THE BUZZ 2: Coverage Conundrum

By on January 25, 2017

Millenials in Jackson don’t remember a time before the Affordable Care Act, and they don’t know what to expect next.

After taking his oath of office, President Donald Trump made his first order of business Friday to sign an executive order encouraging the swift repeal of Obamacare.

Jackson Hole, WY — Twenty-four-year-old Danika Comey has bounced back and forth between her parents’ healthcare plans her entire life. Her health insurance depends on whose plan was better between her two parents, which is determined by one thing: The plan that provides the best coverage for her Type 1 diabetes.

Comey was diagnosed with diabetes when she was four years old. She considers herself lucky to have benefited from her parents’ insurance until now. But after she graduates from graduate school, she says her future is less certain.

“It’s pretty scary for me looking forward to the next year or two where healthcare is not a guarantee.”

Comey says that since the Affordable Care Act passed in 2010, she has rested assured that she would have access to healthcare when the time came for her to buy her own plan. Over the past few weeks, her confidence has waned.

This month both the Senate and House approved a budget resolution that would begin to dismantle sections of the Affordable Care Act, also known as Obamacare. And just hours after his inauguration, President Donald Trump signed an executive order urging Congress to strip as much of the Affordable Care Act as they can.

So far, Republicans have not proposed any viable plans for replacing ACA should they succeed in repealing it. Without a replacement, an estimated 18 million people would lose their healthcare coverage in the first year. At least 22,000 Wyoming residents would risk losing theirs.

For millennials, this is both concerning and mystifying. Much of their generation has never known a time before the Affordable Care Act. They have nothing with which to compare the ACA, and cannot know with certainty what a future without it looks like.

Dawn Meckem, licensed insurance agent and self-proclaimed healthcare fanatic, says the before the Affordable Care Act, “unhealthy people were not able to get insurance at all.” Or if they were, it was for everything except the condition for which they needed it.

Without a job and without access to her parents’ plans, Comey says she doesn’t know what her options are, and fears the possibility that she might not have any coverage.

“When you lose employee sponsored insurance, to enter into the private market is expensive,” Comey said, “and then you have this big red flag saying it’s gonna cost insurance more, so you’re gonna have to pay more.”

Comey attends a number of Type 1 diabetes support groups, and has heard enough horror stories to make her nervous.

“It’s not uncommon for [insurance] companies to drop people when they’re diagnosed with Type 1,” she said.

Ensuring coverage for people with preexisting conditions is actually one of the tenants of ACA Republicans want to uphold. The problem, Comey says, is that without a mandate or sufficient subsidies, healthy people, particularly young people, will opt out of coverage all together, and her premiums will rise.

“Most people in our generation are young and healthy,” Comey said, “and I understand the temptation to opt out and not have insurance, but that’s why Obama implemented the mandate … you need healthy people paying in as well.”

But Obamacare isn’t perfect, and this sense of altruism—of paying your premium so others can afford to pay theirs—isn’t actually affordable to everyone. Many millennials in Jackson find themselves in a difficult position of either making too much or too little to qualify for a subsidy.

On one hand, Jackson millennials who are too old to stay on their parents’ plan need incomes that reflect the cost of living in Jackson. So for people like Meckem’s son, the Affordable Care Act has been a “total failure.”

Meanwhile, 26-year-old Amanda Payne was shocked by her $500 monthly premium for the plan she needs. She just outgrew her parents’ plan, but has no substantial income to report as a graduate student. She needs a plan with a low deductible that will cover her prescriptions. Wyoming’s failure to expand Medicaid leaves her ineligible for that as well.  In fact, over the course of her interviews with PJH, she called the Medicaid office in Washington State where she goes to school to see if she qualifies.

She does, and she might soon switch.

While Payne is frustrated with her current situation, she does not blame Obamacare as much as Wyoming’s limited marketplace. Blue Cross Blue Shield is the only insurance provider in Wyoming’s market, and she says a lack of competition allows for providers to increase premiums as they please.

“Despite my personal not-awesome experience, I am still a huge fan of the ACA,” Payne said. “Healthcare in this country has been an issue for decades and Obama at least tried to do something about it. I think it’s unreasonable to expect that it came out perfect the first time.”

Local millennial Cody Daigle has mixed feelings about the Affordable Care Act. As a self-proclaimed “libertarian … leaning towards Republican,” he understands the frustration that many healthy people feel when their premiums increase.

“My biggest mantra in life is ‘look out for yourself,’ he said, “and a lot of people are in that same place. But by that same token, it’s hard to justify paying an extra even $60 a year. That extra five dollars a month is coming out of my paycheck, and why am I having to pay that extra money so someone else can have that same coverage for less?”

While he understands and shares, to some extent, that “me first” mindset, he also acknowledges that ACA has been hugely successful in the sheer number of people it has insured — approximately 30 million. He says he’s proud of that.

Daigle, like Comey, says his healthcare future is uncertain. He has never had to shop the marketplace—he has county insurance through his job with Teton County Parks and Recreation—but he has also never known anything else. Finding insurance is one thing, he says, but finding insurance to cover what he needs is another.

Payne says she also feels misinformed. Even after filling out her application on Healthcare.gov as accurately as she could, she felt she did not quite understand her options.

“I wish I had been taught anything about this, ever, because I’m worried I’m just missing something,” she said.

For all of the millennials that spoke to Planet JH, employment was presented as the only alternative to the Affordable Care Act. And all recognized employment at their age as uncertain.

“I could get coverage from work,” 25-year-old Avery Nelson said. “But I’d end up paying more, and only if I work full-time. Otherwise I’m uninsured and in the same boat as other people, hoping nothing happens.”

Comey graduates from Columbia Graduate School in May, and realizes it could take her years to find a job in her field in public health. During that time, without access to an insurance plan, medical bills could leave her bankrupt. Medical bills, she noted, are the number one cause of bankruptcy in the country. And the medical costs of diabetes are high “even with insurance,” she said.

Millennials, as with the rest of the population, cannot reasonably be painted with one brush, and as such cannot uniformly agree on or be protected by the same insurance policies. At so many different stages in life, it is hard for any of them to know what their future holds. The numbers, however, paint a clearer picture.

The Congressional Budget Office predicts that without the mandate in the nongroup (individual) market, premiums in that market will increase by 20 to 25 percent. Not only would individuals opt out of insurance, but insurance companies would likely opt out of the marketplace, leaving approximately 10 percent of the nation’s population without access to marketplace insurance. Approximately 20 million people would lose coverage in the first year after the repeal, and that number could increase to $32 million in 10 years.

The Washington Post reported Monday that repealing the Affordable Care Act could kill more than 43,000 people a year, based on previous studies on Medicaid expansions. A study in the New England Journal of Medicine found that for every 455 people who gained coverage through Medicaid expansion, one life was saved. By those same estimates, if 20 million people lose coverage, then over 43,000 people could die.

Director of Teton County Public Health and Environmental Health Jodie Pond says the impact of Obamacare in the valley is measurable. Teton County has the highest enrollment in the state; 12 percent of its population enrolled in ACA in 2016.

Still, another imperfection of the Affordable Care Act is the lack of access to healthcare across state lines. Doctor Maura Lofaro of Gros Ventre OB/GYN says she sees patients at her clinic in Driggs who cannot get coverage for the same treatment in Jackson.

“There are people in border towns all over the country who may not have access [to special care] in their town, have to cross the border for special care, and aren’t covered.” Expecting mothers in Driggs, for example, either have to drive to Jackson to deliver their child and risk not being insured, or find an OB/GYN somewhere else in Idaho. The Driggs hospital no longer delivers babies.

The fact remains, however, that if fewer people don’t have health insurance, fewer people will seek out healthcare unless they absolutely need it. The problem then is it’s almost impossible to predict when that will be. Unexpected pregnancies, illnesses and accidents can strike at any time, Lofaro said.

Lofaro sees the Affordable Care Act as a government response to a struggling industry. Unfortunately, she said, “the government cannot be all things for all people.” It is also our collective responsibility to manage expectations.

Pond notes benefits of the Affordable Care Act extend further than insurance rates. Ten percent of the Center for Disease Control budget is made up of a fund made possible by the Affordable Care Act. A lot of that money, she says, trickles down to state and local public health initiatives, including immunizations, HIV prevention and treatment, and community health clinics that provide affordable healthcare to the uninsured. These are the same public health funds that Comey hopes will pay her salary and insure her one day.

It is important to remember, she says, that the huge percentage of Jackson’s population that is uninsured, primarily due to documentation status, that still need healthcare. Without the ACA’s public health provisions, that population is at an even greater loss. PJH

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