Since President Barack Obama signed the Affordable Care Act (ACA) into law on March 23, 2010, 20 million people have signed up for health insurance coverage through the federal or state marketplaces.
Still, experiences with the ACA and the healthcare coverage it provides vary greatly.
Income, location, and overall health can influence how well the ACA works for many people.
We asked three Americans who purchased health insurance through the Obamacare system to tell us about their coverage and their experiences.
Name/Age/Location: Noel Green, 28, Gary, Ind.
Occupation: Health Benefits Navigator
Annual Income: $28,000
1. What level (bronze, silver, gold) of ACA coverage do you have, and how much do you pay per month? Is it just for you or your family? Did you qualify for a subsidy? My present coverage is silver. The amount that I pay monthly is $89. It’s just me. I do qualify for a subsidy. My actual monthly payment is $200-something, but then the ACA subsidy comes in and covers a large portion of that, so I only pay $89.
2. Did you have health insurance prior to the ACA? If yes, what type of coverage and what did you pay? Did it cover your needs? I’ve had insurance through employers before. My present employer does not offer health insurance, so I wasn’t able to get it. All of my previous employers before coming into the field of public health, I was covered under my own plan.
3. Politics aside, what is your opinion of the ACA coverage that you actually use? Does it meet your specific needs? It does meet my needs. Some of the issues that I’ve had, understanding the nature of the issue that I deal with [he is HIV-positive], makes it very much so necessary for me to have insurance. If I do not have a job, [the ACA] makes it easier to find coverage, but if I am employed, it’s very difficult to have coverage that enables me to meet all of my healthcare needs.
Just in my previous jobs, I needed the help of copay cards, and then my physician kind of supported me with extra medication in order to just remain healthy and adherent. With the ACA, I see that as being something that is a continuation of a problem. I’m still doing the same thing. There’s no special circumstance, understanding that once they do have some sort of understanding from my provider about the nature of the illness that I deal with, that there’s no extra support, if you will.
There are different state-provided programs that pay the monthly premium, but that is only offered in certain states. Like in the state of Illinois, they pay the premium monthly if you do have ACA coverage, but I’m a resident of Indiana. It’s a completely different system, and they do not cover your ACA premiums.
On top of that, my out-of-pocket cost for my first medication was $867. If I did not have a copay card from the drug manufacturer, I would not have been able to get my meds. Because my doctor was able to assist me with that, I was able to get my medication. So there is a hole, if you will, in support for people who are one: employed, and two: HIV-positive and trying to navigate the terrain of trying to be healthy. The ACA doesn’t really offer any type of coverage for that hole.
Our medications are considered to be specialty. There is no extra support in the gold plan that would not have us pay a huge out-of-pocket cost for those medications. It’s all based on income, but the gold plans would make it so that my meds would be $3, and my out-of-pocket maximum would be very low. The total monthly cost would be upward of $300 or $400, and my monthly cost would be $150 each month, which would not be sustainable for me. I have to move things around and get things together and work in connection with my provider and the drug manufacturer and case management in order to just maintain good health. I want to survive, so I do it, but it’s a hassle.
4. Are you aware of the consumer protections that came with the health law such as covering preexisting conditions, preventative care costs, birth control, etc.? Yes, I’m aware of the preventative care. A lot of the going to get checkups and blood tests, their definition of “preventative” on my end, for a person dealing with my issue, that does nothing for me. The wellness check, checking my blood pressure and things like that, that’s wonderful. They pay for that.
But the necessary component of preventative care that is a part of my situation are lab tests, which constitutes CD4 count, T cells, checking out how my liver is functioning, how my kidneys are doing because of the nature of the toxins I’m putting inside my body. Those things are not covered at 100 percent. They’re considered to just be regular support, so again, that’s that hole.
My preventive procedures are not considered preventive. The wellness check, that’s wonderful, and I do appreciate that. That’s something I do need to take care of as well, but the necessary components of the major issue that I face, those things aren’t covered at 100 percent, and I still end up having to pay a component of those exams in order to just be healthy and just know that I’m healthy.
5. Should the law be completely overturned or should the government find way to improve it? I do not think the law should be overturned. I’m completely against that. The quality of life that I see for the regular, everyday American is enhanced by the system of the Affordable Care Act. I believe that there may be some issues that need to be modified in order to be sustainable long term. But do away with it? No.
If they did do away with it, I would be a person that would be without coverage. Because of the Affordable Care Act, somebody who has a preexisting condition going out to seek coverage can get it. I would basically be turned down everywhere I went because I do have a preexisting condition. Then on top of that, in reference to just having a better quality of life because I have health insurance, that wouldn’t be attainable if they took [the ACA] away. I’m all for whatever is broken, we fix it, but I’m not for throwing it away.
6. Are you better or worse off than you were before the ACA became law? I’m definitely better off because of the ACA. I feel like in my present situation if it was not for the ACA, my quality of life would be, it wouldn’t be at the level with which I’m happy. Just knowing what’s going on inside of my body and being able to go to my doctor and get the tests run that need to be run in order for me to understand that my medication is effective is important.
Plus, as a result of the medication, there are some things that I have to deal with. My liver function could be diminished, but that’s like a thin line my doctors need to study over time so I don’t have another problem later on. I have to make sure that not just now, but in 10 years from now, my quality of life is good. That’s what [the ACA] allows me to do — to have a good quality of life today but also in the future.
7. Should the U.S. government be responsible for providing healthcare to its citizens? Is healthcare insurance a basic human right? I do feel that because of the nature of the government itself, it’s meant to meet the needs and regulatory expectations of the populace. With that being said, I am not a minority in my need for coverage of issues that in previous years would have left me unhealthy with basically very bad quality of life. With that being said, I firmly believe that the government is responsible for providing a level of care or assuring that there is health coverage available to meet the needs of all citizens in this country, and that they, in this capacity that they are providing it, that it is an exact response to meet the need in an effective way for many people.
I do say that the government should be responsible for that. If we were a country that we were able to have the cost of healthcare at a level which was sustainable for the average, everyday American that’s working a minimum wage job to pay for their own insurance and still have a great quality of life without the help of the government, then I would say “No.”
But the cost of maintaining a good quality of life and being healthy is high, so the government needs to intervene in that process to make sure that our basic right of being healthy, of maintaining a good quality of life, is protected.
8. Other thoughts on the ACA? I feel like there needs to be some extra. All the plans are not HIV-friendly. That is a problem in itself. Even if it’s a lesser quality, there should be some type of universal expectation in reference to this particular issue for people who are trying to maintain independence in their lives and maintain a quality of life that they can support themselves on.
There should be some universality on the coverage of medication. There should not be this fractured understanding between insurance plans where if you’re on this insurance plan and you have a high out-of-pocket cost, but you’re left high and dry. But if you’re paying more for coverage, your medications are paid at a higher rate. There needs to be a universal concept on the HIV medication because that in itself makes it that much more difficult as a person going in and saying I need health coverage and having to comb through all the plans. I have to decide do I want the medicine covered at 100 percent and just be broke most of the time, or do I want something that gives me good coverage all around but doesn’t cover all of my meds 100 percent and then navigate through the system to find additional resources that are out there.
Name/Age/Location: Leanne Bryson, 63, Sacramento, Calif.
Annual Income: Fixed income from savings
1. What level (bronze, silver, gold) of ACA coverage do you have and how much do you pay per month? Is it just for you or your family? Did you qualify for a subsidy? We have gold. We would have to be paying $2,681, but we get a subsidy. Our subsidy is $1,417, so our out-of-pocket is roughly $1,264 per month for the two of us. So we can keep our subsidy, we pull from our retirement at less than $62,000 per year.
2. Did you have health insurance prior to the ACA? If yes, what type of coverage, and what did you pay? Did it cover your needs? We did, through my husband’s employer. It was excellent coverage. We had UnitedHealthcare, and it was top of the line. We chose to go with the best you could have. His was free, totally free. His company paid for his, and I want to say mine was $90 per month. It was fairly inexpensive. We used COBRA for the 18 months, and our COBRA payment for UnitedHealthcare was $1,830 per month.
3. Politics aside, what is your opinion of the ACA coverage that you actually use? Does it meet your specific needs? It has so far. We have gold, so we have the best that you can get in our market. When we came off COBRA and I called eHealth.com to get our coverage, I explained to the representative what we needed, what our health is — my husband and I are in relatively good health. We take a couple of prescriptions and see our doctor twice a year so we have pretty normal needs, but I also knew I needed to have surgery at the beginning of the year.
[The eHealth.com representative] directed us toward the gold plan, and I’m pretty pleased thus far. I’ve been on this since the first of the year. I’ve had surgery already. I had my gall bladder removed, and I had a small umbilical hernia. As the final bills are coming in, we’re going to pay out-of-pocket a little less than $500. That includes the anesthesiologist, the outpatient, the surgeon, and follow-up care.
4. Are you aware of the consumer protections that came with health law such as covering preexisting conditions, preventative care costs, birth control, etc.? So obviously preexisting condition was important to me because I had this condition going before the first of the year. I knew going into this that I had to be covered well because I had to get this taken care of. I would prefer not to live with the pain. I knew this was coming up, so I was thankful for the preexisting condition coverage.
5. Should the law be completely overturned or should the government find a way to improve it? I think there’s huge room for improvement. I would prefer for myself a cafeteria plan where I can go in and choose the important things for my husband and me. With our previous healthcare plan through my husband’s company, we could do that.
We also had a healthcare savings plan. I don’t know that I want the government being my savings account, but I would like maybe something possibly along those lines as a private savings account for bigger things that happen along the way because you never know.
I would prefer not to pay for women’s reproductive benefits because it doesn’t affect me. I had a hysterectomy 20 years ago. It’s not something I need.
I don’t like to pay for pediatric dental or pediatric healthcare. I don’t have kids. My kid is 39 years old, and she has her own healthcare.
There are parts of it that I don’t appreciate having to pay for. And if I were able to change it to something that’s truly more affordable, in our case, we can only pull $62,000 a year, which sounds like a lot of money. However, after taxes, that’s only $48,000 a year that we live on. Now $1,200 a month comes off the top of that for our healthcare, so when all is said and done, we have about $32,000 we live on a year in the state of California.
The frustrating part of the whole thing is we saved all of our adult lives for our retirement. When our raises came through, we put half of it into our 401k. We’ve always made sure we had our 401ks and our IRAs. There were years that we forewent vacation so we could save for retirement. So when we retired we really thought that we would have much more freedom in our own money that we could spend, but we can’t. If we go over, we’re going to get hammered with that higher rate.
6. Are you better or worse off than you were before the ACA became law? I think that we’re better off as far as the insurance is concerned, but being restricted on what we can pull from the retirement is going to make life different for us. We have to budget our money much differently now. We don’t have the disposable income that we had. We have to budget gift giving to our grandkids. We have to budget if we go out to eat. If we do any extra spending, we have to take that into consideration. Part of the reason we retired early was so that we could travel while we’re still healthy.
7. Should the U.S. government be responsible for providing healthcare to its citizens? Is healthcare insurance a basic human right? That’s kind of a loaded question. There’s a role the government should play. It should be available to people who need it. It’s not something that should be done for free.
I have a bigger problem with “everything should be given.” I think that everything is eventually paid for. Either I’m paying for it with my taxes, or I’m paying for it out-of-pocket. I don’t necessarily agree that the government should be in the business of insuring. That’s not their job. That’s not the job that I see government having.
8. Other thoughts on the ACA? I think that going through eHealth.com made it easier for us. I called early enough in the middle or beginning of December and explained to the representative what I needed, what was important to us, that I would have to gallbladder surgery after the first of the year. I said I’ll give you a week, so you come up with your best efforts and email me the plans so I can take a look for myself.
Within a couple of hours, I had two plans sitting in my inbox. He called me back a week later, we discussed it a little further, and this turned out to be the best plan for us. eHealth got us our dental [coverage] as well.
Rather than going on the open market and trying to dive through all that stuff by yourself, you’re much better off going through whoever is available. eHealth was available to us; it was recommended to us by our financial advisor. I felt like I had a very good advocate with eHealth.
If I could change anything about the Affordable Care Act, I feel like it needs to be post tax because I feel like I’m being taxed doubly for this. If it could be after taxes, it makes more sense to me. I’m getting taxed when I pull this money. I’m being taxed again when I use this benefit in essence. So it should be post-tax. It makes more sense to me, especially with how bad we’re getting hammered with this. The next year and a half to two years is going to be interesting for us. It’s not the retirement we envisioned, that’s for sure.
Name/Age/Location: Jeff Wilson, 49, Athens, Ohio
Occupation: Television Host, Author, and Video Producer
Annual Income: $60,000-$70,000
1. What level (bronze, silver, gold) of ACA coverage do you have and how much do you pay per month? Is it just for you or your family? Did you qualify for a subsidy? We have bronze level. The bronze level is an HSA, a health savings account. Our deductible is $12,800 for the family. That’s total out-of-pocket, excepting premiums each year. We pay, for the four of us — I have a wife and two teenage daughters — $304 per month. We do get a subsidy because our income is where it is. I don’t know exactly what the subsidy is this year, but it typically runs between $600 and $700 per month.
2. Did you have health insurance prior to the ACA? If yes, what type of coverage, and what did you pay? Did it cover your needs? It didn’t cover our needs, but we hoped that we would be covered so we wouldn’t be ruined.
As a young actor in my 20s, I did enough work through the union — you only needed to make like $7,500 per year and then they would pay for health insurance for you and your family. I had a couple of years in my late 20s and early 30s when I got a few commercials and did well for a few years. Nicely enough, of those three years, two of those years are years in which I had children. I had full coverage with minimal deductibles the years that we had both of our children.
Unfortunately, other years, when I didn’t qualify and I wasn’t making that much money, we just didn’t have coverage. Of course we thought, our health insurance is the fact that we are very healthy people — we work out, we eat organic food — except that the year between having our first daughter and our second daughter, my wife, who is very athletic, broke her wrist in a softball game. We had both of our cars die in the same week. Basically, within 10 days, we ran up almost $12,000 in bills for a person who, in my freelance career, made about $25,000 a year. We lived too close to the edge at that point. We were very frugal people, but that was a wake-up call. I basically went out and got a job painting full time for a friend until I could pay off our $12,000 worth of debt on top of my other job.
I realized I had to do something. I went to an agent. They said, “Hey, you don’t need healthcare. Don’t prepay for healthcare.” That’s what most people do. If they don’t go to their doctor, they’re paying for care they never use. They said, “What you need is to not lose your home. You can deal with $12,000, but say it was $50,000? What would have happened?” Well, I would have lost my house. He convinced me that the high deductible with a health saving plan was a way that I could use our health as part of our equity and build an account that could eventually pay that deductible at $12,800. I was pretty young, probably early 30s when I signed up for that. We could only put a little bit of money away. It was probably four or five years before I could put away that first $13,000 for the deductible. I kind of focused on that because I wanted to make sure that we were safe for, I wanted a three-year pad. At this rate, if someone broke an arm or a leg in my house, I would pay for it out-of-pocket. I could deal with that financial hit, no problem. I would take on extra work or whatever. But, if one of us got cancer or needed a liver transplant, it could sink us.
Back then, in my early 20s, I was only paying $220 or $240 per month. It hasn’t gone up that much. Right before ACA, I was paying in the $300 range. On that front, the ACA didn’t change much. Except that the coverage got much, much better. Before the ACA, my insurance had $1 million lifetime maximums per person. I bought this to have insurance so I wouldn’t lose my house or my cars or my business. But if I needed a liver transplant, a million dollars will not cover it. Once you have a transplant, you’re talking well over a million dollars, and we would still lose everything.
I had been paying for insurance that only kind of covered me. Plus, we had no preventive care, so we were not going for well visits until we really had to or felt like we should. We would take the kids in or we would rely on friends who were doctors to do their sports physicals and things like that, but we never went in for preventative healthcare. Things like mammograms and gynecological visits are expensive. My wife’s 53, I’m 50, and we’re in colonoscopy age. We’re talking a couple grand to have that done.
What Obamacare did for us was say you can still have the insurance that you were getting, but now we’re going to insist that the insurance companies make that care worthwhile because before, quite honestly, it wasn’t. It would have cost my health insurance far more, if I had gotten sick, rather than just pay to have me looked at every year for preventive care. Our care just got a lot better.
Now that I’m 50, I use the HSA deposit as a way of mitigating my adjusted gross income. I can put the full $6,750 amount into that account, and it’s taking off my income before I report my adjusted gross income. It goes in tax-free. It comes out tax-free assuming you use it for healthcare, and it grows tax-free. It’s a good investment. For someone like me — I am not wealthy, I’m solidly middle class if you look at the numbers — that health savings account is a really good, inexpensive way to keep your money from going to the insurance companies.
I was worried that the HSA was going to go away. They talked about that one point with Obamacare. That would have upset me because I would have paid a lot more. I would have had to buy in at a higher level. Or I would have to buy a bronze plan, but there would be no way for saving for it. I would have to save individually for it. It wouldn’t be tax-free. I could still do that, but I would have to pay taxes on that money, so there’s less encouragement to do that. That works for me. That would not work for someone who has a chronic illness or traumatic illness. Nobody can take a $12,000 to $13,000 deductible.
But for most of us, what that deductible does, it makes us a better healthcare consumer. Instead of just going whenever we want — they get their insurance through their work, they don’t think about it, they just go, and they consume a lot of services that they don’t need. We have to do things like ask how much things cost. I need to know the price ahead of time. Even though it’s something that’s supposed to be covered, in case there might be some small print and it’s not, I need to know so I can be prepared to pay.
3. Politics aside, what is your opinion of the ACA coverage that you actually use? Does it meet your specific needs? The coverage that we use — we’ve been in for our well visits, my wife for a colonoscopy recently, and I’ll be going in soon — it’s all been great. We are able to choose doctors that we like. We actually go to a sports medicine facility because we’re fit people, and we kind of find that people where we live in southeastern Ohio, people are generally not fit, so the advice that we hear from doctors, it doesn’t fit our body types. They’re not used to treating people like us. We go to the sports doctors because I run 20 miles a week and hike about 20 miles per week, and my wife is similarly active, so our aches and pains are different than other people. We go up to Columbus, which is about a one-hour drive, to a sports medicine facility to do our preventive care once a year. We have great doctors that we like.
I’m a center-left progressive, and I did vote for Obama. I canvassed for Obama. I did vote and canvas for Hillary Clinton. But I’m happy to be critical of Obamacare because there are things wrong with it. There’s no doubt that the ACA was not a finished product, and I don’t think even Obama said that. My first experience was getting through that website. Getting signed up, there were so many errors. I had to go back so many times and talk to so many people on the phone that it took literally eight or nine months to sort the problems out. And this was after the website was up and quote-working-unquote.
But that was the end of it. At this point, it’s really easy. The site works really great. We’re in Ohio, so we go through the marketplace. I go in, I check out the plans, change up the information during the enrollment period. It’s really easy.
In terms of the other problems with it, are there people who pay more? It’s possible. I think most of the people who pay more don’t realize their coverage was really bad before. The objection that people don’t want an individual mandate — there are extremely inexpensive plans for individuals. I can’t imagine anyone will pay more than $100 per month for a bronze HSA for an individual person. For someone to complain that that’s a burden, you’d have to be really poor, and in that case, you’d be on Medicaid. We insist that everyone has car insurance, and everyone seems OK with that, but when we insist that everyone has health insurance, everyone gets up in arms.
4. Are you aware of the consumer protections that came with health law such as covering preexisting conditions, preventative care costs, birth control, etc.? I am aware because, for example, I wasn’t sure how things, like the colonoscopy, were covered. Until recently, I was not aware of the fact that women’s coverage, because there are three women in my family, is pretty good. You get a preventative checkup with your regular doctor, but then you get a gynecological visit. Pap smears are covered, and mammograms at certain times are covered, so I’m aware of those things.
But we really consume so little healthcare at this point. We choose not to go to the doctor when we’re sick typically unless it’s bad, and it’s rarely bad. I know that I’m going to pay when I go because I have such a big deductible. The last time we were at a doctor because one of us was actually sick would have been a year ago at New Year’s. My younger daughter ended up with a sinus infection, and because it was an infection, we needed antibiotics. We went to a nurse practitioner, so we chose not to go to a doctor but to somebody who could handle it just as well, so we saved money there. We just consume healthcare differently because we’re aware of the cost, and we make ourselves aware of the cost. That is part of understanding what is covered and what is not.
5. Should the law be completely overturned or should the government find way to improve it? I think the talk about overturning it is a lot of hogwash. They’re not going to overturn it. What they’re going to do is repeal it and replace it with a lot of the same things because if they didn’t, they would have a revolution on their hands. They’re going to replace it with a lot of the same things and call it something else. Probably what they’ll do is push people toward plans like what I have. We as Americans consume way too many health services. We have a system that should, by all rights, be the least expensive, but it’s not.
I don’t believe it should be overturned. I don’t see any point in that. If cooler heads prevailed, I think even Republicans would find it politically expedient to say, “Here are the things that work. We admit, this works.” It was Mitt Romney’s plan to begin with, by the way. We’re talking about a plan that made sense because of the individual mandate. It’s a responsibility issue, and that’s a very Republican kind of issue.
I think simply the law should be amended and fixed. Honestly, in the end, it’s hard to see why you wouldn’t have a system like most of the richest countries in the world, like Canada’s and Britain’s, which is a healthcare system that’s basically paid for by the government and open to everybody. Single payer is going to end up being where we focus on outcomes, and not on payments and deductibles. You focus on health outcomes; the system gets cheaper. That was happening under the ACA, as well. They were paying doctors for having good health outcomes, instead of paying doctors for prescribing tests. I have a hard time thinking that the system can change a lot. If they go back to the way things were before, I may survive, but you’re going to see a lot of people lose their homes and businesses even though they have health insurance. Most of the people who were losing everything, who were going bankrupt because of health issues, already had insurance when they got sick. That’s just wrong. We’re a caring, rich society, and there’s just something really fundamentally, philosophically, ethically, morally wrong with that.
6. Are you better or worse off than you were before the ACA became law? We’re definitely better off, no doubt, and that’s because of the preventative care that comes with our insurance now and because of those lifetimes maximums — and the fact our daughter, who is in college now, can stay on the healthcare until she’s 26. She’s likely, in this economy, to need more than a bachelor’s degree, so she will probably go on to get at least a master’s. She will likely be in school for a long time and not earning, and being able to keep her on my insurance for that long is going to give her a good start as well. So there are a lot of benefits to us and to society, so we’re better off.
7. Should the U.S. government be responsible for providing healthcare to its citizens? Is healthcare insurance a basic human right? This is something I think a lot about. Where does clean air come from? It certainly doesn’t come from corporations who just decide out of the goodness of their hearts to make sure that the crap they pump into the air is clean.
We need the government to regulate the industry so that we have clean air and clean water. For some reason, people can’t seem to act honorably or with integrity 100 percent of the time. We rely on the government to make sure we have clean air and clean water. We believe that’s a basic human right.
We’ve already kind of established that. But then you go into food and housing, and things get murkier. People think if you get something for free, and you don’t work for it, then you’re just a freeloader.
Healthcare is there as well. We all need food. We all need water. We all need healthcare. We all need housing to live. To a certain extent, yes, the government has to be there to help provide for people.
One of the issues with healthcare is that we all are dealt vastly different cards when we’re born, on the healthcare front. I do not know whether I will come up with cancer or need a liver transplant when I’m born. I cannot control that, except trying to eat healthy and work out. If that much of it is luck, are we really saying as a society, “Oh man, you were just unlucky so you get to lose everything?” Are we really that kind of society? Yes, I do believe ethically. For some people, it’s moral in terms of their religions, but for me, it’s an ethical issue. I do believe we are some of the most wealthy people in the world, even the poorest of us, and we have an obligation to people who are less well-off to provide some of those things. So yes, we as a society, whether you say it’s the government, we have the obligation to make sure we have good healthcare for everybody.
It just makes economic sense. I heard this a lot when I was getting out of college, “I need to take a job. I need health insurance.” When I look back on it, there’s a lot of creative innovation that doesn’t happen because people are horrified of losing everything if they get sick. Can you imagine if we just took care of that?”