Let’s face it: Getting health care coverage in America has sucked at least since the last GP who charged five bucks for a house call hung up his little black doctor’s bag. As an employee at Creative Loafing, I’ve purchased my health insurance through the company’s group plan for the last nine years (most of them pre-Obamacare), and every year the coverage got more expensive — either for the employees directly, or for the company as a whole — and the benefits themselves, though still good, were often “adjusted” to offset costs.
The Affordable Care Act (ACA) was proposed and passed as a way to slow endlessly climbing costs while taking the more than 50 million people without coverage off the ER’s curb and bringing them into the nation’s health care system. The ACA leaves the core mechanism of the system untouched, in that people looking to get covered still buy that coverage from a private insurance company. But the company must offer policies that meet certain minimum levels of coverage. For example, annual wellness exams and birth control must be included, along with many other things that used to cost extra or be excluded entirely.
For the average American, the major change is that they are now required to have health insurance or face fines collected by the IRS, an agency no one wants to deal with ever. To help pay for this, the ACA grants government subsidies — called “advanced premium tax credits” in GovSpeak — to households that earn between 138 and 400 percent of the poverty line (currently about $32,000 to $94,000 for a family of four) per year. Simply register at healthcare.gov and start shopping for coverage. Or so they said …
If you’ve paid any attention to the news in the last eight weeks, you’ve no doubt caught wind of the fact that the launch of healthcare.gov has gone down with Hindenburg-like efficiency. I was one of the “early adopters” trying to navigate the site from day one for my wife, a freelance journalist and photographer currently purchasing a quasi-shitty policy (i.e., no maternity coverage) from Blue Cross. We were hoping to do better in the exchange, even though my wife does not qualify for subsidies because she’s married to someone (me) who can, in theory, add her to his work insurance policy. In practice, the CL family plan (covering my wife and 2-year-old son) is much too expensive at over $900 a month to be a viable option.
For a week, I could only get one step into the enrollment process before the system crashed — that’s trying every hour or two, all day, every day. In week two, I was able to fill in a registration form (woohoo!), only to have the system kick me to a blank page with a URL that ended in “/SUCCESS.” It sure didn’t feel like it, especially when this went on for several more weeks without progress.
At the end of October, my wife and I visited with a “health care navigator” working out of an office at the University of South Florida in Tampa. The navigator program is controversial for some reason, with Gov. Rick Scott citing privacy concerns while working last year to undermine it by banning navigators from operating at local health departments. My experience was largely a positive one, though there was one technical hiccup: healthcare.gov was completely down for maintenance for the duration of our visit. That prevented us from doing any signing up, and we were (wisely, as it turns out) advised against filling out an old-fashion paper application.
On the plus side, the navigator did point us to Florida Kid Care, the Sunshine State’s branch of the federal government’s Child’s Health Insurance Program. Coverage for my son is a major linchpin in our decision, and Kid Care provides quality coverage that can cost anywhere from $15-$200 depending on whether you qualify for subsidies. The navigator seemed to think we would qualify, and encouraged us to apply, a process we completed about three weeks ago.
We’re now waiting for a response from Kid Care (I expect it early in the new year) before making a final decision. For the moment, my wife and son remain on their current policy, which Blue Cross says will continue until July. As such, I was not rushing to make the Jan. 1 Obamacare deadline. The final enrollment deadline for 2014 is March 31, but the way the administration kept pushing back December enrollment deadlines, I won’t be surprised if March 31 becomes some day in April.
The good news is that healthcare.gov now works, albeit with some bugs. By mid-December, I was able to navigate the entire site with my brother (he needed to find a new plan to kick in Jan. 1), from creating a login to applying for the subsidy (status: denied) and then comparing plans. In the end, he was presented with 115 insurance plans, of which we compared 30 to 40 before settling on one that provided full health, dental and vision coverage for about $340 a month, more than $100 less than it would cost to stay on his wife’s employer-based plan. Little glitches still popped up — for example, we couldn’t get the system to accept a credit card, a bug I suspect was related to our choice of browser — but it worked.
Is the system complicated? Yes. Do you need some kind of college-level course to understand the vagaries of all the different plans? Probably. But the level of coverage for the price looks reasonable, especially if you qualify for the subsidy.
There are still big problems, the largest being the estimated 800,000 people who make too much to qualify for Medicaid but too little to qualify for ACA subsidies — victims of the Republican-led Florida Legislature voting not to expand the state’s Medicaid program as part of Obamacare. The federal government would have largely picked up the tab for the first three years, and paid 90 percent thereafter. Florida said no, and as a result these people are in health care limbo.
Forget the website — how do we get that fixed?
This article appears in Jan 1-8, 2014.