A man looks over the Affordable Care Act (commonly known as Obamacare) signup page on the HealthCare.gov website in New York in this October 2, 2013 photo illustration. The federal government's portal logged over 2.8 million visitors by afternoon October 2, largely in an attempt to sign up for Obamacare.  REUTERS/Mike Segar  (UNITED STATES - Tags: HEALTH SOCIETY POLITICS) - RTR3FIUH

Obamacare Is Actually Good. No, Really

I’m a low-income PhD student with a shaky health history and limited earning capacity. The Affordable Care Act should improve my quality of life. But will it?

This isn’t the answer you tend to hear on the news, but yeah, it will. Dramatically.

Here’s my background. I’m a 30-year-old, soon-to-be PhD graduate with an expected income in 2014, the first year of Obamacare, not much above the minimum wage. My $190-a-month student health plan runs out the day Obamacare starts. I’m a nonsmoker, but I have had some serious health issues in the past. In the eyes of health insurers, I’m hardly a solid bet. So Obamacare should, if it’s fit for purpose, help me out of a bind when I go to change my plan. Let’s see if that holds up.

Join author Alex Kotch for a live Facebook chat about his Obamacare experiences Tuesday, Dec. 17, from 2 to 3 p.m. ET.

Obamacare Actually Good_01
That's me, Alex Kotch. (Michael Thomas)

When friends heard that I was enrolling in Obamacare, they told me their own health insurance costs would rise if they signed up. They’re mistaken, but that’s not surprising: Media coverage has often ignored subsidies and focused on insurance premiums. Understanding the subsidies is essential to understanding how much your health care will cost. To make matters worse, states like mine (North Carolina) have stymied the work of Affordable Care Act (ACA) navigators, who are paid by state insurance exchanges or federal grants to educate people about the program.

North Carolina alone turned away $23 million of federal money allotted to educate and assist the uninsured. It also rebuffed $4 billion allotted to expand Medicaid, and its Republican members of Congress heaped onerous paperwork requests on navigators.

Once HealthCare.gov finally began to work reliably, I started to fill in my details. Before the ACA, I would have been asked to disclose “pre-existing conditions.” The worse your pre-existing health conditions, the more you pay.

In fall of 2010, I suffered a life-threatening brain aneurysm rupture. While working out at the gym, I burst a central cerebral artery. I underwent major surgery at Duke Hospital, followed by two weeks in the intensive care unit. Without world-class medical care, I wouldn’t be alive. I spent two weeks in the neuroscience ICU, including a week in the room where Ted Kennedy convalesced after a brain operation.

Just months before my rupture, President Obama had signed the ACA into law. In pre-ACA America, having had an artery explode inside my head would have left me struggling to find any insurance company that would accept me without charging exorbitant rates. Under Obamacare, it isn’t an issue.

The income section of HealthCare.gov is all-important. As a freelance writer and musician with a PhD, I estimated that I’ll earn $16,800 for 2014. That’s 146 percent of the national poverty level, qualifying me for very inexpensive “cost sharing” Silver plans. Most of my fellow musicians are there with me near the bottom of the income ladder. According to a recent study, 53 percent of musicians in the U.S. are uninsured, so the ACA could be many musicians’ first health insurance in their adult lives.

On Silver plans, if your income is between 100 and 250 percent of poverty, you get reduced deductibles (what you pay before the plan kicks in to subsidize the rest). You also get reduced out-of-pocket costs such as prescription drug prices and doctor visits, as well as extremely low out-of-pocket maximums (a cumulative, annual ceiling on the amount you personally contribute to your health care).

Silver plans have the second-lowest premium prices in the four-tier system. Because of my income, 94 percent of my expenses will be covered by the insurance plan and government subsidies. If my income were above 200 percent of poverty ($23,000 for the year)but below 250 percent, it would cover 73 percent of my expenses. In contrast, Bronze plans, with cheaper premiums, pay for only 80 percent of one’s costs.

plans_comparison

The cheapest Silver plan will cost me about $47 per month. Its $5 primary care doctor visits and $10 generic prescription drugs (after a $200 drug deductible) are great, but the out-of-pocket maximum of $700 is exceptional. If I have another expensive medical emergency and keep my health care within my health network, I won’t pay more than $700 for the year. Also, with plans that have predetermined co-payments for doctor visits, these kick in immediately, as the deductible does not apply. A limited plan from Coventry Health Care of the Carolinas costs $53 per month, has no deductibles and offers free primary care doctor visits and $3 generic prescription drugs (but a $1,000 out-of-pocket maximum).

I even qualify for a free Bronze plan and another that costs a whopping $1.89 per month, but these come with high deductibles and out-of-pocket maximums, so I’ll save more money if I enroll in a Silver plan. If I happened to be ideologically opposed to the ACA, I’d take the free plan and forgo the penalty for remaining uninsured.

Every plan I’m considering is much more affordable than the nearly $190 per month I paid this fall for my student plan. This plan has no in-network deductible, but the out-of-pocket maximum is $2,500 within the network and $3,000 out-of-network, far more than the $500 or $700 I’m considering now.

plan_duke

Put it this way: If I were to have another brain aneurysm in January 2014, my health bill for the year under the cheapest Silver plan could top out at $1,264. On my old college plan, it would be four times that.

I’m relatively lucky. However, in 25 U.S. states, people who fall below the poverty line ($11,490) may end up in a health care no-man’s-land. Many in North Carolina are officially too poor for subsidies, yet still ineligible for Medicaid.

The Medicaid gap for those below the poverty line here in North Carolina, which refused to expand the program, is a big problem. There are 4.8 million Americans, including 319,000 in my state, who will fall into this category, according to a Kaiser Family Foundation study.

One 29-year-old woman I talked with, who wished to remain anonymous, has been without work for the last year, and conservative legislators took away her unemployment benefits in July. Now, well below the poverty line and already denied unemployment benefits and food stamps, she won’t be getting any help with her health insurance either.

As a single woman under 65 with no children nor a disability, she doesn’t qualify for Medicaid or subsidies from the health insurance exchange. Even the available catastrophic plans are more expensive than the plan she has struggled to pay for over the past three years.

Let’s get one thing straight: I believe the U.S. should institute true universal health care, like nearly every other “developed” nation on the planet. Health care is a right, not a privilege, and for-profit companies have no business deciding who deserves subsidized care and who doesn’t. The ACA is a big step forward, and for those it covers, particularly those on lower incomes, it’s a bigger one than I had previously thought. I’ll save on heath insurance premiums, doctor visit charges and prescription drug costs, so maybe I’ll have a shot at making ends meet by writing articles and playing DJ sets.

Respond Now
  • Great to get another positive story on ACA. 

  • Key words: subsidies and GET GET GET…

  • For this young man, that is great. But WHY should I or anyone else but this young man, help pay for his health insurance? Out of the kindness of our hearts? Is he willing to go to war in place of my son who is in the Army out of the kindness of his heart? My husband, not covered, making $11/hr can not get subsidies and the plan’s deductible is outrageous, $6000 before insurance kicks in and covers anything with a $300/mo payment. Sorry but NOPE! Healthcare is not a right, it is a privledge! Unless he has a copy of a different Bill of Rights than I do or he was raised to believe he is owed something. You are owned nothing in this life but the freedom to live it as best you can. That is it, nothing more. Get your hand back in your pocket and out of mine!

  • Is the author a shill for Ocare or what? Obamacare SUCKS A$$!It may work for a few, but is largley another of King Obama’s lies. Wait a few more years and then get back to us.

  • You are apparently unconcerned about the trillion dollar (and climbing) cost to taxpayers, the millions who have lost insurance, the millions who will lose employer insurance next year (and be forced into substandard exchange policies), and the millions taken from Medicare (sorry Mom and Dad) to pay for your cheap insurance.  Glad it worked out for you.By the way, most leading edge hospitals will be out of network for ACA policies.  So you would have been on the hook for >20% of that world class hospital’s care.    

  • This guy should stop smoking right now. His life style is one of the reason why healthcare cost is increasing a lot. It’s not fair for the people who take good care of themselves  living healthy life style and rarely see doctors / using drugs but are paying more and more into the system each month because other people like this guy abusing the system. The system must offer big discount for those with good healthy behavior and rarely use the system. Instead now the system force them to pay more and pay the fine if they don’t want to play this rigged game. 

  • Show More
  • Health care is a right?   Where is that written? 

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    everyone else.   Parasites rejoice.  Obamacare is here.

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  • Hey Temperedge, do you have insurance? Then you’re subsidizing other people. That’s how insurance works. Except now, you’re paying LESS for this guy’s insurance because of the ACA.Hey Colder67, do you have insurance? Then you’re “relying on people … to support me.” That’s how insurance works. Also, pretty sure the author did not choose to have a brain aneurysm.It’s amazing who comes out the the woodwork to snipe at someone who has some good news to share about a program that sets out to help people afford health care. Horrors!

    1 Reply - Reply Now
    • You are wrong about how insurance works.  You have it confused with socialized medicine a la western europe.  In the US an insurance business works like every other business, some transactions are profitable, some are less profitable, but premiums and care are not means tested. You get what you pay for. Risky people pay higher premiums to offset their higher costs.  So if the insurer is profitable, no policyholder is supporting/subsidizing anyone other than themselves and the insurer, just like you don’t subsidize my car purchase because your model included a higher margin for the dealer.  Obamacare, now that’s a different story…

  • Obamacare promised to treat issues that other insurance plans wouldn’t cover, and yet It won’t cover the cost of strippers to help me get through my sex addiction. What a load of lying bull puckey

  • “Health care is a right”? Is it also YOUR right that I have to pay for YOUR healthcare? Healthcare is available for everyone, only you’re expected to pay for what you get. (Radical concept, right?) If the taxpayers OWES you healthcare, then it also OWES you food, clothing, and shelter, because no one can survive very long without those essentials. And then, you can argue for taxpayer paid fertility treatments, because children are also needed for your genes to survive. And then you need free public schools, free school lunches, breakfasts, and dinners, health care, and sports uniforms. The socialist march away from common sense and self reliance toward rewarding stupidity and lack of any planning. For a PhD, you don’t think very straight. 

    1 Reply - Reply Now
    • Speaking of straight thinking, you are ALREADY paying for others’ health care through your current health insurance and others’ food and shelter through your taxes, which go toward federally subsidized housing and development programs and food stamps. And yet we are not yet living in a socialist prison camp. The idea of a market model of health care is just sick. Gonna die? Pay up or we let you bleed out. This is America? 

      1 Reply - Reply Now
      • Yes, this is America… But not all americans, thanks God! 

  • You mention you will have a PhD.  In what field?  Do you have student loans from college or graduate school?  Can you get a better paying job in the field you studied?  Thanks.

  • Yeah, I wanted to be an astronomer, but when I realized that they didn’t make much money, I chose a different profession.  I based my choice on what I liked to do, if I could support myself and a family and the potential benefits related to my profession, including, medical and financial.  My family could not support me for 8 years of school.  I made the choice.  I did have several friends that chose other routes. (welding, farming, factory, etc….) they made their choice, I made mine.  Why now must I subsidize you and them for your choices.  Sorry about your aneurysm, but a friend of mine had an aneurysm and our insurance paid somewhere neare $500,000 for her treatment.  Now my premiums have increased by 39% and deductible has increased from $3,500 to $ 12,700.  Please tell me how this is benefiting me.

    1 Reply - Reply Now
    • You are, in your thinking, the exact caricature of selfishness. If I see you on the road side starving, if the only thing I have is a half loaf of bread, I will split it without asking you “why are you on the side” and accept that for you to starve a little less, I will be hungry a little more. This is called “sharing”It is a word you don’t understand, so if things where reversed, you would keep your bread for yourself and let me starve to death, because you don’t care about others.Since there is a majority like you on this planet, no wonder why little people have too much  and a lot not enough…

      1 Reply - Reply Now
      • So, you live in a box with no posessions because you’ve “shared” everything you have with those less fortunate? Love the hypocracy from the person who obviously has internet access and a smartphone/tablet/computer, which he or she ironically ascribes less value than life saving medical care.

  • I really wish I could have made to choice to be a freelance write and musician with a PhD in who knows what without regard as to what income that would afford me, instead relying on people who made responsible choices on how to support themselves to support me

  • Are Duke and your neurosurgeon in your silver plan?

  • Obamacare is a socialist power grab, no more no less. Selling your soul always has a price.

    1 Reply - Reply Now
    • The cost is going up because Obama relied on millions of invincible teens to sign up so they wouldn’t have any health issues.  Everyone expect your insurance premiums to rise dramaticly next year.   But of course those who are in poverty get a break.  Make sure you thank us for paying for your insurance.

      1 Reply - Reply Now
      • Yeah, poor people suck.

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