The Latest News
Melissa Quinn /
Pamela Weldin’s experiences with Obamacare can be boiled down to just a few numbers.
Since the health care law’s implementation three years ago, Weldin, 60, has lost her insurance four different times.
And the Nebraska woman is currently enrolled in her fifth new insurance policy in four years.
“Yet again, and through no fault of my own,” Weldin told The Daily Signal. “I’m just sitting here minding my own business, and here we go again.”
A former dental hygienist, Weldin has all the hallmarks of a consumer intended to benefit from the Affordable Care Act.
She has been denied coverage in the past because of a pre-existing condition related to her career as a dental hygienist.
Additionally, Weldin qualifies for a tax credit, which she has received every year since 2014.
As a result, her premiums are low when compared to consumers who don’t qualify for financial assistance: In early 2015, Weldin purchased a plan through Blue Cross and Blue Shield of Nebraska that cost her $232 each month.
This year, premiums for her silver-level plan with Medica are $161 per month after her tax credit.
But though Weldin has benefited from aspects of the law, she hasn’t been immune to the changes in the health insurance market that have occurred in last few years.
“I’m a person who has been denied because of pre-existing conditions,” Weldin, a Pampered Chef director, said. “I’m on Obamacare and have lost my insurance four times in three years. I understand the challenges, but it’s not sustainable.”
Since HealthCare.gov opened for business in the fall of 2013, four policies sold by three different insurance companies—Humana, CoOportunity Health, and Blue Cross and Blue Shield of Nebraska—that Weldin purchased were ultimately terminated.
The Daily Signal previously covered her experiences with Obamacare in a February 2015 article.
But since then—when Weldin lost her insurance for a third time—she’s logged another cancellation.
First, Weldin’s initial policy with Humana, which she held for several years, was canceled in the lead-up to Obamacare’s implementation in January 2014.
The Nebraska woman then purchased a platinum-level plan for 2014 through CoOportunity Health, a consumer operated and oriented plan, or co-op. But CoOportunity Health terminated her platinum-level policy for 2015 after the co-op decided it would no longer offer those policies.
Weldin, though, decided to stick with CoOportunity Health and selected a silver-level plan for 2015.
On Jan. 23, 2015, Weldin received a notice from the co-op notifying her that it was going out of business. CoOportunity far outpaced its initial enrollment projections, and its customers racked up medical expenses that far outpaced what they paid in premiums.
Weldin had no choice but to select a new insurer and policy, and purchased coverage through Blue Cross and Blue Shield of Nebraska for the remainder of 2015 and 2016—a plan that, though a bit more expensive, allowed her to see her original doctor.
Late last year, though, Blue Cross and Blue Shield of Nebraska announced it would no longer sell coverage on the exchange in the state.
“This system is collapsing under its own weight,” Weldin said, “like the co-ops and basic companies like Blue Cross pulling out of Nebraska.”
To ensure she would be covered for 2017, Weldin went to HealthCare.gov to select a plan that allowed her to see her current doctor in Colorado.
In Nebraska, consumers on the exchange had just two insurance companies to choose from: Aetna and Medica.
A policy through Aetna was more expensive than its competitor, but because Weldin thought her doctor was considered in-network, she selected a plan through that insurer.
It wasn’t until after she paid her first month’s premium, however, that Weldin learned from the insurance company that any doctor located more than 100 miles from her rural Nebraska home wasn’t in her network.
If she wanted to see her doctor in Colorado—considered out-of-network now—Weldin had to meet a $20,000 out-of-network deductible before Aetna would start covering her medical expenses.
That information, she said, wasn’t listed on HealthCare.gov when she was shopping for plans.
“$20,000 for a deductible? Are you kidding me?” Weldin said. “How is that affordable?”
Across the country, millions of Americans faced higher premiums heading into 2017.
And premium hikes have been well documented by The Daily Signal and others.
Less attention, however, has been paid to the number of insurers and plans available to consumers.
According to an October report from the Department of Health and Human Services, insurer participation in Nebraska decreased from four insurers in 2016 to two in 2017.
And consumers nationwide aren’t just seeing a decline in the number of insurance companies selling coverage on the exchange in their states.
The federal government reported that Americans would also see a decrease in the number of plans insurers offered in 2017.
In Nebraska, there was an average of 18 fewer plans per county available on the exchange to consumers this year. Nebraskans purchasing plans on HealthCare.gov in 2017 had 13 plans to choose from, down from 31 last year.
“That speaks volumes in terms of ultimate consumer benefits,” Rep. Adrian Smith, R-Neb., told The Daily Signal of the change in insurers selling plans in his state. “Fewer choices most often means higher prices and less quality.”
In 2015, Smith introduced a bill to exempt consumers like Weldin who purchased coverage from a failed co-op from the individual mandate. The legislation passed the House, but stalled in the Senate.
Now, Smith and other Republicans—who have spent six years talking about repealing Obamacare—are looking to check the box on a major campaign promise.
Republicans have taken the initial step toward dismantling the health care law after passing a budget resolution earlier this month, and often cite the experiences of Americans like Weldin to bolster their arguments that Obamacare needs to be repealed and replaced.
But despite their control over Congress and the White House, Republican lawmakers differ on their approaches to unwinding Obamacare.
Conservatives are urging GOP leadership to move forward with repeal as soon as possible and say they’re frustrated with the speed at which their leaders are moving to dismantle the health care law.
House Speaker Paul Ryan said last week repeal would be slated for March or April.
“I’d like to see an acceleration of the front-end repeal side,” Rep. Jim Jordan, R-Ohio, said Wednesday at a monthly gathering with reporters. “Let’s get rid of [Obamacare]. That’s what we told the voters that we were going to do.”
Jordan was joined by other Republicans who said they want to see GOP leadership move faster on Obamacare repeal.
“I, too, am frustrated with the pace,” Rep. Scott Perry, R-Pa., said Wednesday. “We need to not only be against the [Affordable Care Act] or Obamacare, which I am for a myriad of reasons … but we also, if not for political reasons, but for the reason that our constituents and America needs to know what we stand for. We should vote on something.”
But during a gathering last week of House and Senate lawmakers in Philadelphia, other Republicans showed tepid support for dismantling the law and even expressed doubts over their party’s plans to repeal and replace Obamacare.
Though the GOP agrees that the law needs to be scrapped, members haven’t yet concurred on whether to repeal major parts of Obamacare like its taxes. Many also want to see Congress move a replacement at the same time they repeal the law.
Still, Smith, the Nebraska congressman, points to Americans like Weldin as a reason why Congress needs to act.
“When you look at the overall picture, [Obamacare] has failed miserably and will continue to cause great damage,” Smith said. “That’s why we need to step in.”
“We want to prevent further pain that we know will happen if we just let Obamacare sit the way it is,” he continued.
After learning about her $20,000 out-of-pocket deductible, Weldin contacted HealthCare.gov to seek assistance with purchasing another plan.
A representative there was able to enroll her in a new policy with Medica, and Weldin learned that her doctor was, in fact, included in the new plan’s network.
This year, the Nebraska woman will pay $161 per month in premiums after a tax credit.
Weldin is one of the more than 9 million Americans who receives a tax credit and has been relatively immune to the increased costs of health insurance, but she still wants to see changes made to the health care system.
“Allow us the choice of what kind of policy and coverage suits our needs,” she said. “Allow us the choice of deductible and to cross state lines for provider care so we can choose and keep our own doctors. Allow insurance companies to compete across state lines so we have more options and have more choice of providers.”
And Weldin said she recognizes that any action Republicans take on Obamacare could very well lead to further changes with her insurance and the health insurance market.
Still, she said she wants to have additional choices, even it means more coming out of her pocketbook.
“Something has to be done because this is not sustainable,” Weldin said. “I’m fine paying a little bit more if it’s what I need. But let me choose a policy that’s appropriate for my needs. Let me have a policy that’s appropriate to my medical needs. Let me choose a deductible that’s appropriate for my budget.”
This article has been modified.
Melissa Quinn /
On the night of the election three weeks ago, Rochelle Bird stayed up late watching the returns with a friend.
Bird, a financial adviser from Overland Park, Kansas, recalled being in knots in the days leading up to the election.
“If it didn’t go the way of [Donald] Trump, the next four years and possibly eight were going to be hell on wheels to financially endure in this country,” Bird told The Daily Signal.
So when the Associated Press eventually announced real estate mogul Donald Trump as the winner, Bird let out a sigh of relief.
Public policy affects Bird, as it does many other Americans, and she says she hopes that policymakers will consider people like her while making decisions in Washington, D.C.
Bird doesn’t expect to like everything Trump does after he takes office Jan. 20, but there’s one issue in particular she’s watching: health care.
Bird is one of roughly 10 million Americans who doesn’t receive insurance from an employer—she’s self-employed—and also doesn’t qualify for a subsidy. So when insurers announced double-digit premium increases for 2017, she prepared to pay full price for coverage purchased in the individual market.
And that wasn’t it.
Coventry Health Care sent Bird a notice last month saying it would cancel her policy at the end of the year.
On the first day of open enrollment, the Overland Park resident selected a new plan through Blue Cross Blue Shield of Kansas City, one that is only $50 more than her old policy.
But though Bird’s premiums increased minimally compared to others across the country, her deductible is higher and she has less coverage than with her previous plan.
“I’m paying more for less,” she said.
According to the Obama administration, 20 million Americans gained health insurance coverage under Obamacare. While many of those 20 million may be worrying about the future of their health insurance in a Trump administration, Bird isn’t one of them.
And she’s not alone.
“For the percentage of people who have been helped, it’s significantly impacted people in a disproportionate way,” Bird said of Obamacare. “It’s irrational. If you want to say we want to be a country that makes sure everyone has an option for health care, OK. But we’ve proven this isn’t working.”
Repeal Before Replace
Republicans in Congress voted more than 60 times to repeal the Affordable Care Act, popularly known as Obamacare, and each bill failed to make it out of the Senate and go to the White House.
But following Trump’s victory Nov. 8, GOP lawmakers are fine-tuning their strategy to get a bill repealing the health care law to Trump’s desk in the White House—a bill he is likely to sign.
Trump said repeatedly on the campaign trail he would repeal Obamacare and is in favor of allowing insurers to sell policies across state lines, expanding access to health savings accounts, and creating block grants for Medicaid.
Earlier this month, leaders of the House and Senate budget committees endorsed a repeal plan that involves passing two budget resolutions—one for 2017 and one for 2018—that include instructions for reconciliation, a budget tool that allows legislation to pass the Senate with only 51 votes.
Congressional Republicans used reconciliation to repeal Obamacare in 2015, but President Barack Obama ultimately vetoed the bill earlier this year. Now, they’re looking to use that legislation as a model to roll back the health care law in 2017.
Republicans haven’t yet agreed on a replacement plan for Obamacare, but House Majority Leader Kevin McCarthy, R-Calif., told reporters Tuesday that replacement would come later.
“My personal belief, and nothing’s been decided yet,” McCarthy said, “but I would move through and repeal and then go to work on replacing.”
Republicans have said they want to ensure those with coverage through Obamacare have a smooth transition to the new system, and legislation dismantling the law likely would include a delayed enactment date, giving lawmakers time to craft and pass a new plan.
But some health policy experts believe any Obamacare replacement could take years to put into place.
“If we’ve learned anything, it’s that implementation isn’t automatic,” Timothy Jost, a law professor at Washington and Lee University School of Law, told The Daily Signal.
“The idea that we can repeal by Jan. 6—there are going to be millions grievously hurt by this, including people who have coverage through the Affordable Care Act and don’t have the money and can’t get the money to cover cost-sharing or insurance on their own,” Jost said.
Indeed, some Americans are worried about the future of their coverage come 2018.
In an interview with CNN earlier this month, Ron Pollack, executive director of the pro-Obamacare group Families USA, said there could be significant backlash from consumers if health insurance under Obamacare is taken away.
“There are a lot of things we don’t know yet [about a replacement plan], but we do know there are tens upon tens of millions of people who depend upon the Affordable Care Act, who depend on Medicaid, and, of course, they are terribly worried that the coverage they have would be taken away,” he said.
Still, health policy experts advocating Obamacare’s repeal are encouraging policymakers to set a timeline to ensure reforms are in place by 2019.
In a paper released last week, Nina Owcharenko and Ed Haislmaier of The Heritage Foundation said Congress should not allow provisions of the Affordable Care Act, such as the subsidies, to expire before new measures take effect:
Timing and sequencing of these efforts are complex, and proper execution is critical. Congress, the new administration, and the states should work together to ensure a smooth transition for the repeal of Obamacare and to create a path toward a more patient-centered, market-based approach to reforming the health care system.
Like Bird, Warren Jones, a veterinarian in Missouri, is also optimistic about Obamacare’s repeal and what will replace the law.
“It’s a good thing overall, and I think everybody is open to the optimism of it,” Jones told The Daily Signal. “The media has been portraying it in such a way that Trump was going to take all the insurance away from the people that were insured on Obamacare.”
“He’s not talking about ripping everyone’s insurance away,” Jones said. “He’s talking about replacing it with something better, and that doesn’t mean you take everyone’s insurance away first and let them suffer from that.”
Jones, who also spoke about Obamacare with The Daily Signal last month, has a plan through Blue Cross Blue Shield of Kansas City. The company sent Jones a letter in October notifying him that his monthly premiums would increase from $491 to $716 for 2017.
Jones toyed with the idea of changing carriers, but when rates for Missouri were released before the start of the 2017 open enrollment period, the veterinarian learned that his plan would be the cheapest option available.
As a business owner, Jones said he’s looking forward to the impact that repeal of the health care law will have not only on his own wallet, but also on the business community.
Before, many business owners opted to lessen workers’ hours to below 30 hours per week to avoid having to provide them with health insurance coverage. Jones said he also knows of many employees who were forced to watch their hours and income so they wouldn’t lose their subsidy.
But now that Obamacare is likely to be repealed, he sees “cautious optimism” from his fellow business owners:
They’re going to loosen the purse strings a little to make the repairs and make the growth moves that they want to do to improve their business. People have been holding off to see what direction things were going. Now they know what direction it’s going to go.
There are aspects of Obamacare that Jones would like to see included in a replacement plan, such as the measure that allows those under age 26 to remain on their parents’ plan, as well as the provision that prohibits insurers from discriminating against consumers with pre-existing conditions.
But he said he hopes that any new plan would create high-risk pools, expand access to health savings accounts, and do away with the essential health benefits package, a list of mandatory benefits each plan must cover.
“We might be able to have a choice that makes an affordable plan for us, instead of having to take the one-size-fits-all,” Jones said.
Trump hasn’t yet said whether he plans to roll back any of the regulations implemented as part of Obamacare, but Jones said he hopes the new president takes a more piecemeal approach to changing the law, one that would help eliminate some fear among consumers.
“I understand there are people afraid and worried about it now that they have insurance,” he said, “but I don’t think you’re going to run into a heartless decision that jerks insurance away from people.”
Since the beginning of 2016, four ObamaCare co-op insurance plans have failed. That means tens of thousands of Americans are feeling the pain, all thanks to the so-called Affordable Care Act:
A new wave of failures among ObamaCare’s nonprofit health insurers is disrupting coverage for thousands of enrollees and raising questions about whether regulators could have acted earlier to head off some of the problems.
The latest round of failures poses an even thornier problem than earlier cases because enrollees’ coverage is now being disrupted in the middle of the year. That can increase patients’ out of pocket costs and make it harder to keep the same doctors.
In Illinois, Oregon and Ohio, a combined total of about 92,000 people are being forced to find a new plan. A co-op in a fourth state, Connecticut, will last until the end of the year.
Ouch. That’s 92,000 more people who have had their health care plan unceremoniously disrupted, all thanks to ObamaCare.
Are you one of those people? If so, could you take just a few minutes to answer a couple of questions to help us learn more about your experience with ObamaCare’s failing co-ops?
— Broken ObamaCare (@BrokenObamaCare) July 25, 2016