Pensacola, Florida
Tuesday October 16th 2018


Taking Apart the Affordable Care Act

By Jennie McKeon

After beating cancer for the second time, there are two things Nancy LaNasa is grateful for: her health and her healthcare.

Nancy and her husband, Tom, are both 63 and both self-employed. Nancy is a yoga instructor and Tom is a general contractor. They’ve had insurance through Blue Cross Blue Shield pretty much throughout their adult lives. After the Affordable Care Act (ACA) was made law in 2010, they signed up and found better coverage at a better price.

“It saved my life,” Nancy said. “I don’t know what we would’ve done.”

When Nancy was diagnosed with a rare form of cancer earlier this year, it wasn’t news she wanted to hear. But she had peace of mind knowing her bills would be covered.

“I got to see the best doctors, surgeon, oncologist,” she said. “There was no waiting on surgeries. It was a great insurance plan that was affordable. MD Anderson is even in network.”

While Nancy’s cancer is in remission, there’s a chance it could come back—again—since cancer runs her family. Despite her healthy eating habits and regular exercise, the nightmare could be reoccurring.

“There’s a misconception that people get sick because they deserve to get sick,” she said. “I’m a 63-year-old woman who can stand on her head.”

The cost of care
Amber Solnick didn’t have health insurance until she signed up through the marketplace four years ago.

“I always had this fear in the back of my head that if something happened, I would just have to suffer,” she said.

Working as a consultant for small businesses and restaurants, Solnick didn’t have coverage options. While filing taxes through TurboTax, she had six months of penalties when she was prompted to find an affordable plan. It was a good decision in hindsight.

“I never used my insurance the first 18 months,” she explained. “But I started getting weird stomach pains that were so bad, I kept calling in sick to work. When I finally went to a doctor, they found some very large growths in my belly. Luckily, it wasn’t cancer.”

Solnick had to go through hormone and steroid therapy for months at a time. Medications were upwards of $500 a month. Then, she started having another set of stomach issues.

“I literally couldn’t swallow food and if I could, it wouldn’t stay down,” she said. “I lost about 20 pounds and was nearly bedridden.”

She got an endoscopy, thanks to her insurance. Without it, she would’ve faced a $6,000 bill.

“I wouldn’t have been able to afford it,” she said. “Who knows where I’d be? I still have one more procedure to go, not to mention all the ultrasounds and MRIs it has taken to figure out how to fix my stomach.”

Nancy LaNasa and Solnick are just two of nearly 20 million people in America who received coverage through the ACA, otherwise known as Obamacare.

The future of affordable care
During his campaign, President Donald Trump promised voters to repeal ACA. While that hasn’t happened, the law has been weakened with marketplace premiums on the rise. In September, the Florida Office of Insurance Regulations estimated premiums would rise by 45 percent next year. The cause being the uncertain future of the ACA.

After looking for 2018 plans, Tom LaNasa said it would be more than $3,730 a month to insure both him and his wife through the marketplace. Before that, they were paying less than $1,000 for their silver plan.

Solnick said her premium is now tripled from the first year she signed up. There were also more choices.

“At that time (during first enrollment), there was a lot to choose from,” she said. “Not so much now.”

In Florida, where insurance providers have dwindled, Tom said they’ve never been able to keep the same policy since they signed up in 2013. In Escambia County, there is expected to be just one insurer in the marketplace next year. Around 15,000 people are insured here, according to a graphic from the Washington Post.

Still, the LaNasas consider themselves fortunate to have coverage at all.

“We went to the emergency room and it was full of people, a lot of them didn’t have a primary doctor because they couldn’t afford it,” Nancy said.

One important and popular provision of the ACA has been the coverage of pre-existing conditions. Even with the threats of repealing the law, Nancy hopes that any replacement of the ACA keeps pre-existing conditions insured.

“This particular cancer could come back,” she said. “I still have to do CT scans for the next five years.”

Florida is also one of 19 states that did not expand Medicaid. Without the expansion, there’s a gap of people who are left without any coverage options. If you live under the poverty level—the 2016 threshold for a one-person household is an annual income of $12,228—and you don’t qualify for Medicaid under your states rules, you still won’t find a plan through the marketplace.

“Some people are too rich for Medicaid and too poor for ACA,” Tom said.

After two failed attempts at repealing and/or replacing ACA, Republican lawmakers have not given up. President Trump has threatened to cut subsidies, which help pay for the out-of-pocket expense for low-income people. And last week, Senate Republicans announced a tax plan, which includes ending the ACA mandate. Critics of the plan say this action essentially repeals the law.

Congressman Matt Gaetz, who represents the 1st district in Florida, is in favor of the repeal. In June, Gaetz said conservatives should “call the bluffs” of Republicans who passed a repeal of Obamacare in 2016 but in 2017 are saying “now that we could actually get it done, I find myself wringing my hands, wetting the bed and hiding under a table somewhere.”

After the House passed the tax reform bill on Nov. 16, Gaetz went on Fox News with his comments.

“If tax reform turns out to be the vehicle that can give us some liberty from the individual mandate that’s costing money and hurting our economy, I say all the better,” he said.

Meeting in the middle
While the debate over healthcare continues, there are bipartisan efforts to reform.

In a recent op-ed piece, Jules Kariher, Chief Advocacy Officer for Ascension healthcare organization (which Sacred Heart Health System is a part of), talks about ways to cross the aisle and reform healthcare.

Kariher writes that there is a need to stabilize the individual insurance market and applauds the efforts of senators Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) to create the Bipartisan Health Care Stabilization Act of 2017 to fund cost-sharing subsidies and provide more flexibility for states.

Kariher says other timely issues include federal funding for Children’s Health Insurance Program, support for community health centers, access to care for veterans, restraining and price hikes for prescription drugs. She also expressed concerns for children of low-income families.

“As the only children’s hospital in the region, Sacred Heart provides a disproportionate share of care to low-income families who rely on Medicaid funding for children’s care,” she wrote. “Sacred Heart stands to lose large amounts of funding unless lawmakers work together to prevent reductions in payments to healthcare providers who serve a disproportionate number of patients who are most vulnerable.”

Kariher said there have been “major” budget cuts to Medicaid in Florida.

“The State cut $521 million from hospital Medicaid payments this year and Sacred Heart lost $17 million in reimbursement as a result,” she wrote “At a time when safety net hospitals like Sacred Heart are seeing more uninsured persons, Medicaid’s reimbursement has dropped to only 50 percent of the actual cost of providing care.”

Covering mental health
Another important, though not as talked about, side of the ACA is how it expanded mental health coverage. All plans through ACA are required to cover mental health and substance use disorder.

As a psychologist, Patrick Preston said he saw the ACA as a positive turn for the country and people who suffered from mental illness.

“It opened up the opportunity for people to get the care they needed,” said Preston, who owns a practice in Pensacola. “I’ve seen people who were suicidal get the help they needed. This really saved lives.”

At his practice, Preston sees clients who are suffering from PTSD. Regular therapy, which can last from six to 16 sessions, can dramatically help someone. Now, with premiums rising some patients can no longer afford the services. Preston said he had taken some hits at his practice to help prevent patients from “falling between then cracks.” However, some chose to stop treatment altogether.

“I’ve seen folks who were responding really well to treatment, but then they had to bow out,” he said.

Preston said he believes better access to mental healthcare can be good for the economy. People with a healthy mind do better at work and can eventually move on to better jobs. Taking away access only creates more stress, he said.

“When you get to the heart of the matter, these political games just hurt everybody,” he said.

Sign up
Despite its uncertain future, Americans are signing up for healthcare at a faster pace than last year.

Already, more than 1.48 million have signed up for healthcare, a 46 percent increase from this time in 2016, according to the federal Centers for Medicare and Medicaid Services. The deadline is shorter than in previous years running from Nov. 1 to Dec. 15.

Insurance can be complicated. For those who are anxious or unsure about the process, you can opt to sign up through a healthcare navigator. Navigators are free of charge and help you find the plan that fits your needs.

While many nonprofits and organization provide this service, the Epilepsy Foundation of Florida (EFOF) is the second-largest provider of ACA enrollment assistance. You can sign up for assistance at 1-877-553-7453. On average, enrollment takes about an hour.

Cecily Chundrlek is the regional organizer for the ACA Navigation Program for EFOF covering the panhandle to Jacksonville. Since the first open enrollment in 2013, the nonprofit has helped 20,000 people get coverage.

“The Epilepsy Foundation of Florida originally started the navigation program to assist our own clients who were not covered by insurance,” Chundrlek said. “This program was ideal for them since Epilepsy is a pre-existing condition…the program expanded when we realized that there was such a need in the community for us to provide the navigation service.”

Chundrlek said most clients are able to find a plan through ACA, but there are some who cannot meet income requirements. In those cases, EFOF navigators try to link those clients to community resources or private insurance companies.

As early adapters to ACA, Nancy and Tom advise folks looking for insurance to do their research and opt for any coverage over no coverage. You never know when you may need it.

“It’s literally a lifesaver,” Nancy said. “It has been so good for this little family of two.”