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Spotlight on Health: ACA and the uncertainty of health care in a shifting political climate

  • Lisa Beaudoin of Temple researches health insurance plans after no longer qualifying for Medicaid because of a pay raise. Ashley Saari / Monadnock Ledger-Transcript



Monadnock Ledger-Transcript
Monday, October 01, 2018 5:33PM

As the November election approaches, both sides of the aisle have health care among their top priorities.

Last year, the Republicans’ plan to repeal the Affordable Care Act and replace it with the American Health Care Act failed to gain enough traction to pass. However, since then, several other measures impacting the ACA have made their way through the Legislature.

Notably, the individual mandate requiring citizens to either carry insurance or pay a fine has been lifted. While the measure doesn’t go into place until 2019, those filing their tax returns may now claim a “hardship” exemption to the insurance mandate, without needing to provide a justification or backing information.

Detractors of the move feared removing the mandate would de-stabilize the ACA, as there would be fewer young and healthy people to offset those who were using their insurance with more frequency. However, Ken Woods, an insurance broker with Dublin Health and Benefit, said those that come to him seeking assistance with health insurance are still buying through the government marketplace with the same or more frequency since the mandate was lifted in November. While some clients chose not to continue their insurance, those numbers were small, he said, and there was no mass exodus.

“I think most people understand that a penalty isn’t insurance, and not having to pay a penalty still doesn’t give you insurance,” Woods said. “It’s not a cost-effective way of managing your risk.”

Dublin Health and Benefit has about 1,500 clients enrolled in insurance through the ACA, Woods said, and the number has been increasing each year, with this year being no exception. Growth has been particularly robust in the area of small businesses offering group plans to employees, he said, likely a result of a growing economy and continual stiff competition to hire and retain employees in a low-unemployment market.

There have also been, over the past year, cuts to programs meant to assist educating people about the ACA and how to enroll, including slashes to the advertising budget for open enrollment times, and cutting funding for “navigators,” – people trained to assist those enrolling in the program,

Programs such as the River Center and Monadnock Service Link have provided navigator services in the past, said River Center Executive Director Margaret Nelson, but no longer have people in those positions. Those that need assistance can consult brokers such as Woods – who have qualifications that allow them to both answer questions and give advice on plans – or consult with application counselors available at Monadnock Community Hospital.

Alexandra Davison, a resource assistant at MCH, said the lack of funding for navigators will likely put more pressure on her department. Like Woods, she hasn’t seen a drop-off of residents interested in enrolling in health care through the marketplace since the ending of the mandate.

The health insurance struggle

Since the beginning of August, Lisa Beaudoin of Temple has been faced with the daunting prospect of not having health care.

In July, she received a pay increase at the nonprofit she works for – usually a cause for celebration. But the increase in her salary meant she no longer qualified for her health insurance, which she had been getting through the Medicaid expansion program.

Faced with looking to the insurance marketplace, Beaudoin was dismayed to find that buying her own insurance would cost twice her salary increase in premiums.

“It makes jumping into the marketplace unaffordable,” she said.

Leslie Lewis of Peterborough, however, said she had the opposite experience. She was getting her insurance through her employer in 2009, when the cost became so expensive that her employer decided to stop providing health care benefits, leaving Lewis to look at the healthcare market.

Lewis bought her plan through the ACA marketplace, she said, and was able to find a plan with similar coverage, for about the same cost as her 50 percent contribution to the plan she received through her employer.

She was happy with the experience, Lewis said, but she was in constant fear of a repeal of the ACA. So, she made a decision to change jobs, to another digital marketing firm in Keene that provided health insurance. It wasn’t the only reason for her decision, she said – but it was a definite factor.

“That was a big impact,” Lewis said.

There are downsides to relying on an employer for insurance, Lewis said, including that the need to keep your health insurance will keep you at a job that may not be a good fit.

What people are most concerned about, Woods said, is the political “footballing” of the issue of health care.

“A common theme is a general sense of frustration and uncertainty as it pertains the partisan politics around health care,” Woods said. “It leaves people with a general sense of unease as to what’s next.”

Ashley Saari can be reached at 924-7172 ext. 244 or asaari@ledgertranscript.com. She’s on Twitter @AshleySaariMLT.