Cutting through the confusion on health coverage

Nancy Becker is upbeat on Obamacare. Her income qualifies her for a subsidy, so she will get better coverage for less money.
Nancy Becker is upbeat on Obamacare. Her income qualifies her for a subsidy, so she will get better coverage for less money. (JEFF GELLES / Staff)
Posted: November 04, 2013

Nancy Becker recently got notice that her health insurance would vanish come Jan. 1 - a change her insurer blames on 2010's Patient Protection and Affordable Care Act. To replace it, Becker managed to create an account on HealthCare.gov, the new health-insurance exchange for Pennsylvania and 35 other states. But since then, the website has clammed up whenever she attempts to enroll in a plan.

In other words, Becker is among the millions of Americans trying to navigate the tricky crosscurrents surrounding Obamacare's launch - and finds herself at the center of two of last week's biggest news stories.

One is the firestorm over the malfunctioning federal exchange. The other is the controversy over cancellations, which critics say fly in the face of President Obama's assurances that "if you like your health plan, you can keep it" even after the law is fully in effect.

To help cut through the confusion surrounding the law - some sadly blamable on the not-ready-for-prime-time website - I spoke with Becker and her insurer, Independence Blue Cross, as well as other area residents who got similar notices.

Their stories illustrate some of the law's complexities and the misunderstandings they generate, and also why it's so urgent that HealthCare.gov get fixed. It's not "just a website," as some embarrassed advocates have suggested. It's the linchpin of a 21st-century marketplace, and crucial to the law's vision of providing universal access to affordable coverage via the private insurance market.

Becker, 60 and hampered by a chronic illness, lives on a tight budget. She expects to earn less than $20,000 this year, mostly as a dog walker, after years as a nurse and restaurant owner.

That makes her eligible for a subsidy under Obamacare. And it's one reason that, while frustrated by HealthCare.gov's hang-ups, Becker is upbeat about the law, in contrast to some who complain that they'll have to pay more for insurance they like less.

Becker won't miss her current, bare-bones policy, which costs her $156 a month and limits hospital stays to 21 days. Thanks to the subsidies, available to individuals above the poverty level earning to about $46,000 a year and a family of four earning as much as $94,200, Becker expects to pay less than half that for full-fledged coverage.

As a former nurse, she knows how benefit limits can lead to financial ruin. "Yes, it's going to cost some people more money," Becker says, "but there are not going to be caps on their coverage. They're not going to go into the hospital and find out that half of their care isn't covered."

Becker's current Special Care plan isn't a scam. It's one of several plans that Independence provides about 24,000 policyholders under the state's "guaranteed issue" program - a pre-Obamacare answer to the problem that insurance had become unavailable or unaffordable to people with preexisting conditions.

All are being ended because they don't comply with the new law, says IBC vice president Paula Sunshine, although she acknowledges that other noncompliant plans will be renewed for a year on Dec. 31 - a day before the new rules bar them - if customers want them.

Sunshine says the discontinued plans have changed too much to be extended as "grandfathered plans" under the law. Statewide, as many as 250,000 people have gotten similar notices, the Insurance Department says.

One was a Chester County businessman, who complained to The Inquirer about "misleading information from the Obama administration" after getting a cutoff notice for his family's Personal Choice Basic plan. He said he expected to pay $2,400 more a year for similar coverage, and was surprised to learn, via a Kaiser Family Foundation calculator ( http://bit.ly/13YLrxq), that he'd likely pay much less since an injury had cut into his income.

Economist Jonathan Gruber estimates that 2 percent of Americans will have to switch to Obamacare-eligible policies. He says some will pay more, but all will get better coverage in the bargain. Others, like the Chester County man, will pay less, yet don't even know they can get subsidies.

Which brings us back to HealthCare.gov. If only the website worked, that's something they might actually know.


jgelles@phillynews.com

215-854-2776 @jeffgelles

www.inquirer.com/consumer

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