Why some see ACA as a ‘godsend’ despite its flaws

Print Friendly and PDF By: Andy Miller Published: Oct 14, 2013

Joy Kramer of Smyrna has run into the same dead ends with the insurance exchange website as millions of other Americans.

An inability to log on. Interminable delays. A busy site.

Joy Kramer

Joy Kramer

But the technical problems with healthcare.gov are not going to deter Kramer from enrolling, she says. And she is an unabashed supporter of the Affordable Care Act.

When she’s enrolled, Kramer, 54, will be a three-time winner under the ACA. At its core, the law was conceived to help people like her, and whatever its other issues, it has done that.

Kramer, who is a cancer survivor, was initially helped by the 2010 law when she was able to enroll in the special insurance pool covering people with pre-existing health conditions. Under the gradual implementation of the ACA, the pool program was created as a bridge until discrimination on pre-existing conditions is banned next year.

And this summer, she received a rebate when her insurer failed to spend a certain percentage of premiums on medical expenses, a “medical loss ratio’’ requirement instituted by the ACA.

Her third win will come when she joins a health plan in the insurance exchange in January that, with a subsidy, could cut her current monthly premium almost in half. “That would be a godsend,’’ she says.

The health exchange, also called a marketplace, debuted Oct. 1, and from a consumer standpoint it has been a mess. The online marketplace used in Georgia and 35 other states for residents to compare and buy insurance has been beset with technical problems. The New York Times reported Sunday that these flaws could take weeks to iron out.

“Obamacare has a lot of cynics in this country, and it needs to get off to a better start than what we see so far if it’s going to be a success,’’ Bob Laszewski, a Washington, D.C.-based health care industry consultant, told the Associated Press.

Kramer herself, though she’s enthusiastic about the exchange, has been frustrated in trying to log on.

 

Sickness and desperation

Her serious medical problems began in 2005, when she was diagnosed with lymphoma. For two years, she underwent chemotherapy and tranfusions and trips to the ER. Unable to work, she quickly used up her savings. “I drained my 401(k) just to live,’’ she recalls.

And, she faced a second battle — with her insurance company. After she paid more than a year of premiums, she says, the company denied her claims, saying there was a problem with her original application. Kramer was forced to ask an attorney friend to help her fight for her coverage in order to continue treatments.
“It was hard to deal with when you have no strength,’’ she says now. “In the end, they decided to cover me.’’

“Fighting cancer was the slowest, longest climb of my life but now I feel well again,’’ she says. “I know that I’m better, because now people feel comfortable enough to say how scared they were for me back then.”

Meanwhile, with cancer in her background, her premiums begin to soar. “Insurance companies don’t want to cover sick people.’’ she says.

Her monthly rate started at just under $400 before her illness. By 2009, the premium reached $789 a month, with a $2,000 deductible. The next year it decreased to $505, but she had to take a $5,000 deductible. She never reached that deductible level.

In 2012, she faced another premium increase, and the only path to a slightly lower rate was to raise the deductible to a whopping $10,000.

“That’s when it became ridiculous,’’ she says now. She gave up and went without insurance for several months.

Eventually Kramer qualified for the new Pre-Existing Condition Insurance Plan (PCIP). The cost was significantly less: $383 per month, with a $2,000 deductible.

The rebate came when her insurer, Golden Rule, spent only 71.8 percent of its premium dollars on medical care for its members. So, thanks to the ACA, Kramer got a check from the insurer. (The ACA requires insurers to spend 80 percent, but Georgia received a waiver to make that level 75 percent.)

Her PCIP plan will run out in December. But the new exchange will lower her premium further.

 

Waiting for specifics

Kramer has registered on the government website but has been stuck on the “Choose your Plan” page, unable to advance further in enrollment. So she’s not sure of the exact details of what she will buy.

But the Kaiser Family Foundation subsidy calculator indicates that for a silver plan, she could pay $210 per month after her subsidy. A typical deductible for that plan is $2,000.

Her choice of doctors and hospitals may be more limited than currently, as the AJC reported Sunday.

Still, she’s grateful for the Affordable Care Act, and she doesn’t have much patience with its many critics.

“I think those people have never experienced what I’ve experienced,’’ she says. “They are shutting the door on the cancer survivors and the self-employed.”

 

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