For the 2.1 million people who’ve signed up for health insurance under the new federal and state exchanges, Jan. 1 is when the rubber meets the road.
Health and Human Services Secretary Kathleen Sebelius called it “an exciting new day in health care” as latest enrollment figures were released Tuesday. But for people like the Schulz family of Phoenix, Ariz., Rita Rizzo and Lou Vincent of Akron, Ohio, and Joyce Moore of Zionsville, Pa., it’s the first test of whether Obamacare will really work.
They all say they’re relieved and excited to finally have new access to health care, and they hope that the rocky rollout of the exchanges under the Affordable Care Act will actually give way to the smooth delivery of vital medical services.
“I’ve been afraid for the last three years to get preventive care, because if they found something, I couldn’t afford to treat it,” said Rizzo, 59, who runs a management training business with her husband. “I haven’t had any blood work in three years and my right hip is starting to give out.”
But now that she and Vincent, 64, are covered by a new CareSource silver-level plan under the federal exchange, he’s insured for the first time in years after being denied by dozens of private plans because he has high blood pressure and diabetes. And Rizzo said they’ll pay $184 a month, with a $2,000 deductible and a maximum of $3,400 out of pocket, far less than the $400 a month and $6,000 deductible they were paying for her alone with a private plan.
“The coverage is wonderful,” said Rizzo. “We’ll get prescription coverage. Right now, his prescriptions alone are $170 a month.”
The Ohio couple are among the more than 2.1 million people to sign up under the federal and state exchanges and another 3.9 million new Americans who qualify for Medicaid, the Centers for Medicare and Medicaid Services reported Tuesday.
Expanding health insurance to some 32 million uninsured people was the goal of the 2010 Affordable Care Act, commonly known as Obamacare. The new enrollments, however, are still far short of the 3.3 million the White House was hoping for by year's end — or the 7 million initial sign-ups projected by the Congressional Budget Office. People have until March 31 to sign up for coverage in 2014 or face fines.
Still, Rizzo’s optimism is shared by Claudia and Joseph Schulz, who started trying to sign up for Obamacare on Oct. 1, the first morning the federally run Arizona exchange was open, and only succeeded in the last hours of an extended deadline on Christmas Eve.
The pair quit their jobs in September to start an independent real estate business, putting them among some 1.5 million newly self-employed people projected to seek coverage under the ACA, according to a Georgetown University study.
That left them frustrated and a little nervous about the repeated glitches and long delays of the sign-up process. But Claudia Schulz, 34, said she and her 37-year-old husband always expected it to work out eventually.
“We weren’t happy that the website wasn’t working,” said Claudia Schulz. “But we figured it’s the U.S. government. I’m sure they’ll fix the website.”
For the past four months, the couple has been paying $1,600 a month for COBRA benefits to extend the insurance provided by Joseph Schulz’s former job as a mortgage broker. Now, however, with a silver-level plan through Health Net of Arizona, they’ll pay just about $700 a month to cover themselves and their three children, ages 2, 7 and 10. There’s a $3,000 deductible and $12,000 maximum out-of-pocket payment per year.
That’s more, certainly, than the $420 they were paying through the employer-sponsored care through Joseph Schulz’s job, but it allows them to pursue their longtime dream of working for themselves, Claudia Schulz said.
“We are very happy with our choice and so glad we had the ability to compare so many options and choose for ourselves,” she said.
Joyce Moore, a Pennsylvania financial planner, is pleased, too, even though she was among at least 4 million people whose private insurance policies were canceled, sparking criticisms of President Barack Obama’s early promises that people who liked their plans could keep their plans.
An estimated 11 million to 19 million people previoulsy got insurance through the private insurance market. That’s dwarfed by the 149 million people who get insurance through an employer and another 97 million who get government coverage through Medicare, Medicaid or the Children’s Health Insurance Program or CHIP.
“I was expecting it to be canceled. The idea that you can keep your plan was never an option for me,” said Moore, 58, who runs her own retirement and estate planning business. “That was fine with me because my plan was awful.”
Under the old plan, Moore paid a $550 monthly premium and had a limit of $8,500 a year for out-of-pocket costs — for one person.
“If you had to have surgery that year, you’d have to have $10,000 set aside just for medical bills,” said Moore, who signed up for a silver-level plan with provider Geisinger. “Under my new plan, the premium is $100 less a month and the out-of-pocket is $4,750 less per year.”
But Moore, a longtime supporter of the ACA, said she was dismayed by the botched exchange rollout and by the Obama administration's last-minute deadline extensions and other changes, such as allowing people with canceled private plans to apply for “hardship” exemptions to keep them.
“Changing the rules in the middle of the game is not the way to go about it,” Moore said.
She said she worries that the flubbed launch will discourage young people — the very people needed to help make the system work — from signing up.
“It might take years to overcome the damage caused by this rollout,” she said.
For now, though, newly insured people like Rizzo and Vincent have finished their countdown to insurance and are making appointments with new doctors in the new year.
Vincent will need prescriptions for the medications that keep his high blood pressure and diabetes in check. Rizzo said she’d like to see about a host of ailments, including her sore hip, a broken rib that healed funny and a cyst in her throat — all conditions that she simply endured because she didn't want to pay for treating them.
“I’m going to be 60 next month and that’s when I hear you start to unravel," she said. "I’m starting to see the first threads.”
First published January 1 2014, 4:16 PM