In the era of Affordable Care, some still uninsured — by choice

Thursday, May 22, 2014 | 6:00 a.m. CDT; updated 6:37 a.m. CDT, Thursday, May 22, 2014

COLUMBIA — Younger people have been a hard sell on health insurance, according to the numbers. But not everyone who decided against buying insurance in the Health Insurance Marketplace made that choice without the facts.

The online marketplace launched on Oct. 1 as part of the Affordable Care Act. The federal government-operated website allows consumers to compare and buy health insurance plans from private insurance companies.

The Missourian talked to Columbia residents about their trials, worries and successes in navigating the marketplace created by the Affordable Care Act.

Some said they had trouble enrolling because of glitches on the website. Some decided they would rather pay the fine for being uninsured. Others were thankful they finally could afford health insurance.

Columbia business owner Darneill Marshall, 39, hasn't been insured for roughly the last 10 years, though he provides insurance to some of the employees at his janitorial business.

Marshall said he deliberately chose not to buy coverage and knows he'll be penalized for being uninsured. His reason? He said he wants be able to choose his own health care provider if he decides to buy insurance.

Via the online marketplace, people can choose an insurer and specific plan from those provided. After picking a plan, people can then choose a network provider accepted by the policy.

Marshall said that he may someday buy health insurance, but for now he would rather pay the penalty.

"I've never been ill, never been sick," he said. "I've never been in situations where I may need it."

Meanwhile, three of the five employees of his commercial janitorial service, Marshall Janitorial Services, qualify for insurance through his business. He said he offers health insurance to those who work more than 29 hours per week.

William Ramsey, 28, was covered by his parents' insurance while he was a student at MU, but he was dropped from the policy when he graduated in 2009 and was uninsured for about half a year.

Because of a pre-existing condition, Ramsey was unable to get health insurance through a private company and ended up buying subsidized heath insurance for about $240 a month from the Missouri Health Insurance Pool, a nonprofit organization that provides coverage to people who can't get insurance due to health conditions.

But Ramsey's plan didn't meet federal requirements under the Affordable Care Act and ended Dec. 31.

In October, a few months before his plan would end, Ramsey began looking for new coverage and tried to enroll through the online marketplace. He said he tried six times and each time spent 20 minutes on the site before being kicked back to the home page because his "username was already taken." Ramsey said he created an account but couldn't actually buy a plan.

He looked for insurance using the online marketplace again in December and still found it "absurdly confusing." Eventually, he called the help number on the marketplace website but said there was a long wait and he was unable to speak to a representative.

After he got into a motorcycle accident on March 21, he began his search anew. In April, he called the marketplace help number again for help enrolling and bought insurance from Coventry Health Care with coverage that began May 1.

Ramsey said he pays $171 per month for a plan that has higher deductibles and less coverage than his previous insurance.

He's taking prerequisites at MU so he can apply to graduate school and become a physician assistant. He said that whatever graduate school he attends may offer insurance, but he will continue to be insured through the plan he found on the online marketplace for now.

Although Amanda Nell Edgar, 32, has free health insurance through MU, she said her parents had a more difficult time finding coverage.

Edgar is a communications graduate student at MU and is a teaching assistant. She receives free health insurance through the university, but she said she looked at the plans on the online marketplace, mostly as a hypothetical exercise.

"I looked when there was all the controversy about it (the website) being awful, but I didn't see any problems," Edgar said. "The plans looked really good."

Edgar said she cares mostly about women's physicals, which are now free for all insured women through the Affordable Care Act.

Her parents, however, are about five years away from qualifying for Medicare and make just enough money to disqualify them for subsidized insurance through the government.

Edgar said her mother is retired, while her father is insured through his job as a contract worker. She said that their insurance policy is expensive, and it's unfortunate that they have an added strain on their finances.

Edgar said that she's not worried about her parents' situation, and while she supports the Affordable Care Act, she wishes that the government provided health care for everyone.

Jen Davis, 29, was uninsured for five years before deciding to buy health insurance in March.

Davis owns a 3-year-old eco-friendly house cleaning service called Nitty Gritty Green Cleaning, where she cleans houses and produces alternatives to harsh chemicals that end up in waterways like the Missouri River.

Davis said she has been uninsured for the past five years because she couldn't afford health insurance. Now, she said, she bought coverage from the online marketplace because of the law and to avoid the penalty. But the biggest incentive to buy, she said, was that health insurance was finally affordable.

Davis tried to enroll through the online marketplace but said that she had technical issues on the website — the screen kept freezing and she gave up, she said. She called the 800 help number to finish the enrollment process and is currently insured and has coverage.

"I'm really thankful for the program — for having health insurance through the Affordable Care Act," she said.

Supervising editor is Katherine Reed.

Didn't enroll? Here's what's next

The next open enrollment period for 2015 coverage through the online marketplace begins Nov. 15.

For now, people who didn't act quickly enough still have a few options if they want health insurance:

  • See if you qualify for a Special Enrollment Period to buy a private health plan through the online marketplace. To qualify for a special enrollment period, you must have a "qualifying life event" such as moving to a new state, changes in income or changes in family size. You can also qualify if you have what the federal website classifies as a "complicated situation," such as a serious medical condition that kept you from enrolling, or having a technical error while enrolling.
  • Enroll in Medicaid and the Children's Health Insurance Program, which provide health insurance for some low-income individuals. While Missouri has chosen not to expand its Medicaid program, you can see if you qualify for Medicaid under Missouri's current laws by contacting Missouri's Medicaid agency.
  • Buy a private insurance plan outside the online marketplace.

Under the law, most people who didn't buy insurance by the March 31 deadline are required to pay fines, collected and enforced by the Internal Revenue Service. This year, the penalty for an individual is 1 percent of total income or $95, whichever is more. The penalties increase for the next two years and then adjust for inflation.

The higher the fines for not enrolling in a health insurance plan, the more likely Americans are to sign up, according to a Gallup study. With a fine of $95 for being uninsured, 47 percent of Americans said they would buy insurance, 46 percent said they would pay the fine, and 7 percent had no comment. However, as fines increase to $500, 60 percent of Americans said they would buy a plan, as opposed to 32 percent who said they would pay the fine and 8 percent had no comment.

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