By Warren Vieth, Oklahoma Watch
Hugh Meade hopes he can find a health plan that costs less than his home mortgage. Katie Bolin is looking for an insurer who won’t turn her down for pre-existing conditions. Ricardo Lopez Jr. wants coverage so he can stop going to free clinics.
Meade, Bolin and Lopez are among several hundred thousand uninsured Oklahomans whose lives could change when the next phase of the Affordable Care Act takes effect.
Starting Oct. 1, Oklahomans can begin applying for private-market policies through a new federally-operated health insurance marketplace. The policies will take effect on Jan. 1, 2014.
The marketplace is open to anyone who is not eligible for affordable employer-provided insurance or public insurance programs such as Medicare and Medicaid. People who fall within certain income ranges will qualify for federal tax credits and cost-sharing subsidies that will reduce their health-care expenses.
Many people remain confused about the rules, although the federal government is offering information and pre-registration at www.healthcare.gov and, in Spanish, at www.cuidadode salud.gov. The toll-free information line is (800) 318-2596. Licensed health insurance agents and brokers can provide assistance, too.
The Kaiser Family Foundation’s online tax credit and premium cost estimator is at http://kff.org/interactive/subsidy-calcu lator/
The coverage options available through the health-care act, widely known as Obamacare, won’t necessarily work for everyone. But for people like Meade, Bolin and Lopez, they might make sense.
Here are their stories.
Name: Hugh Meade
Location: Oklahoma City
Occupation: independent sign contractor
Estimated 2014 income: $28,000
Estimated silver plan premium: $84 per month
Estimated bronze plan premium: $26 per month
Hugh Meade has been working with saws and other power tools all of his adult life. So far, they’ve been good to him.
But he worries about what might happen.
“I don’t know a lot of guys who work with tools as long as I have who still have all their fingers,” he said. “It’s luck more than anything else. And I don’t know how long that’s going to hold up.”
Meade, 43, has gone without health insurance since moving to Oklahoma City from Atlanta 10 years ago. His wife Tammy was uninsured, too, when one of her spinal disks collapsed several years ago, requiring emergency surgery.
“She was literally unable to move. She had to crawl across the floor to get somewhere,” Meade said. “We still have massive debt from that.”
Meade is a cabinetmaker by trade. But he found that he could make better money as an independent sign contractor, so he opened Oddfab Design Lab, a small sign-fabricating shop in Oklahoma City’s Film Row district.
The firm did well last year, generating about $45,000 in income for the family. Revenues were much lower this year. He expects his income will be about $28,000 next year, when the Affordable Care Act insurance marketplace takes effect.
Meade’s 9-year-old son, Nic, is covered by a private-market health plan. The Meades purchased the policy when Nic was 11⁄2 years old and have been paying the premiums ever since. His wife now has health coverage because of her disability.
Meade continues to do without. He shopped for private-market insurance, but gave up after learning the premium would cost close to $600, more than his monthly mortgage payment.
“I’m the only income earner,” Meade said. “I’m the guy who should be insured. But we can’t afford it.”
According to the Kaiser Family Foundation, Meade should be able to get a silver-level health policy through the Affordable Health Care Act online marketplace for about $84 per month, after tax credits. Silver plans are designed to cover about 70 percent of an average person’s annual health care costs.
He should be able to get a less generous bronze plan for about $26 per month, after tax credits. Bronze plans are expected to cover 60 percent of health care expenses.
If Meade chose a silver plan, he would also qualify for federal cost-sharing subsidies that would further reduce his annual health care outlays.
Meade said he plans to check out his options when the health insurance marketplace begins taking applications on Oct. 1. He also wants to see whether he might qualify for coverage through Insure Oklahoma, an existing program operated by the state.
“I’ve done physical, hard labor almost all of my working life. I can feel it every day when I get up. My back hurts, my leg hurts, my hands,” Meade said.
“It’s very frightening. I don’t even know necessarily whether insurance is the correct answer. What I need is access to health care. I’m willing to pay for that. But I think that people who can’t afford to pay for it shouldn’t have to expect to simply become sick or become crippled or die.”
Name: Katie Bolin
Occupation: licensed practical nurse
Estimated 2014 family income: $65,000
Estimated silver plan premium: $307 per month
Estimated bronze plan premium: $255 per month
Katie Bolin works a 16-hour shift every Saturday as a home health-care nurse, helping other people deal with their aches and pains.
But when she gets sick, she’s pretty much on her own.
Bolin, 35, works as licensed practical nurse in Yukon. Because she’s part time, she doesn’t qualify for employer insurance.
She tried to get private market insurance after her husband, Rick, was laid off from his full-time job in 2009. She was afraid she might get turned down because she had a history of sinus infections and bronchitis.
Her hunch was correct, but not for the reasons she expected.
“When I had my first son, I was diagnosed with postpartum depression. I was on Prozac for about two months. They told me I had a diagnosis of depression and was uninsurable,” Bolin said.
“I was devastated,” she said. “My husband had just been laid off. Ever since I’ve been able to, I’ve been a working person and worked hard and carried insurance and everything, and then it was just like being left out in the cold.”
Rick, 44, now works as a part-time graphics designer. He and their two sons, Levi, 5, and Emmett, 4, are covered by a private-market health plan at a cost of about $500 per month.
Bolin was able to get employer-provided insurance for awhile after she went back to work as an LPN. But when she stopped working full-time to spend more time with her sons, she lost her coverage. She’s been without insurance for more than a year.
On Jan. 1, Bolin will be able to get insurance again. That’s the effective date of the policies being offered through a new federally-run health insurance marketplace created by the Affordable Care Act. People can begin applying for coverage on Oct. 1.
Under the terms of the act, widely known as Obamacare, participating insurance companies can’t deny coverage based on pre-existing conditions. That means Bolin is guaranteed she can get a policy.
According to the Kaiser Family Foundation, Bolin should be able to buy a silver-level health plan in the Affordable Care Act marketplace for $307 a month, or a less-generous bronze plan for $255.
Bolin estimates the family’s combined income will rise to about $65,000 next year, after she receives a nursing degree from Oklahoma City Community College in May and goes to work as a registered nurse. At that income level, Bolin would not qualify for federal tax credits to reduce the cost of her insurance, if she buys it only for herself.
But if the entire family enrolls for coverage through the marketplace, the combined monthly premium would be $477 for a silver plan or $309 for a bronze plan, after tax credits, according to Kaiser.
That’s less than the Bolins are paying now for the plan that only covers her husband and the boys.
“If it’s going to be a better deal, I’m all for it,” Bolin said. “I figure that on Oct. 1, I’m going to be on the computer checking it all out.”
Name: Ricardo Lopez Jr.
Occupation: legal assistant
Estimated 2014 income: $25,000
Estimated silver plan premium: $286 per month
Estimated bronze plan premium: $237 per month
Ricardo Lopez Jr. resides in the coverage crater.
He can’t receive reduced-cost health coverage under the Affordable Care Act, because he doesn’t make enough money to qualify for its tax credits or cost-sharing subsidies.
But he makes too much money to qualify for Medicaid.
As a result, Lopez is one of the estimated 130,000 uninsured Oklahomans who won’t benefit from the next phase of Obamacare.
Lopez, 30, is a full-time legal assistant at a small law firm in Tulsa. The firm doesn’t offer health insurance to its employees. He said his annual income is about $25,000.
Lopez has four boys and a girl at home, ages 3 months to 15 years. His 31-year-old wife, Diann, is a full-time mother. The five children are covered by Oklahoma’s version of Medicaid, called SoonerCare, but Lopez and his wife have too much income to qualify. So they get by without insurance.
Lopez is a diabetic. He goes to a free clinic every month to refill his prescription for Metformin and another diabetes medication. He pays $4 per month for each prescription.
“I haven’t really gone to the doctor,” he said.
The Lopezes fall below the federal poverty line for a family of seven. When the Affordable Care Act was signed into law in 2010, people like them were supposed to be covered by a nationwide expansion of Medicaid.
The Supreme Court struck down that portion of the law, saying the federal government couldn’t force states to expand their Medicaid programs. Oklahoma refused to do so.
Lopez and his wife still can buy insurance through the health-care law’s online marketplace. But they would have to pay the full rates charged by participating insurance companies. The tax credits and subsidies are available only to people with incomes above the poverty level.
According to the Kaiser Family Foundation, it would cost Lopez an estimated $286 a month to buy a silver-level plan for himself in the federally run marketplace. A cheaper bronze plan would cost $237 a month.
Because his wife is a year older than he, a silver plan would cost her $292 a month and a bronze plan $242.
Lopez said it would be difficult for him to pay that much for insurance, although he didn’t rule it out completely.
But there may be a silver lining for the Lopez family. The state runs a separate program called Insure Oklahoma, which provides health insurance to about 30,000 working people who satisfy certain income and employment criteria.
It appears the Lopez family would qualify. If so, they could receive health insurance for $71 per month apiece, or a combined $154, according to the Oklahoma Health Care Authority.
It’s not clear whether Insure Oklahoma will continue beyond 2014. The federal government had planned to stop funding it at the end of this year, because Oklahoma declined to make changes it had requested. The state recently announced it had obtained a one-year extension of the program, but its future remains murky.
Lopez said he was aware of Insure Oklahoma, but had never looked into it.
So far, he said, his health care expenses have been minimal because the free clinic has absorbed most of the cost. But he plans to investigate his options soon.
“I know I’ve got this problem, but I’m not doing too much about it,” he said.
“That’s something I will check into.”
Oklahoma Watch is a nonprofit organization that produces in-depth and investigative journalism on important public-policy issues facing the state. More Oklahoma Watch content can be found at www.oklahomwatch.org. Oklahoma Watch receives funding from the George Kaiser Family Foundation.