As controversy has swirled around the Affordable Care Act and its troubled website, some Nebraskans have been shopping for health insurance and signing up for policies — sometimes reluctantly.
Many Iowans with individual coverage have policies that will not need replacing until later in 2014, but most Nebraskans with individual insurance coverage face decisions now about their coverage after Jan. 1.
Last week, many in Nebraska got anther option: The state's Blue Cross Blue Shield affiliate offered to let them renew their 2013 policies for another year rather than buy new policies that meet the standards of the law known as Obamacare.
Here are the stories of some of those who are shopping and, in some cases, buying new insurance. Some had spoken with The World-Herald earlier and now provide updates.
If the law is called “Affordable,” then its insurance should be affordable, said Tracy Hawkes, who owns Omaha's Nite Hawkes Cafe, 4825 N. 16th St.
“It's not,” she said, even though, as it now stands, she might pay $250 less than renewing her existing Blue Cross policy, with similar benefits.
She's not happy that, at age 49 and beyond having kids, she would be paying for maternity coverage and childhood vision and dental coverage she doesn't need.
She's frustrated that she hasn't been able to shop easily on HealthCare.gov and doesn't trust the website's security. She wants to see her options, but the sample insurance policies on HealthCare.gov are too vague unless she enters her personal information into the computer.
“I hate putting that stuff out on the Internet,” she said.
She filled in some of the blanks on the site, but the computer now thinks she wants coverage for herself and three other family members with the same name, and she can't delete the erroneous names. A HealthCare.gov representative told her a supervisor would have to call to fix the problem, but that hadn't happened yet.
When all that discussion is done, Hawkes reflects.
Her health care expenses have gone up. Eight years ago she paid $578 a month for a family of four, and now she's paying $886 for herself and one son.
But a few years ago she was paying $2,000 a month. Then her husband became disabled and has Medicare coverage. She estimates renewing her Blue Cross policy would cost more than $1,000 a month.
With that history, an Obamacare-compliant policy looks like a bargain.
Blue Cross offered her one of those policies for $596.67 a month. But her family deductible would go from $2,500 a year to $7,000, and her out-of-pocket limit would go from $10,000 to $12,700.
So she's now favoring a “gold” policy at about $750 a month, with deductibles close to her current policy and better prescription drug benefits.
She doesn't think she would qualify for tax credits to lower her premiums, but she hasn't been able to find out yet.
Still, the new policy would mean lower monthly premiums. She might have slightly higher copayments because her doctor is on a lower-tiered benefit level for Blue Cross, and she doesn't want to switch doctors.
In the end, she said it looks as if Obamacare offers lower-cost comparable coverage.
“This is a breath of fresh air,” Hawkes said finally. “It's still hard, though. It wasn't easy. You don't dare go without. You could lose everything. I was really hoping that with more people in the pool, the premiums would be lower, but they weren't. It's still a lot of money.
“I'm mostly upset that this is not affordable. Don't call it the Affordable Care Act.”
LYNN AND JEFF JAEGER
Jeff Jaeger is working but uninsured because his employer doesn't offer coverage and a policy doesn't fit in his family's budget. He hasn't had a checkup with a doctor in more than a decade.
At 45, he's healthy, but he has a family history that could signal potential health problems.
His wife, Lynn, recently shopped for coverage for him — “I'm the one that does all the paperwork in the house” — at, of all places, a pink camper parked along Plum Street in the Jaegers' hometown of Doniphan, Neb., population 69.
She sat across from a laptop with Charles Olson, a representative of OCi Insurance & Financial Services Inc., who had slept the night before on the camper's couch after spending a day with clients in Central City, Neb.
Lynn, who is on Medicare disability because she has muscular dystrophy, recited her family income and other details.
Olson searched insurance company websites and soon said: “This one makes the most sense.”
It's a policy offered by CoOportunity Health that would start coverage on Jan. 1. The policy would cost $3,082 a year, or $256 a month — too much for Jeff. He's a meat cutter, one of three employees at Steve's Butcher Shop in Doniphan.
But at Jeff's estimated income, the Affordable Care Act allows a tax credit of $2,682, reducing the annual cost of his policy to $400. Benefit assistance would lower his potential out-of-pocket spending for the year to $450, instead of the $3,350 max for many policies under the law.
“Thirty bucks a month,” Lynn said. “This sounds like something that would fit in our budget without breaking our budget. I think that this is going to be the one that is going to work for us.
“It's a relief to know that my husband will finally be able to go in to see a doctor.”
Later, Olson said: “This is really what it was designed for.”
Lynn took an eight-page form home to fill out details, and she will talk with her local insurance agent, Dave Kusek. He's the one who invited the pink RV to town, and he'll help his clients apply for coverage and qualify for income tax credits.
“This was an opportunity for people locally to learn something directly instead of just what their friends are telling them,” Kusek said. “People who came, they came off that RV better informed.”
Because HealthCare.gov has not worked smoothly, Kusek said, most don't know if they qualify for tax credits. “I'd hate to see them go and pay full price if they're eligible for the subsidy.”
Kusek went through about eight hours of training to be certified to help people buy the new policies. He's looking forward to seeing Jeff Jaeger covered by insurance.
Lynn Jaeger showed the options to her husband, telling him, “You've got a really good policy, and the premiums, you won't be able to beat.” He agreed and signed the application.
Everyone's happy, right? Not exactly.
Though Lynn likes the coverage, she also sees the other side of the coin: If her family is paying less for coverage, somebody else is paying more. And who is dictating this whole thing, anyway?
“I like the idea behind enabling people to get health insurance,” she said, “but being forced to do so is repugnant. I understand the economics behind it. But it's not a freedom of choice. I can see both sides of the issue. I feel caught in the middle.”
Omahan Jean Wendl was resigned to paying more for her health insurance next year, possibly a few hundred dollars a month. Her deductible and out-of-pocket maximum will go up, too.
Even so, she isn't upset and favors health care reform.
“Just because it's more expensive and you think it's a pain in the neck, in the long term it will be a good thing,” said Wendl, who is self-employed. “I know it's really bumpy — not a good start — but I think this will be good in the long run.”
Blue Cross suggested replacing her $335-a-month policy with one that would cost $519 and meet Obamacare standards, with a $2,500 deductible and a $6,350 out-of-pocket limit.
She's also considering a Blue Cross policy that would cost $430.20 a month with a $2,750 deductible and a $5,000 out-of-pocket limit for the year. Her current policy — “a really good policy” — has a $1,500 limit on deductibles and out-of-pocket.
“That out-of-pocket, that's a crazy amount,” she said. “I'm healthy up until this year, but I'm 60. If somebody blows through a stop sign, then all that's out the window. This is the first year I didn't think I was going to live forever.”
Now that Blue Cross has offered to renew her 2013 policy, she will consider how much that premium would go up and decide whether to renew the old policy or sign up for the new one.
She also might buy insurance offered by another company. She wants to visit HealthCare.gov when it's working well to see what she can find.
Wendl's income is high enough that she won't qualify for tax credits that would reduce her monthly premiums.
Her husband's individual coverage was dropped last spring after he suffered a heart attack, but he receives medical care through his veterans benefits. If he didn't, he could buy individual coverage again under the Affordable Care Act.
But whatever she buys now, she said, the real benefit of health care reform will come later. “Eventually there will be a really big wrestling match over the cost of health care in general. I think this is the first step. Change is inevitable.”
In the meantime, Wendl said, “You have a responsibility to do everything you can to make sure you're healthy,” such as eating right and not making risky choices. You want to be able to see your grandchildren and be really old and die in your sleep. That's the goal.”
Christine Quick turned 26 last month and, she said with a laugh, “I was kicked off my parents' insurance.”
The University of Nebraska at Omaha graduate student had visited her doctor, renewed her prescriptions and prepared for being uninsured for two months while she signed up for coverage under the Affordable Care Act.
Her method: She sat on her couch with her laptop about 9 p.m. one Sunday, signed on to HealthCare.gov and went through all the steps, including the tax credit qualification page.
Now she's signed up for a “silver” Blue Cross policy that will cost her about $50 a month and has what she considers to be reasonable copayments.
“I put in my Social Security number, and it asked some questions to be sure I was the person I said I was,” she said. “I didn't have any problems. It was really easy. It told me right away 'Thank you for signing up.' ”
Her monthly premium is low because she qualified for tax credits due to her low income.
The only lingering point, she said, is that she hasn't received a promised email telling her how to pay her first month's premium. “It should work out. I'm feeling pretty confident.”
Quick said she hears about the controversy surrounding the health care law but doesn't pay close attention. “I just hear that the website and the rollout have been kind of a disaster, which makes me nervous because my experience was so good. I feel like I may be missing something.”
It doesn't bother her that while she is paying low premiums, thanks to the tax credits, someone else is paying higher premiums for the same benefits.
“If I were seeking medical treatment that cost thousands of dollars, I think I would feel more guilty about it,” she said. “But I have, like, one routine checkup a year. ... I don't really feel like I'm feeding off of other people. I'm paying my bills and I'm trying my hardest — trying to have preventive care so I don't have to pay those huge medical bills.”
LINDA AND KEN BECKSTROM
After about an hour's conversation and computer search with a reporter, Linda Beckstrom found a Blue Cross health insurance plan that she agreed is roughly equivalent to her Blue Cross policy that will expire Dec. 31.
The new policy will cost about $475 a month — $50 a month less than she's paying now. As for its benefits, she said, “I think it's about the same, actually.” She signed up for the coverage.
In addition, she's pleased that Affordable Care Act policies cover mental health treatments, because she worked for more than 20 years in the mental health arena. Her old policy and most old insurance policies didn't cover mental health, “which was stupid,” she said.
Mental health is one of the “essential health benefits” required by the Affordable Care Act.
Her husband, Ken, agrees with the law's requirement that insurance companies must accept all applicants regardless of their medical conditions.
Last week's decision by Blue Cross to let customers renew their 2013 policies, with a premium increase, isn't likely to change the Beckstroms' decision, given the lower premium of the Affordable Care Act policy.
“I hated losing the policy we had,” Ken Beckstrom said, “but now that we're all switched over to go with something else, it's going to take a lot to get me to switch back.”
That's not to say that either of the Omaha couple is willing to embrace Obamacare. In fact, Ken is strongly opposed to the whole idea of government-required health insurance and the Obama administration's handling of it.
The cheaper policy his wife found is inferior, he said, because it has a higher deductible and a higher out-of-pocket annual maximum. The fact that she doesn't reach her annual deductible is beside the point, he said.
The policy provides maternity benefits and pediatric vision and dental benefits, which the Beckstroms won't use and don't want. Obamacare is simply wrong, Ken believes — a “health care debacle.”
His wife will have to deal with Obamacare for only a few months before she joins him on Medicare. It's their seven grandchildren that the couple are really worried about because of what they see as continued government actions that impose new rules, eliminate freedom of choice and pile up government debt.
Mike Kennedy isn't sure what he'll do.
He could pay $400 a month for a Blue Cross policy he's selected that has a similar deductible but more coverage than the $250-a-month policy he has now. Or he could decide to go back to his old policy, if its new premium isn't too high.
Either way, he's not happy.
“Nothing's going to change, because the market's been destroyed,” he said. “Next year, you're back to square one.”
And he hasn't been able to check out all the options on HealthCare.gov. “I've pretty much given up on it.”
Kennedy, an Omaha attorney who serves on the Millard school board and is a politically active Republican, was one of the first Nebraskans to complain when he got one of 45,000 letters from Blue Cross in September saying individual insurance policies would be replaced.
Since then Kennedy has gotten married and told Blue Cross to switch him to a “gold” policy that costs more but has deductibles, copayments and out-of-pocket expenses closer to his old policy.
Now that Blue Cross can renew his 2013 policies, Kennedy said, “I need to compare apples to oranges. If it's affordable, I'll take it back. But I don't know how they're pricing it.”
He looked at some other company websites and made some phone calls, but often the operators were busy. He doesn't blame the insurance companies, because they're trying to follow what he considers to be a flawed law. And he's lucky that his new wife's coverage is continuing, because that would have added $350 to the monthly bill.
“I'll be able to pay for my insurance,” he said. “I'm concerned about families that are in the community and don't have the ability to pay it,” and can't find out whether they qualify for premium-reducing subsidies.
“It's been a horrible experience for me and my family,” he said. “What happens the following year? They're just pushing it back one year. There's no long-term solution.”
Khari Reynolds of Omaha has looked into HealthCare.gov and plans to meet the Dec. 15 deadline to buy insurance that would start covering his health care on Jan. 1.
“I've procrastinated a little bit,” he said. The website seems to be working, he said, but he hasn't gone far enough to see what prices or coverage might be available to him.
“Right now I'm still looking,” said Reynolds, 35, who is a personal trainer and fire sciences instructor at Metropolitan Community College — both part-time jobs.
“I haven't really made a decision, but I've learned a lot more,” he said. “For the most part I'm trying to figure out what my best option is. I'm talking a little bit to my parents, actually, because they've had some similar business going on with their employees. I'm trying to get the dumbed-down version.”
He said he definitely needs insurance — a lesson reinforced by the $1,500 he paid this fall to have his wisdom teeth removed. “I'm trying to figure out what would be the best option. I'm going to get some type of something.”