Friday, January 27, 2017

Help me tell ACA stories

Greetings, dear readers: I would like to tell stories about people's experiences with lesser-known ACA benefits -- or shortcomings. Writeups may appear elsewhere -- or other publications -- or here.  These are the categories I have in mind:

1) Donut hole: I'd like to speak to Medicare enrollees who have benefitted (or not so much) from the ACA's gradual closing of the "donut hole" in prescription drug coverage.

2) Lifetime coverage caps: pre ACA, in 2009, 59% of people insured through employers were subject to lifetime caps on coverage -- typically $2 million by 2009, but often $1 million. The ACA banned lifetime and annual caps.  In a recent post, I  dug up a 2007 study finding that 20,000-25,000 people would hit lifetime caps by 2009.and forecasting that 300,000 would max out by 2019 if the caps were not raised. I'd like to speak to anyone who ever hit the caps, or was saved from the caps by the ACA, or is worried about hitting the caps (because of an expensive chronic condition) post-ACA.

3) The satisfied unsubsidized (or not so satisfied): there's no denying that many people who don't qualify for ACA subsidies but have to buy their own insurance have been hit hard by premium increases. On the other hand, in the pre-ACA individual market for health insurance, about a third of people who tried to buy were turned away because of pre-existing conditions (either denied outright or discouraged by brokers) -- and about a third of those who did buy had to pay above-market rates because of same. A smaller group perhaps 6% or more had to or accept coverage that excluded treatment for their condition (those estimates sourced here. In 2014 I profiled in the Atlantic several people who did not qualify for ACA subsidies but still benefitted from its coverage rules. I'd like to do so again. I'm happy to do stories in which the ACA market did not work out well, or was a mixed bag, but I do want to stick to people who had or would have had problems in the pre-ACA market.

Much appreciated if anyone can tell me a story, or refer me to someone who might in any of these categories. I can keep tales anonymous if necessary, as long as verifiable, though I'd like to use real names if possible.  To contact me use the email address in the "about me" on the right margin. Thanks.


  1. I'm part of the third group. I earn too much to receive a subsidy, but I am satisfied with my coverage. I enrolled in the Blue Cross Blue Shield of Michigan Multi State Plan with Dental and Vision. I'm 27 and live in Zone 7 so my premiums are $371 per month. It's a lot of money, but my prescription drugs and doctor visits are covered before the $3500 deductible. The drugs would be unaffordable without coverage. For example, one drug is $443 per month without insurance, but only $15 at rite aid with a copay. I don't get coverage through work because I only have 6 coworkers and all receive coverage through spouses, the VA, or Medicaid. My Board of Directors decided to give me a pay raise rather than health care due to the employer mandate after the ACA ruled that all full time employees had to be covered if anyone was covered. Everyone is full-time so this did not work out for me.

    I have benefitted greatly from the ACA's coverage rules even though I don't get any subsidies. The under 26 provision saved me probably $15,000 until I was kicked off my Mom's plan at the end of the year that I turned 26. Blue Cross Blue Shield lets you do it this way rather than on one's 26th birthday. I remember what health plans on the individual market looked like pre-ACA and they were significantly worse than they are now so I am grateful for the ACA. I remember a Blue Cross plan that had a $10,000 deductible and covered nothing before that. I like the Essential Health Benefits regulation which makes ACA plans as good as employer based plans. I like that many different services are covered because plans are more like real coverage now even with the high deductibles. It doesn't bother me to not receive a subsidy because I earn enough. That's like envying poor people because they get food stamps and don't pay taxes. Even if I don't qualify for a government benefit, I'm still better off than those that do.

    Part of the reason that I like my coverage is because I know how much health care costs without it and it makes me feel safer. My family has always had coverage, but when my father was in a car accident and we received the medical bills later. Our cost was $6,800 instead of $42,000 for everything. A $6,800 out of pocket maximum is a lot of money, but it's manageable compared to $42,000 and up.

    Part of the reason that I'm grateful for the ACA is because of student loan reforms that were slipped into the reconciliation bill. While even I, a supporter of the ACA, found this odd. I really don't want the law repealed because without Income Based Repayment, my payments would be $336 instead of $143. So not only would I lose my health insurance, but I would also be paying a lot more for my student loans.

    1. Thank you for the detailed info, Casey. Would you be willing to do a phone call? If so, please email to the address in "About me" - Andrew