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Division over Affordable Care Act persists, even among those it helps

Updated: 2014-02-22T06:10:23Z

By ALAN BAVLEY

The Kansas City Star

Judy Swanson is going to see her insurance premiums plummet this year, courtesy of the Affordable Care Act.

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 don’t 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 we’re all in this together. I’m optimistic people will see this as a need and responsibility. It’s 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 didn’t meet ACA coverage standards. “I can’t get over it, the president lying to us about keeping our old policy and doctor,” Tony Philip of Liberty said after his wife’s 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 company’s nightmare.”

The 64-year-old Overland Park man is a former smoker who has had three bouts of oral cancer. He’s overweight and has high blood pressure. He knows he can’t 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 they’ve had health problems.

For Gray, that’s yielded a savings of $881 per month, or $10,572 per year.

“I’m coming out like a champ,” he said.

But that didn’t 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.

That’s unfair, Gray said, especially to healthy young people who don’t use much health care.

“I’m saving $900 a month. Someone else is picking that up. Asking others to pay for my bad choices just doesn’t sit well with me.”

Swanson, 58, of Lee’s Summit, works as a business and computer consultant. She used to rely on health insurance from her husband’s 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 I’ve been denied by every provider out there.”

Swanson stayed on her husband’s employee plan through the COBRA law until her eligibility expired. Then she entered Missouri’s 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. “I’ve 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 won’t 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 law’s passage in 2010. As of January, the nation was as divided as it’s 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, weren’t aware of the ACA’s premium subsidies or the law’s 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 there’s been an awful lot of coverage and rhetoric about the mandate. It’s a big part of the political frame.”

“I think there will continue to be a fight,” said Vonnahme, the UMKC political scientist. “It’s a pretty strong commitment by the Republicans to oppose it and Democrats to preserve it. We’ll see the public continue to be torn.”


As of last month, most people in the Kaiser poll said they hadn’t 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 law’s 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 don’t 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 didn’t have before.

“I think it’s still too high, but it’s manageable,” Tiller said. “It’s a great surprise.”

Tiller said he’ll be putting some of the savings into Raymond’s 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 doesn’t like the ACA’s solution.

“I fully agree people should have the right not to buy insurance. Otherwise, what’s 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 wife’s 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 doesn’t.

“There’s nothing better in the plan at all that we see,” he said.

Slobodzian doesn’t like it that the ACA requires his insurance to cover birth control and maternity and newborn care, things he and his wife don’t need.

“That’s an extra cost I don’t 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 aren’t 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? They’ll 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, didn’t think she’d have trouble getting health insurance. But she hadn’t 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 don’t 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 I’d be in a car accident and be paralyzed and my costs would be astronomical.”

Bonar didn’t 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.

There’s one more twist to Bonar’s story. Because insurance companies no longer can charge someone with medical conditions more, the ACA phased out the high-risk pools. Bonar, who doesn’t qualify for a subsidy, went shopping for an insurance plan. She selected one with a monthly premium of $524.

“Paying what I’m paying now is a lot, but I don’t care. I have health insurance. I’m thrilled, and I’m 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. “It’s the people who wait on me who don’t 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 didn’t 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 Act’s 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 abavley@kcstar.com.

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