Advertisement
YOU ARE HERE: LAT HomeCollections

The Obamacare success stories you haven't been hearing about

November 25, 2013|By Michael Hiltzik
  • Delaware artist David Shevlino will get better health coverage at lower cost next year, thanks to Obamacare. Why aren't we hearing more about him?
Delaware artist David Shevlino will get better health coverage at lower… (David Shevlino )

Last summer Ellen Holzman and Meredith Vezina, a married gay couple in San Diego County, got kicked off their long-term Kaiser health plan, for which they'd been paying more than $1,300 a month. The cause wasn't the Affordable Care Act, as far as they knew. They'd been living outside Kaiser's service area, and the health plan had decided to tighten its rules.

That's when they discovered the chilly hazards of dependence on the individual health insurance market. When they applied for a replacement policy with Anthem Blue Cross of California, Ellen, 59, disclosed that she might have carpal tunnel syndrome. She wasn't sure--her condition was still being diagnosed by Kaiser when her coverage ended. But the possibility was enough to scare Anthem. "They said, 'We will not insure you because you have a pre-existing condition,'" Holzman recalls. 

But they were lucky, thanks to Obamacare. Through Covered California, the state's individual insurance marketplace, they've found a plan through Sharp Healthcare that will cover them both for a total premium of $142 a month, after a government subsidy based on their income. They'll have a higher deductible than Kaiser's but lower co-pays. But their possible savings will be impressive.

RELATED: Yes, men should pay for pregnancy coverage. Here's why.

More important than that was knowing that they couldn't be turned down for coverage come Jan. 1. "We felt we didn't have to panic, or worry," Holzman says. "If not for the Affordable Care Act, our ability to get insurance would be very limited, if we could get it at all."

Holzman and Vezina are exactly the type of people Obamacare is designed to help--indeed, rescue from the cold, hard world of individual health insurance of the past. That was a world where even an undiagnosed condition might render you uninsurable. Where your insurance could be canceled after you got sick or had an accident. Where your financial health was at risk as much as your physical well-being.

These are the stories you're not hearing amid the pumped-up panic over canceled individual policies and premium shocks--many of which stories are certainly true, but the noise being made about them leads people to think they're more common than they are.

We've compiled several alternative examples for this post. They're anecdotes, sure, just like the anecdotes you've been seeing and reading about people learning they'll be paying more for coverage next year.

The difference is that Americans learning that they'll be eligible for coverage perhaps for the first time, or at sharply lower cost, are far more typical of the individual insurance market. Two-thirds of the 30 million Americans who will be eligible for individual coverage next year are uninsured today, whether because they can't afford it now or because they're barred by pre-existing condition limitations, which will no longer be legal. And more than three-quarters will be eligible for subsidies that will cut their premium costs and even co-pays and deductibles substantially. 

Let's hear from a few more of them.

David Shevlino, 51, is an artist in Delaware. Between the COBRA policy that extends the coverage his wife, Kathy, received at a former job and the bare-bones policy that covers himself and their 15-year-old son, they've been laying out $1,000 a month in premiums. Next year they'll pay $650 a month, after the government subsidy, for a plan through Blue Cross of Delaware that covers the entire family and provides many services that have been excluded up to now.

That makes a big difference, especially for Kathy, who is still dealing with injuries she suffered in a cycling accident and that would have made her uninsurable once her COBRA ran out less than a year from now. "She had already been turned down by Aetna and Blue Cross, the very company that will now insure her," Shevlino says. "This is a really significant thing--to me, the fact that insurance companies could turn you down didn't make sense in terms of what healthcare is supposed to be for."

And Judith Silverstein, 49, a Californian who was diagnosed with multiple sclerosis in 2007. Her family helps her pay the $750 monthly cost of her existing plan--which she only had because of federal law requiring that insurers who provide employer-based insurance continue to offer coverage if the employer goes out of business, as hers did. Next year she'll get a subsidy that will get her a good "silver" level plan for $50. 

For Silverstein that coverage is indispensable. Her case is relatively mild, but MS is a progressive condition that typically has made its sufferers pariahs of the individual insurance market in the past. "I researched the options," she says. "Nobody's going to sell you insurance in the individual market if you have MS." But these customers can't be excluded or saddled with big premium markups any more. 

Advertisement
Los Angeles Times Articles
|
|
|