Faces of the Affordable Care Act: With policy canceled, couple mulls options

They qualify for subsidy, but feel burden is on those already struggling

By Marissa Harshman, Columbian health reporter

Published:

 

Washington insurance commissioner won’t allow canceled health plans

Washington Insurance Commissioner Mike Kreidler quickly quashed President Barack Obama’s offer to allow canceled insurance plans to continue through 2014.

“We will not be allowing insurance companies to extend their policies,” Kreidler said in a written statement issued Thursday morning, shortly after the president spoke. “I believe this is in the best interest of the health insurance market in Washington.”

Health insurance profile

Name: Lindsey McChesney.

Age: 27.

Family members: Husband, Jesse, 26.

Annual family income: $40,000.

Current coverage: Kaiser Permanente individual plan, ($230 per month).

Qualify for federal subsidy? Yes.

New coverage: Undecided.

Examining health care reform

Editor’s note: This is the first in a series of stories looking at how the Affordable Care Act affects residents of Clark County.

The Columbian is sharing the stories of residents who have found cheaper health insurance through the state-based exchange, qualified for expanded Medicaid, opted to pay a penalty rather than purchase a health plan or are unhappy with the new insurance offerings.

All of the stories also will be available on The Columbian’s Examining Health Reform site.

Up until August, Vancouver residents Lindsey and Jesse McChesney had insurance coverage through an employer.

But once Lindsey decided to leave her job as a pharmacy technician and enroll in pharmacy school, the couple joined the ranks of the uninsured. Jesse works for a small business that doesn't offer medical insurance. But Lindsey's school requires her to be insured, so the couple purchased an individual plan through Kaiser Permanente.

The plan has a $7,500 deductible and $35 co-pays. Lindsey, 27, said it works well for them because they're young and healthy and rarely need to see a physician. Plus, it was what they could afford, Lindsey said.

They pay $230 per month for their current insurance plan.

But last month, the McChesneys received a letter from Kaiser. Their current plan doesn't meet the minimum requirements set by the Affordable Care Act and is being canceled.

The Affordable Care Act requires every individual and small-group plan to cover 10 essential health benefits, which include emergency services, mental health care, substance abuse treatment, prescription drugs and maternity care. Many of the state's current individual plans don't cover prescription drugs or maternity care, according to the state insurance commissioner's office.

As a replacement for the McChesneys' current plan, Kaiser recommended a new, bronze-level plan with a lower deductible ($4,500) but higher co-pays ($50). That plan will cost the couple $491 per month.

Lindsey checked the Washington Healthplanfinder site and learned the couple is eligible for a federal tax subsidy of about $230. That would bring their monthly premium down to about $260 — a $30 increase over what they're currently paying.

But the cost of the plan isn't what upsets Lindsey.

"Before this law goes into effect, I was paying for my health care myself," she said. "Now, I have to get help from the federal government to pay for it. So I'm just another person on welfare, basically."

The new plan includes coverage the McChesneys don't currently have — prescription drug coverage, for example — but Lindsey doesn't think the $260 per month increase in cost makes up for the added benefits. Instead, it seems the cost of the plans were pumped up artificially, she said.

"The market isn't driving the price anymore," Lindsey said.

When Lindsey first heard about the Affordable Care Act, she thought the financial burden of providing insurance coverage for those who couldn't afford it would be spread more evenly. An across-the-board income tax, for example.

But as the law is now, the lower-middle class is hit the hardest, Lindsey said.

"It's putting this huge burden on people who are struggling in the first place," she said.

The McChesneys are still deciding what they're going to do. If Lindsey wasn't required to have coverage, she would likely opt out and pay the fine. They may take Jesse off the new Kaiser plan and pay the fine for him. They're also considering finding a different plan on the insurance exchange.

"I'm not sure what we'll do," Lindsey said.