Judy Swanson is going to see her insurance premiums plummet this year, courtesy of the Affordable Care Act.
By ALAN BAVLEY
The Kansas City Star
So is William Gray.
But the two are poles apart in how they feel about the law, representing a nation as divided as ever over whether the ACA is a good thing or bad.
Gray thinks enrolling in health insurance should be voluntary. The ACA puts most people at risk of a tax penalty if they dont have coverage by March 31.
One of the things I like about this country, you make your choices and live with the consequences, Gray said. Health insurance should be a choice.
Swanson thinks requiring insurance coverage works for the common good: My feeling is were all in this together. Im optimistic people will see this as a need and responsibility. Its being a good citizen.
Gray and Swanson were among the people The Star interviewed in depth from among readers who wrote in last month about their experiences with the ACA.
Readers expressed near-universal frustration with the problem-plagued healthcare.gov website, which went online Oct. 1 as a portal for enrolling in insurance plans and seeking the tax subsidies the ACA offers many low- and middle-income people to help pay their premiums. Readers said it took about eight weeks before the website functioned adequately.
Some readers expressed feelings of betrayal when their health plans were canceled because they didnt meet ACA coverage standards. I cant get over it, the president lying to us about keeping our old policy and doctor, Tony Philip of Liberty said after his wifes plan was dropped.
Others expressed elation after finding truly affordable insurance for the first time.
I feel like I have re-entered the middle class, said Cindy Cheng of Overland Park. With the help of a tax subsidy, her monthly insurance premium payment for herself, her husband and two college-age daughters has been reduced from $880 to $130.
But whether they saw their costs go up or down, readers disagreements over the ACA like those of Gray and Swanson frequently went much deeper, to a fundamental tension in American politics between individual rights and civic responsibilities.
You definitely see those principles playing out in the two parties, said Beth Miller Vonnahme, a University of Missouri-Kansas City political scientist who studies public opinion and political psychology. People have those predispositions and parties tap into that, with Republicans taking the side of individual rights and Democrats the side of civic responsibility.
I think it has resonated with voters.
William Gray is, as he says, an insurance companys nightmare.
The 64-year-old Overland Park man is a former smoker who has had three bouts of oral cancer. Hes overweight and has high blood pressure. He knows he cant risk going without health insurance and had been paying $1,416 a month for coverage.
When Gray got on healthcare.gov, he signed up for a benefits-rich gold plan with a monthly premium of $535. Beginning this year, the ACA put an end to insurance companies denying people coverage or charging them higher rates because theyve had health problems.
For Gray, thats yielded a savings of $881 per month, or $10,572 per year.
Im coming out like a champ, he said.
But that didnt turn Gray into a cheerleader for the Affordable Care Act.
Also starting this year, the ACA mandates that most people carry insurance. The reason: To make insurance more affordable, particularly for the older and less healthy people who are most likely to run up medical bills, everyone needs to enroll.
Thats unfair, Gray said, especially to healthy young people who dont use much health care.
Im saving $900 a month. Someone else is picking that up. Asking others to pay for my bad choices just doesnt sit well with me.
Swanson, 58, of Lees Summit, works as a business and computer consultant. She used to rely on health insurance from her husbands employer. But when he retired from an executive position with the American Academy of Family Physicians a few years ago, Swanson discovered that she was virtually uninsurable on her own.
It could have been the drugs she took to control her cholesterol. Or the couple of months of physical therapy she got after a strenuous DIY patio project.
It depended which insurance company. They all denied me for different reasons, Swanson said. I think Ive been denied by every provider out there.
Swanson stayed on her husbands employee plan through the COBRA law until her eligibility expired. Then she entered Missouris high-risk insurance pool, a state program of last resort for the uninsurable. Her monthly premium was about $700.
When she looked for insurance this fall, she found a high-deductible bronze plan for $475 per month.
With my husband being so involved with health care policy, we knew this was a good thing, she said. Ive benefited from it immensely.
Swanson said she has heard people complain about having to buy insurance. But she has an answer for them: The young people of today will be the 50-somethings of tomorrow, and wont they be happy to have insurance?
The nonpartisan Henry J. Kaiser Family Foundation has been tracking public opinion about the ACA every month since the laws passage in 2010. As of January, the nation was as divided as its ever been: 50 percent had unfavorable opinions of the ACA, and just 34 percent were positive.
The poll also found that large numbers of Americans still had just a sketchy idea about what the law actually does.
About four in 10 adults overall, and half the uninsured, werent aware of the ACAs premium subsidies or the laws requirement that insurance companies make their plans available at the same price to people with pre-existing conditions.
The one thing the vast majority 81 percent was familiar with was the mandate to have health insurance or pay a fine.
People are learning about the ACA mostly through the media and the media have focused on the political side and political controversies, not what the law actually means, said Kaiser pollster Mollyann Brodie. Certainly theres been an awful lot of coverage and rhetoric about the mandate. Its a big part of the political frame.
I think there will continue to be a fight, said Vonnahme, the UMKC political scientist. Its a pretty strong commitment by the Republicans to oppose it and Democrats to preserve it. Well see the public continue to be torn.
As of last month, most people in the Kaiser poll said they hadnt been directly affected for better or worse by the ACA. Here are the stories of three people who have direct experience with the law:
• Jeff Tiller, 53, was always in favor of the ACA.
The system they had (before the ACA) was destined to collapse, jacking the prices up 10 to 15 percent a year, the Kansas City, North, business owner said.
He and his wife, Kathy, 41, run Omni Entertainment, a booking agency for musical acts. They were paying nearly $2,000 per month for insurance to cover themselves and their 10-year-old son, Raymond. And those premiums had been going up regularly by $150 or more.
It was getting unaffordable, Tiller said.
Tiller had heard through the media about the problems people were having with the ACA and conservatives arguments against the law. You see the news, all the horror stories. But he also appreciated the laws rationale for requiring everyone to carry health insurance.
If an insurance pool is to work, everyone needs to be insured. It keeps the prices down, he said. You put your money into the pie and pull it out when you need it.
The ACA has worked out for Tiller and his family. They dont qualify for a subsidy, but Tiller found a silver plan, with coverage similar to what they had, with a $780 monthly premium. That also includes dental and vision plans, which the family didnt have before.
I think its still too high, but its manageable, Tiller said. Its a great surprise.
Tiller said hell be putting some of the savings into Raymonds college fund.
• Steven Slobodzian recognizes the problem of making insurance affordable to people with medical conditions: The 61-year-old Overland Park man has multiple sclerosis and his care runs up substantial bills.
But he doesnt like the ACAs solution.
I fully agree people should have the right not to buy insurance. Otherwise, whats to stop the government from requiring you to buy something else? Slobodzian said.
Slobodzian had to stop working several years ago after he was diagnosed with a progressive type of MS. He maintained insurance coverage through his wifes employer. When she went to part-time work about a year and a half ago, they continued on her insurance plan through the COBRA law.
Their COBRA coverage expired the first of this year, so the Slobodzians went through an insurance agent for a new plan. It costs $1,253 per month, about $100 more than what they had before. The old plan included dental coverage; this one doesnt.
Theres nothing better in the plan at all that we see, he said.
Slobodzian doesnt like it that the ACA requires his insurance to cover birth control and maternity and newborn care, things he and his wife dont need.
Thats an extra cost I dont think I should have to pay for someone else, he said.
And Slobodzian said he took a financial hit last year when the ACA raised the tax threshold for deducting medical expenses from income taxes from 7.5 percent to 10 percent of income. Because many of his expenses arent covered by insurance, that change already has cost him about $1,550, he said.
Slobodzian knows insurance for him and his wife would have cost more without the ACA. But he thinks there must be a fairer and less complicated way to provide affordable health insurance for people like him without making everyone else buy coverage.
I understand how that (ACA) works, but how do you get someone 20 years old to sign up? Theyll just pay the penalty.
• In 1998, Sandy Bonar and her husband had saved enough to retire from their jobs at Hallmark. Bonar, still in her 40s then, didnt think shed have trouble getting health insurance. But she hadnt reckoned with her medical history: surgery on her spine when she was a teenager, a bout of depression later on.
That is the kiss of death with health insurance, she said. They dont want to touch you with a 10-foot pole.
Eventually the Prairie Village resident landed in Kansas high-risk insurance pool. Her premiums were about $550 per month when she started, but they rose steadily. By 2011, they were a financially painful $770 per month.
Bonar decided to take a risk. The ACA had created new state programs with lower premiums for people with pre-existing conditions. But to keep people already enrolled in the original high-risk pools from jumping to the new programs, which had limited funding, the law required applicants to have been uninsured for at least six months. Bonar swallowed hard and dropped her coverage.
That was scary, she said. My worry for years would be Id be in a car accident and be paralyzed and my costs would be astronomical.
Bonar didnt experience any medical calamities, and in August 2011, she entered the newly established insurance pool. She saw her monthly premium drop to $445. After Bonar turned 60, the premium rose to $565.
Theres one more twist to Bonars story. Because insurance companies no longer can charge someone with medical conditions more, the ACA phased out the high-risk pools. Bonar, who doesnt qualify for a subsidy, went shopping for an insurance plan. She selected one with a monthly premium of $524.
Paying what Im paying now is a lot, but I dont care. I have health insurance. Im thrilled, and Im a healthy person.
Since getting her insurance, Bonar has been promoting the ACA to uninsured people she knows: the divorcee who cuts her hair, the guy who does her oil changes, her massage therapist, the server at a restaurant she frequents. Its the people who wait on me who dont have it and need it most.
The day Bonar said that, she had gone to her doctor for a routine exam. Under the terms of the ACA, it was free. Or at least she didnt have to pay for it.
The latest numbers
As of Feb. 1, about 3.3 million people had signed up for private health insurance plans offered through the Affordable Care Acts government-run online marketplaces, according to data recently released by the Department of Health and Human Services. Open enrollment through the marketplaces began Oct. 1 and runs through March 31. The marketplaces are operated by 14 states and by the federal government (healthcare.gov) in Kansas, Missouri and most of the country.
Among those enrolled so far:
• 55 percent are female and 45 percent are male.
• 25 percent are between the ages of 18 and 34.
• 82 percent are eligible for tax credits or other financial assistance.
Total enrollment in Missouri: 54,157.
Total enrollment in Kansas: 22,388
To reach Alan Bavley, call 816-234-4858 or send email to email@example.com.