Health Reform

Betting on Reno

Editor’s Note: This is the third in a series of articles on the Athens uninsured initiative, produced by graduate students in the Health and Medical Journalism Program at the University of Georgia. Visit the previous article by clicking on the red button to the left.)

Patricia Thiessen was driving in her hometown of Reno, Nev., when she suddenly lost the sight in her right eye. It returned within moments.

Six weeks later, the same thing happened to her left eye. It was obvious something was seriously wrong.

Thiessen, who does not have health insurance, went to her local hospital and took advantage of a free screening offer she had received in the mail. She discovered she was suffering from carotid artery disease, which would ultimately increase her risk of stroke. Plaque buildup in the arteries was blocking the blood flow to her brain and causing the episodes of blindness.

The hospital referred her to a cardiologist, who informed her that she would need two surgeries to unclog the arteries. The bill would be close to $60,000.

Thiessen was working part time as a cosmetologist and caring for her disabled brother and sister. “The cost of health insurance was out of my range,” she said. “It was like a thousand dollars a month.”

The high cost was because she would have to buy an individual policy, and she had a history of skin cancer. The Affordable Care Act had not fully kicked in yet, and insurance companies could still penalize people for pre-existing medical conditions.

“Literally, I would have been paying off medical bills for the rest of my life,” said Thiessen, who at the time of her vision scare was 64, a year away from qualifying for Medicare. Waiting that extra year and gambling on her eyesight wasn’t an appealing option.

Fortunately, a billing coordinator in the specialist’s office told her to call Access to Healthcare Network (AHN), a coalition of health care providers in Nevada and the state’s only nonprofit medical discount plan.

Athens will soon become the first Georgia community – in fact the first community outside Nevada – to implement a plan like the one that helped Thiessen. The Athens Health Network will launch next year.

Fast action in urgent cases

The experiences of consumers and physicians in Reno give us some idea of what to expect.

Members of the network pay a monthly fee that gives them access to a large number of specialists, clinics and hospitals where they pay cash – at deep discounts – for the care they receive.

Thiessen called AHN on a Friday afternoon, and a staff member quickly set up the two procedures she needed to restore blood flow to her brain.

The hospital charged her $800 for each procedure, performed earlier this year. Factoring in the payments to the surgeons and anesthesiologist, Thiessen paid about $4,500 total – compared to an estimated $60,000 she would have owed without AHN.

“It would have been $44,000 just for the hospital,” she said.

Thiessen is one of nearly 600,000 Nevadans without conventional health insurance, and one of roughly 8,000 who now have access to affordable care because they have joined AHN. In Georgia, an estimated 2 million people are uninsured, and in Athens about 5,000 of them would be eligible to join a plan like AHN.

As the Affordable Care Act, the 2010 federal health care law, moves forward, many Athens-area residents will still be in need of this nonprofit medical discount network, especially if Georgia does not expand its Medicaid program under the act.

Easing hassles for caregivers

When it comes to specialized care, “we are the funnel for the rest of the northern half of Nevada,” said Trevor Rice, the member services director for AHN.

Before AHN was created, “People couldn’t get specialty care at a price they could afford, so it just didn’t get done,” Rice said.

As a result, there was a “pent-up” need for care before AHN was launched seven years ago, and lots of early members needed attention from surgeons and medical specialists. But AHN’s rate of referrals for specialty care has decreased in the years since, Rice said, probably because that backlog of unaddressed problems has been cleared.

Although AHN is a “shared responsibility” model, meaning that members, while getting reduced rates, still have to pay for care, “most of our providers would probably view us as a charity program,” Rice said.

“Therefore it’s all about the relationship,” said Rice. The organization works hard to ensure that being part of AHN is as little hassle as possible for health care providers.

In Athens, an uninsured person with carotid artery disease needing immediate surgical attention, like Thiessen, would have found it nearly impossible to get surgery at an affordable price.

Since many specialists in Clarke County don’t accept patients that are uninsured or on Medicaid, many low-income patients who receive primary care at community health centers or free clinics either go without specialty care or travel long distances to get what they need.

Ian Branam is a freelance health and science writer currently pursuing a master’s in health and medical journalism at the University of Georgia. Ian has bachelor’s degrees in history and psychology from the University of Georgia. He is particularly interested in writing about public health, epidemiology, and the environment. Follow on Twitter as @ianbran6

Betting on Reno(Editor’s Note: This is the second in a series of articles on the Athens uninsured initiative, produced by graduate students in the Health and Medical Journalism Program at the University of Georgia. Visit the previous article by clicking on the red button to the left.)

In Athens, a city where 35 percent of residents live in poverty, many people can neither afford health insurance premiums nor pay out of pocket for services.

As a result, hospital emergency rooms may be the only option that uninsured people see for themselves – even though they may have chronic diseases and not the sudden illnesses or injuries that emergency rooms are meant to handle.

Such misuse of emergency rooms is expensive for hospitals and bad for the nation’s soaring health care costs.

A local coalition of health care providers called the Athens Health Network is seeking relief by looking far beyond Georgia. It’s following the example of Reno, Nev.

Reno is very different from any Georgia city. Lying in the high desert at the foot of the Sierra Nevada, it has long been a center of gambling and tourism. Today, the city is becoming known for an innovative health program.

The Reno program, called Access to Healthcare Network, links hospitals, doctors and patients in what the founders call “shared responsibility.” Hospitals and doctors provide services at a reduced fee. Though the fee is relatively low, patients are required to pay it up front, eliminating delays and extra paperwork for caregivers.

“The hospital’s role in the shared responsibility model is that they offer our discounted rate to our members,” said Niki King of Access to Healthcare Network. “The return is that we put our members into a primary care home and get them out of the emergency room.”

For network members, in-patient hospital care at a participating hospital costs $400 a day, all-inclusive, with a $3,000 cap for each stay. According to King, the $3,000 limit protects members against medical bankruptcy.

Outpatient visits and surgical procedures are also discounted, which motivates members to get care from doctors and hospitals instead of the emergency department.

An uninsured woman who comes into an emergency room with pelvic pain may ultimately need a hysterectomy. That’s major surgery. King notes that while ERs are legally required to stabilize all patients, regardless of ability to pay, they don’t have to provide full-scale medical treatment. “They can give you pain pills and send you on your way,” she said.

With the outpatient discounts provided through Access to Healthcare, members can afford the full level of care they need.

A hysterectomy “that might have cost $20,000 to $50,000 [for an uninsured person] . . . is $2,500 to $5,000” for a program member, King said.

Seven years ago, when Access to Healthcare Network began, it contracted with two Reno hospitals willing to treat members at reduced rates: Renown Regional Medical Center and Saint Mary’s Regional Medical Center. The organization now works with seven hospitals across the state.

“Over the past six years, we’ve enrolled 20,000 members statewide, and we have a hospital ER utilization rate of .05 percent,” King said. That means one in every 200 members goes to the ER each year. By contrast, 9 percent to 12 percent of insured Nevadans seek ER care each year.

Reno’s network for the uninsured contracts with seven hospitals to provide care at discounted rates, including Renown Regional Medical Center (above)

Patients share responsibility

Partnering with Access to Healthcare Network was a weighty decision for the Nevada hospitals, according to Chris Bosse, vice president of government relations at Renown Health, a nonprofit health system that includes Renown Regional Medical Center.

“Initially when we sat down with Access to Health and looked at contracting, I think the piece we all had to remember was the rates were not going to be rates that covered costs,” Bosse said.

For this reason, Renown views the plan as a part of the hospital’s charity work, but with a twist. Bosse says network members are engaged with their own care in a way that other charity patients are not: They pay fees for every service they receive and are required to show up for appointments.

If a member misses an appointment without canceling 24 hours ahead of time, the member pays a $25 no-show fee. After two no-shows, the member is removed from the program.

“I believe strongly that it’s been a good thing in the Reno area, primarily because doctors have come to the table, hospitals have come to the table, and the patients have come to the table, and we all have to give something,” said Bosse. “[Members] now have access to primary care earlier, and I believe frequently don’t have to go to the emergency room as their primary care home,” she said.

Like Reno hospitals, Athens hospitals treat many patients who don’t have insurance or a regular health care provider. “The emergency departments in Athens are full, at Athens Regional about 75,000 visits a year and growing,” said Grant Tribble, senior vice president of operations at Athens Regional Medical Center.

A medical discount plan would provide approximately 5,000 Athenians with affordable care outside the ER, according to an Athens Health Network board member, Sister Patricia Loome.

This number is similar to the 4,700 members that Access to Healthcare serves from Nevada’s Washoe County, where Reno is located.

ACA may bring changes

Both Athens hospitals have expressed interest in the discount program, which is not an insurance plan.

It’s a way of buying discounted care through a club membership (like buying discounted products through a warehouse club). As the Affordable Care Act, the 2010 federal health care law, moves forward, many Athens-area residents will still be in need of this nonprofit medical discount network, especially if Georgia does not expand its Medicaid program under the act.

The member pool of the Nevada discount plan may change in 2014. That’s when the ACA’s insurance mandate – the requirement that most Americans have health insurance or pay a penalty – takes effect. Since the medical discount plan doesn’t count as health insurance, some patients may actually buy coverage.

The plan also will still serve individuals choosing to pay the penalty, and those who are not required to buy insurance under the ACA, such as those who would have to pay more than 8 percent of their income for an insurance plan.

Athens Health Network hopes to be able to enroll uninsured Athenians in a similar medical discount plan beginning in early 2014.

Reducing inappropriate, expensive ER visits could save Athens hospitals a lot of money. But Loome, who is also vice president for mission services at St. Mary’s Health Care System, said saving money would not be the primary motivation for the hospital to join a discount plan.

“Our first motivation is how can we care for the community,” she said. “And certainly if more people can come for care, to the right level of care, and there’s some payment, then that’s a help to the hospital.”

Julianne Wyrick is a freelance science and health writer currently completing the health and medical journalism graduate program at the University of Georgia.

Oct. 1 is a big milestone for the Affordable Care Act.

That’s when open enrollment begins for the ‘‘marketplaces,’’ the insurance exchanges where individuals and small businesses will get health coverage under the 2010 law.

Renard Murray is well aware of the upcoming calendar.

Murray is the regional administrator for the Centers for Medicare & Medicaid Services in both the Atlanta and Dallas (Texas) regions.

He will be in charge of the federally run insurance marketplace in Georgia and six other states in the Southeast. And Murray, who hails from Louisiana, will be working with the exchanges in the Dallas region, which consists of Texas, New Mexico, Louisiana, Arkansas and Oklahoma.

Georgia Health News interviewed Murray recently about the planning for the marketplaces, the public perception of the Affordable Care Act (often known as Obamacare), possible problems with its implementation, and the South’s health challenges.

Q: You’re in charge of the exchanges in two regions now?

A: With the Affordable Care Act, it’s basically region-based. So in the Atlanta region, we are running federally facilitated marketplaces in seven of eight states. The executive person in each region is basically running the marketplace for that region –– open enrollment, quality, and its operational components. I’m running the Atlanta region marketplaces.

I’m supporting the Dallas region as well, but not really leading it. It’s still a lot of work.

Texas has the largest number of uninsured among states with federal facilitated marketplaces, and Florida is second. It keeps us busy. But it’s exciting work, because when you think about the mission of getting the uninsured people insurance that they’ve never had before, it’s keeping us excited. Individuals with pre-existing conditions who were denied coverage can now get coverage. That keeps us excited.

Q: Which states in your region are running their own marketplaces?

A: The only one running its own [in the Atlanta region] is Kentucky –– they have a state-based marketplace. We stand ready and available to provide support, assistance, guidance, recommendations to Kentucky as well, even though they’re operating their own marketplace.

Q: And the Dallas region?

A: The only one in the Dallas region running its own marketplace is New Mexico.

Q: How’s the planning for the marketplaces going?

A: It’s going very well. We’re partnering with our federal partners [such as] the Department of Labor, the Department of Education. They have similar interests in getting people insured. There’s overlap.

The Department of Labor operates the COBRA benefit. Individuals are becoming unemployed, but may not afford COBRA coverage, but they qualify for the marketplace. From the federal perspective, we are working with more than a dozen of our federal partners.

We are also working with stakeholder groups –– the hospital associations, the geriatric associations, the various associations that deal with individuals who might be uninsured. We’re trying to get them to understand what the marketplace is.

We are driving people to our website, Healthcare.gov, which has posters, pamphlets, YouTube videos, self-help things –– things that can educate your constituencies in terms of what the marketplace means. We’re developing it in Spanish as well. We want to reach all populations.

Q: Are you working with health insurance companies as well?

A: This is work we recognize we have to do. We haven’t really started engaging insurance companies directly at the regional level. I’m not saying it hasn’t happened nationally at the headquarters level. Here, we have had several conference calls and trainings already, and I’m sure insurance company members have participated.

We’re trying to get people more interested in becoming [insurance] navigators to ask questions and be informed on what the navigators will be doing. We’re giving stakeholders information on what to expect with education, what the marketplace means. We want to make sure that we’re getting it right. We’re asking stakeholders to give us ideas and information that will help us build this correctly.

Q: Will the information technology to launch the marketplaces in October, or definitely by January, be ready?

A: I would say yes. There’s been a lot of work that has been going on with states. There’s been testing in building that [IT] hub. In addition to that, we’re also developing a network of call centers that can help individuals, so a person can call, speak to a counselor who can help them.

I’m pretty confident that our IT infrastructure is going to be pretty solid so that we’ll be able to facilitate marketplace enrollments beginning October 1.

Q: There’s a lot of confusion among consumers about how this marketplace is going to work –– questions such as: Am I eligible for credits? How is this going to help me? Am I going to lose my insurance?

A: Let me use an analogy for you. Fifteen to 20 years ago, we’d go to a travel agent to take a trip. The travel agent would come up with options, you’d pick a flight, you’d go there, you’d have a good time.

The marketplace will be very similar to the transition of moving from travel agents to Travelocity or the other sites [that offer travel assistance via the Internet]. Individuals who would normally go to insurance companies to shop for insurance will go now into a marketplace.

At a one-stop location, they can decide which health plan is the best option for them. Their children can be eligible for CHIP through the marketplace, or Medicaid. Individuals with incomes less than 400 percent of the federal poverty level will also quality for a tax credit.

It sounds like it’s overwhelming, but nonetheless, it puts at the fingertips of consumers the ability to choose a plan that works the best for them. Just like it did for Medicare Part D. There are gold, silver, bronze, platinum plans –– they can choose which coverage is best for them in the marketplace.

It sounds it may be a little bit overwhelming, but they’ll have more ability to manage my own choice health care, instead of going to an agent.

Q: You mentioned Medicare Part D, the prescription drug benefit that debuted in 2006. There were hiccups when that started. Do you anticipate similar glitches?

A: Yes, there were a few hiccups along the way in Part D, but the good thing is we learned a lot of lessons.

We’re applying those lessons to the marketplace . . . We’re looking at our processes now so when people apply October 1, we have procedures and processes already developed [to help them] based on lessons we learned from Part D.

Q: Many of the states in your regions are not expanding Medicaid programs. How much of a problem will that be?

A: Let’s look at it historically. When the law was signed in the ’60s [establishing] Medicaid, several states said, ‘We’re not going to do Medicaid.’ Maybe less than a handful of states said they weren’t going to do it. Here we are [nearly] 50 years later, and we have Medicaid programs in every state. I can’t predict what states will do, [but] Medicaid expansion may follow the same path.

Q: So you believe states will eventually expand their programs?

A; It depends on the Legislature of a state and what they decide to do. I think states will start to re-examine their options, realize the availability of federal funds, and then decide what’s best for the state, based on whatever the governor and Legislature decides to do.

Q: Many critics of the ACA say it’s too costly for states to expand Medicaid.

A: I can’t speculate what a governor is looking at in terms of cost, because what he or she may be using for analysis may be based on some other types of decision points. On the point of reimbursement for Medicaid expansion, all I can tell you is that in the first three years, we’re looking at 100 percent federal reimbursement. The plan has been laid out in terms of Medicaid reimbursement rates for expansion over the next 10 years.

Governors are making a decision based on what he or she anticipates is going to be the growth of cost of the Medicaid program over that time.

Q: Opponents also question whether the federal government can deliver what it’s promising, given the current budget crunch.

A: I’ll use another analogy. You buy a car, you expect it to last five years with a five-year warranty. You have a major breakdown in the fourth year. The warranty is still there; it hasn’t expired. The regulation [says Medicare expansion] will be 90 percent [federally funded] 10 years down the road, and it will be 90 percent.

Q: You’ve heard a lot of criticism of Obamacare. What are the biggest misconceptions about it?

A: The biggest misconception is people basing their comments and decisions on what they’re hearing from a neighbor or someone else who hasn’t read the regulations and doesn’t know what’s going on. I try to debunk the myths and direct people to Healthcare.gov, the official site.

Don’t base what you’re hearing from a media outlet. Base it on what you’re hearing from the federal government. If you have questions, you can contact the Department of Health and Human Services, the Centers for Medicare and Medicaid Services, or if you have a tax question, contact the IRS. . . . We have a team here at CMS that can address those questions.

Healthcare.gov gives information on not just how the marketplace will work but how the Affordable Care Act itself works, how it affects women, affects seniors, affects Asian-Americans . . .

We also have a mobile app, so that individuals can access [the marketplace] from their smartphones, and people can sign up for information. When the marketplace website is launched, you can access it . . . and start the enrollment process.

Q: The states in your region have physician shortages. There are fears that the ACA will aggravate these shortages.

A: I’m not that concerned about that. I hear the comments and the rhetoric about not having access.

Some of the things we’ve done [include] HRSA, with the Medical Service Corps, looking to expand the availability of primary care positions in medically underserved areas.

In Medicaid, we’re reimbursing primary care physicians at the Medicare rate, enhancing more primary care for Medicaid recipients because we tend to have a gap there.

We’re getting more advanced practice nurses out there.

We’ll see a lot of people hopefully accessing primary care, instead of [going] to the ER . . . We’re developing medical homes that will provide primary care and coordinate care. Medicare is developing accountable care organizations. There’s telemedicine.

I think we’re going to have adequate access to services over the next several years.

Q: The South has many health needs and health disparities, along with high poverty and uninsured rates. How important is the ACA in addressing these problems?

A: It’s extremely important. States in the Southeast are among the highest in uninsured rates.

We’re working on other models. There’s a pilot project taking place in Alabama to focus on heart [care]. A lot of people in Alabama have congestive heart failure. African-Americans as well as [Hispanics], we’re targeting those ethnic groups [so they] get more informed about some things that can help prevent heart attacks and strokes.

Q: Do you hope the ACA will help solve these health problems?

A: It’s not going to be solved, but we’re going to make a tremendous dent in it. A lot of the things we’re focusing on, telling African-Americans, Asian-Americans, this is how the ACA can help you to deal with some of the health issues you’re having.

Each state has an office of minority health. There are connections with those state offices. We’re working with them to deal with some of the health disparities.

Q: Anything else you want to emphasize?

A: Even though the marketplace is upon us, we’re still going to administer the Medicare program, the CHIP program, the Medicaid program. We know the natural connections between those programs.

If you walk around the halls at CMS, you’re probably going to see some pretty exhausted people –– they’re doing both things at once. Nevertheless, we’re excited about the work coming from the Affordable Care Act.

The U.S. Supreme Court had a major effect on Georgia health care in 2012. Photo by Chris Phan

Here is the GHN list of the Top 10 stories in Georgia health care in 2012.

Disagree with our choices? Let us know with a comment or email.

10. Grover Norquist’s letter to lawmakers on the Georgia provider fee.

The national anti-tax leader stirred up the debate on the hospital fee before the 2013 General Assembly session.

 9.  Consolidation continues among hospital systems and insurers.

Examples of the cost-cutting combinations were WellPoint buying Amerigroup, Mayo Clinic taking over a Waycross hospital, and Emory partnering with Southern Regional.

 8. Gov. Nathan Deal announces a public-private partnership to fight obesity.

Georgia’s rate of child obesity is the second-highest in the nation.

7. The U.S. Supreme Court hears arguments against Phoebe Putney’s merger with Palmyra.

The FTC challenges the Albany deal, saying it will lead to a monopoly and higher prices.

6. Baxter International announces it will build a manufacturing facility in Georgia.

The biopharmaceutical plant will bring 1,500 jobs to Stanton Springs.

5. A young Snellville woman survives a battle with a rare flesh-eating bacteria.

Doctors gave a grim prognosis for Aimee Copeland, 24, who lost parts of limbs, but her courage made her a national inspiration.

4. Piedmont Healthcare and WellStar Health System form an alliance.

The metro Atlanta hospital superpowers announce they will create a health insurance plan.

3. Two famous Georgia centenarians die.

Besse Cooper, 116, was listed as the world’s oldest person; Leila Denmark, 114, was a renowned  pediatrician and author.

2. Gov. Nathan Deal’s makes his choices under the Affordable Care Act.

The governor declines to build a state insurance exchange, and rejects expanding Medicaid as it’s currently outlined.

1. The U.S. Supreme Court upholds the Affordable Care Act, which Georgia and several other states had fought.

In a surprising ruling, the justices say the 2010 health reform law’s individual mandate is constitutional, but they put the choice on Medicaid expansion back in the hands of the states. (With President Barack Obama’s re-election, the law is safe from repeal and will go forward.)

Liz Johnson says she and her partner owe a substantial amount from unpaid medical bills.

Liz Johnson and Robert Irby have diabetes and other medical conditions, so having insurance has been crucial to them.

The Nicholson couple, who are self-employed, had individual policies with high deductibles through Blue Cross and Blue Shield of Georgia.

Early this year, their monthly premiums jumped by about $100, reaching $628 for him and $677 for her.

The couple had automatic payment online through their bank. But they did not immediately adjust the amount paid to reflect the new premiums.

When they realized their mistake, they say, they sent in the extra money. But Blue Cross and Blue Shield of Georgia, their health insurer, sent the money back and canceled them.

The insurer, replying to a query about the situation from GHN, said in a statement that if a member’s premiums are paid through an online bill pay program via a bank, a member must alert the bank of any changes in amount.

Blue Cross does consider requests for reinstatement, but denied the couple’s request, Irby says.

Such individual health insurance policies have long been problematic for many people, especially those with health conditions.

Reason for cutoff disputed

A 2009 AJC investigation found that individual health policies drew a disproportionately high number of complaints to the Georgia insurance commissioner’s office. Not only are premiums for these policies high, and subject to big increases, the coverages can be relatively limited, the AJC found.

Johnson said she believes that the two were cut off because of their past health issues, a suggestion that Blue Cross and Blue Shield firmly denies. “We do not terminate policies based on claims history,’’ the company said in a statement.

The state’s insurance commissioner’s office says policy cancellations are not common complaints in Georgia now, and that only a handful were received from January 2011, when the current commissioner took office, through May of this year.

The problem of pre-existing conditions, though, has remained an enormous barrier for people getting affordable coverage. It has adversely affected millions of Americans, keeping them from changing jobs due to fear of losing insurance, and leading to insurers routinely rejecting applicants for individual coverage, or setting sky-high premiums.

Johnson’s and Irby’s cutoffs came in February, three months before the Supreme Court upheld the Affordable Care Act (ACA), the federal health law sometimes called Obamacare. Since the ruling late last month, Republicans have mounted a renewed effort to repeal the ACA through congressional action.

Georgia tea party activist Debbie Dooley, a staunch opponent of the two-year-old law, told the AJC recently that regarding “pre-existing conditions — we are deeply concerned about that — but Obamacare is not the solution to that because it will drive up insurance costs.”

Advocates of the ACA, however, note that it is designed to help people with certain health conditions, such as Johnson and Irby, in important ways.

Under the law, Johnson and Irby will be eligible for the state Pre-Existing Condition Insurance Plan, created for ‘’high risk’’ individuals like themselves. More than 1,000 Georgians with health conditions belong to this new health plan. The couple must be uninsured for six months before joining PCIP.

Johnson says she has looked into the PCIP and says, “It might be cheaper than what we had.’’

In addition, beginning in 2014, health plans will be barred from denying coverage to people with pre-existing conditions, and also won’t be able to charge them discriminatory premiums. And people with health problems and individual policies will be able to access private coverage through an insurance exchange, which should lower premiums for many consumers buying on their own.

Anxiety about being uninsured

In the meantime, though, Johnson and Irby are worried about the costs of their care.

Johnson, 56, a real estate paralegal, had a blood test done in February. Insurance has usually covered a good portion of her tests, she says, but this time “they covered nothing.’’ She was canceled briefly in 2010, also because of a payment problem, but was reinstated after three months.

This time, Irby, who tends to their small horse farm, called Blue Cross and asked to be reinstated, noting that they sent in the extra money, but he says the company told him no.

He takes Lantus, a form of insulin, twice a day, going through a $100 bottle each week. He also has high blood pressure and a serious leg problem. At 64, he’s a year away from qualifying for Medicare, the programs for seniors and the disabled.

Under the current insurance rules, the two are essentially uninsurable, except for the possibility of the Pre-Existing Condition Insurance Plan.

Johnson has been hoping that nothing goes wrong healthwise while they’re uninsured.

Like many Georgians, Johnson has serious reservations about the ACA. She cites, as one example,  how the complex legislation was passed in Congress.  “I think it went through too fast,’’ she says. But she’s willing to look again at the law and the coverage it offers to people like her.

“Money is tight,’’ she says, adding that she and Irby still owe medical bills.

“We owe everybody money,’’ she says.