By Jim McLean
KHI News Service
TOPEKA, KAN. — Sherry Calderwood wishes she could turn back the clock.
Last fall, she and her husband decided not to purchase health insurance through the Affordable Care Act marketplace because it cost too much.
The 45-year-old waitress, who banters with legislators and lobbyists at a popular Topeka breakfast spot just a few blocks from the Kansas Statehouse, had gotten by for years without coverage and thought her luck would hold.
“I thought, ‘Oh well, I haven’t been sick all these years. I’ll be fine.’ And here I sit,” Calderwood said while taking a short break during a recent lunch rush.
Sapped of energy and bruised from head to toe, she recently went to the doctor and was given a preliminary diagnosis of idiopathic thrombocytopenic purpura, an autoimmune disease that thins the blood and in extreme cases causes internal bleeding. Thousands of dollars in tests and hospital stays later, doctors still haven’t pinned down the reason for Calderwood’s condition.
Calderwood is worried about leukemia and other possible causes. And she’s worried about how she is going to pay the bills she’s already racked up.
“Yeah, I’m worried,” she said. “I’m worried about my house, my car payments, my family. Christmas is coming up.”
Before Obamacare, Calderwood’s diagnosis would have made it virtually impossible for her to get health insurance.
“She would have most likely been denied coverage,” said Kansas Insurance Commissioner Sandy Praeger. “The high-risk pool was there for folks like her, but the premiums were high. It probably would have been unaffordable.”
But that’s not the case anymore. The ACA says insurance companies can no longer deny coverage to people who already are sick.
“I do feel thankful for that,” Calderwood said. “I would have been sitting here with no insurance for the rest of my life.”
Obamacare has given Calderwood a second chance to get health insurance. A new ACA open enrollment period started Saturday, and she’s made an appointment this week with a navigator to select a plan.
Opponents of the reform law predicted that rates would increase sharply. But the average premium for all plans has increased just 0.1 percent from 2014 to 2015, according to an analysis by the Kansas Health Institute, the parent organization of the editorially independent KHI News Service.
Rates are based on the level of coverage — bronze, silver, gold or platinum — and an individual’s age, place of residence, family status and whether they smoke.
If catastrophic plans — which are available only to individuals under age 30 or those with special hardship exemptions — are excluded, the average premium actually decreased by 1.1 percent.
However, there are wide variations in cost. Premiums for some silver plans — the coverage level selected by most Kansans in 2014 — range from 11.6 percent more to 13 percent less in 2015, according to the KHI analysis.
Still, Praeger said, Kansans who purchased coverage during the first enrollment period should be able to avoid paying higher rates if they don’t re-enroll and instead go back to the online marketplace and evaluate their options.
“I think most Kansans will be able to find something that fits their needs that is either the same price or even a little lower,” Praeger said. “The important thing is that they need to go back and shop.”
Kansans with annual incomes between 100 percent and 400 percent of the federal poverty level are eligible for tax credits on a sliding scale. The credits are paid directly to insurance companies to reduce premiums, Praeger said.
“They (consumers) don’t have to wait until they file their tax returns,” she said. “They get the benefit of that tax credit up front.”
An individual making $12,000 a year and living just above the poverty line could buy a silver plan for about $200 a month but pay a monthly premium of only $20 after the tax credit is applied. A person making $25,000 a year would get a smaller tax credit and pay $142 a month for the same plan.
Kansans may choose from among 82 plans offered by five insurance companies in the 2015 marketplace, up from 72 in the previous enrollment period.
Trained “navigators,” many of whom work for nonprofit organizations, are available along with insurance agents to help consumers shop the marketplace and select a plan. Information about how to contact a navigator and a schedule of upcoming enrollment events is available at the InsureKs website operated by the Kansas Insurance Department.
A little more than 57,000 Kansans purchased insurance in the marketplace during the first enrollment period. That is about 19 percent of the 298,000 Kansans that KHI estimates are eligible to get coverage through the marketplace.
Well-documented problems with the marketplace website operated by the U.S. Department of Health and Human Services depressed enrollment during the first sign-up period, Praeger said.
“I think potentially we’ll have more enrollees this year because we’re not going to have all the problems with the website crashing as it did last year and people getting frustrated and giving up,” she said.
The current open enrollment period extends through Feb. 15, 2014.