The impact of the ACA, one year later

(Harrisburg) — Four years that featured accusations, starts and stops, and finally, a working exchange have passed since President Obama signed the federal Affordable Care Act into law. Saturday marks the start of the second year of open enrollment for insurance plans. In the midstate, it has changed lives, for the better and worse.

“When we looked at these kinds of cost increases, we said you know, there’s just no way we can afford to keep passing that along and stay in business, in terms of being competitive,” says avice president at a mapping and consulting firm in Lancaster County with some 10 employees. He didn’t want to be identified for this story, so let’s call him Scott.

His company would shop every year for health insurance for its employees. But when it found out premiums for its current plan are shooting up nearly 50 percent next year, it shook the owners. Even after trying some creative solutions, the smallest premium increase it could find is about 22 percent.

So, the company is dropping health coverage for its workers, and instead plans to offer subsidies for those who go to the exchange

“They understood. They know we’ve been trying hard to make this thing work over the past couple years. We have one or two who are a little bit more upset because they have family that they’re trying to cover,” he says.

William Gumbinger hasn’t reached that point, but is getting close. He works on commission for New York Life Insurance in Harrisburg, and hit a crossroads about health coverage after his deductible more than doubled and prescription drug coverage was cut back.

“We’ve looked at the numbers to see if it might even be more cost effective for me to drop my plan and go on to part of her family plan,” he says.

For help navigating the Affordable Care Act, check out Transforming Health’s Getting Covered tool.

This is the most common complaint about the Affordable Care Act, and rates could still go higher in the future. Insurance brokers are finding themselves working with more companies who are following the same path of moving workers off health insurance.

But for every downside, there’s an upside.

As a freelance journalist, John Katz of West Hanover Township, Dauphin County was responsible for finding health care on his own before the ACA came around. With a number of chronic conditions, he had to drop his catastrophic health insurance in 2012 because it cost more than rent and living expenses combined.

“It was really hard to imagine how it could get worse,” he says.

Even with the high premium cost, John’s plan had a $5,000 deductible, and he still forked over about $3,000 out of pocket every year.

But since the first enrollment period last year, he’s back on medication, feels healthier, and doesn’t have to rely on going to the ER for care.

“The premium is low enough that I finally called them and said it’s ridiculous writing a check for this amount every month, how about we just pay it a year at a time? So we’ve gone from higher than my rent and utilities combined to not worth writing 12 checks and putting 12 stamps on it.,” he says.

“Now that’s pretty dramatic.”

Janet Joynes lost her health coverage in 2012 when her divorce became final. She fell and broke her wrist just as open enrollment was starting in 2013, so she didn’t have any safety net. Paying about five percent of her income for health insurance now is worth it.

“For me it’s perfect. I mean for me it’s ideal. I am now 62, I don’t have expectations of increasing my earnings at this stage of my life,” she says.

Joynes sees this as the bridge to Medicare, and calls it a win.

Thus, passing final judgment on the Affordable Care Act may not be advisable. Even years after it was signed, what is true for some may be false for others.

That leaves the actual enrollment.

John DeLorenzo, legal services director at Pinnacle Health, says for those who signed up through the exchange last year, checking it out again this time around is a smart idea.

“Go back out on the exchange and look at your choices because things are changing, prices are changing, you might get a different subsidy based on what your income is this year compared to last year, so you shouldn’t just allow it to roll over necessarily.”

For first time shoppers, like the workers at the Lancaster County consulting firm, DeLorenzo recommends preparing a little more.

“They want to really hone in those doctors that they see, whether or not they’re still in the plan that they’re selecting, once again those cost sharing amounts. Cost is going to be a factor. Some people are going to benefit from those cost shifts, some are not, it’ll all depend on your needs, your specific situation,” he says.

Going without health insurance will also cost more in 2015 – the penalty is jumping to two percent of yearly household income or $325, whichever is greater. There’s still a long list of exemptions available, however.

But, many lower income people are in a better position than before because of the A-C-A. Meanwhile, small businesses struggle to find a solution to premium hikes of more than 20 percent or higher.

So, John DeLorenzo, what’s the future look like?

“Will it ever be easy? No. I’ve been in the industry for 25 plus years, and I’m confused sometimes, so I can imagine what it’s like for people who have never done this before, and are doing it for the first time. So there always will be challenges.”

Those involved in health care policy would likely say the same thing – crafting a law that expands access for tens of millions of people while slowing increasing costs has been (pause). Challenging.

This story is a part of WITF’s Public Insight Network. To share your experiences, click here.