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Highmark drops Obamacare in York area

Written by Brett Sholtis/York Daily Record | Nov 1, 2016 8:01 AM
obamacare-donna_taylor.jpg

Donna Taylor sits in her Spring Garden Township home Friday, Oct. 28, 2016. An adjunct chemistry instructor at York College and a seminary student, Taylor is one of the York County residents affected by insurers' pullout from the Affordable Care Act. She recently discovered that Highmark, her provider through the ACA, will no longer provide plans through the marketplace in York County for 2017. (Photo: Chris Dunn, York Daily Record)

Highmark has pulled out of the Affordable Care Act exchange in York and Adams counties, leaving its customers scrambling to find coverage.

(York) -- When talking about health care, Donna Taylor doesn't like to use the word "consumer." For her, health insurance is about survival.

"They look at you as a consumer," Taylor said. "They don't look at you as a human being."

Taylor had been a chemistry teacher at Dallastown Area High School until 2006 -- a rough year. Her oldest brother died. So did her uncle. Severe stress led to an eating disorder. After Taylor lost a dramatic amount of weight, school officials got her to take medical leave.

She never returned.

"It was a lot harder to get over than I ever imagined it would be," Taylor said.

These days, Taylor, who holds a Ph.D. from Cornell University, works part-time as an adjunct chemistry professor at York College, a job that provides no health insurance. Like about 14 million other people in the U.S., she gets her insurance through the Affordable Care Act marketplace -- though that may change this year.

Taylor's insurer, Highmark, quietly pulled its 2017 marketplace health insurance plans from York and Adams counties. Her behavioral therapist may not be able to accept any of the other plans available on the marketplace, Taylor said. That leaves her scrambling to find a way to keep the vital health services that she's relied on since the eating disorder that ended her high school teaching career and the bouts with depression that followed.

Read: Nearly 14 million Obamacare sign ups expected

Highmark's exit from the region comes during a year of ballooning premiums and insurer dropouts for the government-mandated health option. Unlike Aetna and United Healthcare, which pulled out of the Obamacare exchange altogether, Highmark has opted to drop coverage in specific areas where it faces financial challenges, said Aaron Billger, a company spokesman.

"With current rates, we're getting into a volatile situation where we're paying $1.19 for every dollar we're collecting," Billger said. The 2017 rate increases are insurers' way of offsetting that loss.

Donna Taylor, who was enrolled in Highmark via the Affordable Care Act, recently discovered that Highmark and other insurers are no longer providing plans through the ACA. Chris Dunn, York Daily Record

As a demographic, those who use the Affordable Care Act marketplace tend to use services more than average consumers, posing challenges for insurers, Billger said. Marketplace customers tend to be seven years older than "commercial" members and 30 percent more costly, Billger said. They are 85 percent more likely to have cancer, 88 percent more likely to have coronary artery disease, 69 percent more likely to have hypertension and 110 percent more likely to have chronic kidney disease.

The problem might be less pressing for insurers if more young, healthy people were to sign up for the marketplace, he said. However, those groups haven't been signing up.

Daniel Ungarsky is one of those young, healthy -- and uninsured -- people. Ungarsky said in 2015 he opted to pay a $200 fine for not having insurance. This year, the 32-year-old York man expects to pay more than twice that amount to avoid the mandated insurance.

That's still a lot cheaper than paying for insurance every month, Ungarsky said. He earns just enough money to get by. He might have bought insurance if he needed regular prescriptions, but he's healthy and decided he'd just pay the penalty until he gets a job that offers health insurance.

Taylor doesn't have that option. Instead she's stuck deciding whether to get insurance from another provider -- and finding new doctors -- or paying $875 a month to buy insurance directly from Highmark, according to marketplace estimates.

That's more than twice what the Spring Garden Township resident would pay if only she lived across the Susquehanna River in Lancaster, where Highmark is still offering coverage, she said.

"I was just stunned when I saw that York didn't have it, but Lancaster did," Taylor said.

Still, Taylor said her situation is better than it was before the Affordable Care Act, which prevents insurers from denying people with preexisting conditions. Before Obamacare, she was paying as much as $10,000 per year to keep her former employers' coverage through COBRA. She had no choice but to pay those rates, she said, since no other insurer would accept her because of her eating disorder.

"I called every insurer operating in York County, and I was denied on all of them," she said.

Billger said he understands patients' concerns as open enrollment approaches, but there may be options available even in regions where Highmark no longer offers Obamacare plans. The company has a program called "Crosswalk," which helps customers to find other, comparable insurance plans.

"Highmark is committed to the ACA marketplace, and we continue to offer products in every county we'd previously served," he said. "The best thing to do is shop early. Explore your options. Check out what's out there."

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