Battle Ground family fears health plan costs

They face hardship without tax break or subsidy

By Marissa Harshman, Columbian health reporter

Published:

 

For the first time, Tracy Burgess is hoping — praying, even — that her family doesn't make money. At least, not too much money.

Burgess' family of four is teetering on the line. Tip one way and they'll qualify for a tax subsidy to help pay for a health plan through the state-based insurance exchange. Tip the other way and they're on the hook for the full $1,150 monthly premium.

Tracy, 53, and Larry, 56, own a remodeling business in Battle Ground. Tracy also works as a real estate agent, and their son Dylan, 21, works part time to help pay for his courses at Clark College. They also have a 16-year-old son, Jake.

Tracy Burgess expects her family's income will fall somewhere between $85,000 and $96,000 this year. The threshold for her family appears to be about $94,000. If the Burgesses' income is $94,000 or less, they could be eligible for a tax credit of up to $760. But if their income is $94,250 or more, they likely won't be eligible for any financial help, according to estimates on the Washington Healthplanfinder website.

"I'm praying for $85,000 because then I can sell my soul to the devil and go into the exchange," Burgess said.

About seven years ago, the Battle Ground family purchased an individual plan from LifeWise Health Plan of Washington. For many of those years, the plan's premium and deductible climbed. Last year, the family paid $780 per month for a plan with a $7,500 deductible, Burgess said.

"Then along came the ACA, which we fully supported until we got hit with it," she said.

The Burgesses' plan was replaced with a LifeWise bronze plan that costs her family about $1,150 per month. With bronze plans, the insurer covers 60 percent of costs while the policyholder pays the remaining 40 percent. The plan deductible is the maximum allowed under the Affordable Care Act, $6,350 for an individual and $12,700 for the family.

The Affordable Care Act requires every individual plan to cover 10 essential health benefits, which include emergency services, mental health care, substance abuse treatment, prescription drugs and maternity care. This year, previous plans have been replaced with plans that include those benefits and meet deductible requirements.

As a result, the monthly premium for the Burgesses' new plan is the equivalent of a mortgage payment. The $400 increase over their premium last year totals about half of the family's monthly grocery bill or a monthly car payment -- something else the Burgesses expect they will need to take on eventually to replace their decades-old cars.

While her family is financially stable, they're not wealthy, Burgess said. One serious illness, even with health insurance, could wipe out much of their savings, she said.

"The fact is, there is a financial devastation happening to people just outside the subsidy," Burgess said.

"We're in a worse position than we were before," she added.

Burgess is hesitant to enter the exchange unless she's confident her family will qualify for a subsidy. Even then, she has reservations.

If her family's income from 2013 is low enough to qualify, that doesn't mean it won't climb above the threshold this year. And since the subsidy is based on the current year's income, Burgess fears she may end up paying back the subsidy at the end of the year.

She's also not confident the cost of plans in the exchange won't rise after this year. If enrollment isn't as high as projected, especially among younger, healthier people, Burgess worries plan costs will shoot up to compensate.

"Where will it end up in the future?" Burgess said.

For now, the family remains in limbo.

After attempting to wade through the ins and outs of the ACA income qualifications, Burgess asked her tax preparer to help determine her family and business incomes and whether they qualify for a subsidy. That, however, could take some time during the busy tax season.

In addition, Burgess has been locked out of the Healthplanfinder website. A security question asked what company Burgess had a mortgage with in 1987. She answered incorrectly and was locked out of the system. She said she's made nearly two dozen calls to the call center without getting through.

Unless she gets some clarity in the next month, before the open enrollment deadline, Burgess said she will stay out of the exchange and stick with her current plan -- unaffordable as it is.

"I will just bite the bullet," Burgess said.