the mail in up to 14 days. Until then, he would be in the dark about the cost of coverage, plan details and the subsidy amount, he said.
More than two weeks later, he still hadn’t received anything in the mail. Concerned that his family would be without insurance, he submitted an application Wednesday for a policy outside the federal exchange. He would have qualified for a $900 subsidy on the exchange.
“I am very frustrated with the whole process,” he said. “We will get insurance — and maybe in a year, they might have things settled down.”
Much higher costs
It’s no surprise that thousands of consumers are receiving letters from insurance companies saying that their policies will be terminated Jan. 1, Pogue said. In many cases, the insurers knew that any policy bought after Obamacare was passed in 2010 would not comply with the law.
“The insurance companies knew that the policies didn’t meet the standards of the Affordable Care Act, and apparently they didn’t tell their customers,” she said.
Policies bought before the law was passed were “grandfathered in” and can remain in place, she said.
But that apparently doesn’t lock in the cost of premiums or deductibles, said Robert Kecseg, an investment adviser in Lewisville. Kecseg, 61, said he bought a plan before Obamacare took effect. But the insurer that provided the coverage went out of business.
When he went to buy new insurance, he found that the cost was much higher. He had paid an annual $10,000 deductible before 2012. Now he pays double.
“It’s pretty spectacular,” he said.
The Kecsegs also faced a medical emergency this year that proved expensive, he said. In May, he suffered facial paralysis and had to be rushed to a hospital during a family reunion in Las Vegas. The emergency room care cost more than $3,000, he said.
“We’re paying it off over time,” he said.
Like the Kecsegs, Shari Lusk of Lubbock was enraged when she found out that her premiums would rise under a new policy that complies with Obamacare. Also like the Lewisville couple, she was shocked to learn that the cost is higher partly because her new coverage includes dozens of services that she says she will never use.
Kecseg says, for example, that his wife is being charged for birth control.
“My wife says she’s had her uterus removed, so we’re not really likely to have need for that,” he said. “But we’re going to pay for it.”
Lusk is retired and single. She has children, like the Kecsegs, and doesn’t want more.
“I’m 57 years old,” Lusk said. “I’m single. I already have children. I’m too old to have children. I don’t have the equipment to have children, but on my new plan, I have maternity coverage. So I’m not real excited about that.”
In recent weeks, she bought a private policy, effective Jan. 1, that is expected to increase her monthly premium to $420 from $360 and up her annual deductible by $1,000. She doesn’t want to buy through the exchanges, she said.
“I don’t want any kind of subsidy,” she said. “I don’t want the government giving me money that takes away from a fellow citizen when I can pay for it. And I don’t want my personal information out there for anybody to have ahold of.”
Johnson, the Arlington mother with multiple sclerosis, said she doesn’t mind buying from the federal exchange. But she’s been unable to.
“I’ve never been able to successfully log on,” she said.
Pogue, who has conducted policy research on the impact of Obamacare for several years, said she’s not that worried.
“The website is getting better,” Pogue said. “Enrollment has doubled and people are getting through. And if that website doesn’t work for 80 percent of the people, the federal government will look at Plan B.”