High health insurance costs prompt tough choices

The post-election confusion over the fate of Obamacare has only complicated the already difficult choices faced by middle class consumers who are worried they can't afford their health insurance options this fall.

Premiums and deductibles soared in many parts of the country after the departure of several large insurers from the Affordable Care Act exchanges for 2017. That's led many to fret about how to either afford insurance or how to get by without it.

Loralea Grey, whose husband is self employed, says they are living a "middle-class nightmare" because of the law. They grew used to the necessary sacrifices to afford the premiums and out-of-pocket costs for their "catastrophic" insurance before the ACA, she says. This year they were facing a premium increase of nearly 40% with a $7,000 deductible per family member. They've decided they can't scrimp anymore to afford plans through the ACA exchange.

"How is this possible or allowable?," she asks. "When I contacted the Oregon insurance commissioner, I received a response back telling me I should feel free to shop around; as if I wasn’t smart enough to have already done that?"

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ACA-funded "navigators" and the call center for the federal Healthcare.gov deal with thousands of people a day with challenges finding coverage, and the most find solutions, says Andy Slavitt, acting administrator for the Centers for Medicare and Medicaid Services.

"For the majority of people, coverage is affordable and coverage is something that changes their lives in many ways," says Slavitt. "I won't say there isn't an overall problem with health care affordability in this country" — but drug and hospital prices are part of the problem too, he says.

Some of those worried about affordability questioned whether they needed to sign up for insurance after Donald Trump's election as president.

"People would call and say, 'We have a new president. He’s going to repeal it, so I don’t have to buy insurance," says Ronnell Nolan, CEO of Health Agents for America, who also sells insurance. "While we hope for change and at least address the affordability, I tell them we have to act as if everything’s status quo."

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In North Carolina, the cheapest option with a "decent network" of doctors and hospitals for Jim Harrison's 61-year-old wife would cost $1,421 a month with a $7,150 deductible. (He is on Medicare.) Because he is retired and that isn't affordable, the family got a hardship exemption from the mandate to have insurance.

"So against our better judgment, she is going to go without health insurance next year ... but we put all of our retirement assets at risk should something catastrophic happen," he says, "I never thought we would be in this situation."

Going without insurance does, indeed, put the family in financial danger.

The ACA prohibits insurers from discriminating against people with preexisting conditions. Before the law took effect, it was often impossible for people with cancer to afford or even get insurance  The law also prohibited lifetime maximums for benefits. Kim Thiboldeaux, CEO of the patient group Cancer Support Community, warns against going without a plan that protects them from a costly disease or accident.

"Patients in past were hitting annual lifetime caps and becoming uninsured," says Thiboldeaux. "This is a critical issue for cancer patients."

Among the alternatives:

• Catastrophic insurance. These plans, which typically had lower premiums and were mostly insurance against the costliest diseases or accidents, were grandfathered in the law for a couple years but are no longer an option to meet the insurance mandate. Young people under age 30 can get catastrophic plans on the exchanges and people older than 30 — such as Harrison's wife — can also buy these plans if they get a hardship exemption. So can those whose ACA plans are canceled because they don't comply with the law. This option doesn't work for the Greys as the least expensive plan they could find costs $1,475 a month and has a $7,000 deductible per family member.

• Christian ministry health sharing plans. Most of these programs are available to people active in a Christian church or "fellowship" who sign statements that they abide by a Christian lifestyle.  It is a large pool of money that similarly minded Christians pay into to reimburse certain health care costs other members face.  Money is sent to the organization and either reimbursed to the member or sometimes directly to the health care provider.

Michael Gardner, spokesman for the Christian Medi-Share, emphasizes that it "isn't insurance in any way shape or form."  The Greys are considering joining their local Christian health ministry for health benefits and says it would cost about $500 a month, even though it "obviously won't cover anything like an actual policy," Loralea Grey says.

• Other health sharing plans.  You don't have to be Christian to enroll in an ACA-compliant health sharing plan by Liberty Direct, which tweaked the language a bit to make far more people eligible. Still, there is a "morals clause," so someone who caused a drunk driving crash wouldn't have their health care paid for, although members might voluntarily chip in, says Corey Durbin, president of Shared Health Alliance.

His company combines benefits that include a co-pay drug card and a $0 co-pay doctor program with any health share program for a package he says usually costs 50% less than traditional health insurance. There's also a $1 million cap per incident annually with some health share programs, which Durbin says would be very hard to reach. Caring for a very premature infant could reach that cap, Durbin says.

• Community health centers. ​Community health centers that were once the only option for the uninsured seeking non-emergency care are serving millions more people than they did before the ACA, according to a report by the UCLA Center for Health Policy Research. The number of uninsured people they serve has declined only slightly, due in part to people who can't afford co-payments and deductibles, said Maria-Elena Young, a co-author of the report. Other factors are patients wanting to stay with their center physicians, immigrants and others not eligible for Medicaid or other insurance in their states.

For now, the Greys are getting by with two old cars — a 2005 minivan and a 1986 Volvo — for their family of four working adults. Son Joel, 22, just got a job that allows him to buy group insurance, but that still leaves Grace, 19, and her parents. If they don't opt for a Christian health sharing plan, Loralea is considering getting Grace an unsubsidized plan and doing without insurance for herself and her husband.

Loralea Grey says they can't afford to get rid of the mold in her attic and she buys her asthma inhalers in Mexico for $2 to save money. She didn't vote for former secretary of State Hillary Clinton or Trump — "so I can't be blamed," she laughs — but hopes something is done so middle-class families don't have to spend nearly all of their disposable income on insurance.

"Hopefully everyone will band together for good and possibly health care might be reworked in the end," she said.

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