Faces of the Affordable Care Act: Falling through the cracks of the health law

Woman's variable income puts coverage out of reach

By Marissa Harshman, Columbian health reporter


photoCheryl Landes

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Cheryl Landes hasn't been able to afford health insurance for the last couple years, and the implementation of the Affordable Care Act won't likely change that.

Landes is a full-time freelance technical writer living in east Vancouver. Until about two years ago, Landes worked through an agency that offered insurance coverage. When her contract ended, Landes paid the $450 a month to continue her insurance under the COBRA law.

Examining health care reform

Editor's note: This is the fourth 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.

She looked into individual health plans, but found even the least expensive plans cost about $600 per month.

"There was just no way," Landes, 54, said.

Once her COBRA benefits ran out, Landes became one of the county's estimated 57,000 uninsured residents. She did find and buy dental insurance for $54 per month.

When the state-based insurance exchange, Washington Healthplanfinder, opened for business last month, Landes browsed the plans to see whether its premiums were more affordable.

Landes' income varies from year to year, but she said she usually makes more than $46,000 — the threshold for her to qualify for a federal tax credit. She plugged a few different income scenarios into the website, http://www.wahealthplanfinder.org.

The cheapest plans she found — bronze-level plans, for which the insurer pays 60 percent of medical costs and the policyholder pays 40 percent — have monthly premiums ranging from $350 to $500 and annual deductibles of $5,000 to $6,000. Silver and gold plans cost more.

Health insurance profile

• Name: Cheryl Landes.

• Age: 54.

• Family members: Single.

• Annual family income: More than $46,000 (threshold for subsidy).

• Current coverage: Uninsured.

• Qualify for federal subsidy? No.

• New coverage: Pay penalty.

Without tax credits, Landes said all those plans are too expensive for her budget.

"My annual income is good for Vancouver, but the problem is I don't make the same amount every month," she said.

Landes has regular clients, but she doesn't always know when they're going to call. The unpredictable income makes it difficult for Landes to commit to a high monthly payment for medical insurance, she said.

Her work comes with some extra expenses. Landes also maintains a second apartment in Massachusetts, where she stays while working onsite with clients or attending meetings. Renting the apartment proved to be less expensive than staying in hotels for weeks at a time, Landes said.

"If I didn't do that, I wouldn't be working," she said of maintaining the Massachusetts apartment.

In addition to the unpredictable income and paying two rents, Landes is supporting her mother. Landes shares her Vancouver apartment with her mother and helps pay for her mom's other living expenses.

"It's quite difficult," Landes said.

Landes is waiting to make a decision on purchasing insurance until her tax preparer finishes and files her 2013 income taxes. Unless her income is low enough to receive a federal tax credit, she'll likely forgo insurance coverage and pay the penalty for being uninsured.

Beginning Jan. 1, most U.S. residents are required to have health insurance or face fines. In 2014, the penalty for being uninsured is $95 per adult or 1 percent of the family income, whichever is greater. The fine increases the following years.

"It's going to be cheaper for me to pay the penalty than it is for me to pay each month (for insurance)," Landes said.

"I can't take on another bill," she said.

Landes feels like she and others in similar situations are falling through the cracks of the Affordable Care Act.

"We're working, we're doing everything we're supposed to be doing, and now we're being penalized because we can't afford insurance because it's too expensive," Landes said. "This is not the right solution."

Landes said she will continue to pay for her annual medical checkups and flu shots out of pocket, as she has for the last couple years, and hope that her good health continues until she can afford insurance.