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Obamacare: Good, bad and ugly

By Sherri Ellington As the Affordable Care Act, also known as Obamacare, went into effect Jan. 1, the effects in Lamar County have ranged from the good, the bad to the ugly. One self-employed resident, through sheer perseverance ‘“ and the loss of no less than seven of his applications by healthcare. gov staff members ‘“ finally got through the marketplace maze and got affordable coverage that increased his benefits while decreasing his premiums. It kicked in right on time. ’I’m grateful for affordable healthcare,’ he said, noting his former health insurance company began discriminating against him ‘“ he said due to his age ‘“ soon after the act was passed in 2010. ’They forced me over the years to take downgrades to such an extent that I was paying almost $700 a month for remarkably less health care coverage that in no way came close to providing the benefits of my original policy,’ he said. ‘It went up twice again just a few weeks ago. Although I’m basically healthy and work out five times a week, I wouldn’t have been able to financially maintain my current policy.’ After successfully getting registered by a supervisor he chose a plan that provided more comprehensive coverage than his initial policy taken out 12 years ago. It also included dental, all for a monthly cost of $174.57 after subsidies. For others, things are a bit more difficult than simply navigating the glitch-ridden launch of Obamacare. A family of five, whose sole income comes from Jordan Forest Products, is still dealing with the impact of the results of their online application. The federal government excluded their three minor children from eligibility for tax credits, even though the children are listed as dependents with the IRS. They are appealing a decision that their three children must be enrolled in Medicaid or Peachcare ‘“ for which they do not qualify ‘“ while the adults enroll in a policy from one of three insurance companies that are part of the federally operated marketplace in Georgia. ’We’re eligible for a tax credit but our three daughters aren’t. This doesn’t make any sense,’ said the wife, a stay-athome mother. ‘Why would my husband and I be eligible but not our children? They’re our dependents, our income is their income and they should be eligible for similar tax credits to help pay for insurance for our family.’ They hope a written appeal will allow them to enroll in a plan as a family. ’This is what we want the most, rather than to have different plans for different members of our family, or to have to pay one tax-credit-applied premium for us and an extremely unaffordable premium for our girls,’ she said. ‘We need these tax credits for them; it’s the only way we’ll be able to get health insurance for all of us.’ Once the problem is solved, she added, ‘I think the Affordable Health Care Act will be a good thing for all of us. It gets rid of refusal of health care based on pre-existing conditions and higher premiums for women. Premiums are dropping all over the place and the tax credits are letting people who could never afford insurance before get coverage.’ A pre-existing condition is where things get ugly for a woman whose catastrophic health policy was dropped Dec. 31. It is not part of the new health exchange. In Georgia, Humana, Kaiser Permanente and Blue Cross Blue Shield offer 26 plans. Only one is the platinum level plan that is supposed to cover thousands of dollars a month for medical treatment. She subsists on monthly Social Security checks and has been turned down for Medicaid. ’The agents didn’t even know what was going on. I cannot find one soul who seems to know anything,’ she said. ‘I was told to get Medicaid. I told them Georgia didn’t have the expanded Medicaid. The agent didn’t know that. I haven’t got my card or ID number yet, the one you have to use to go to the hospital. Every time I contact them I have to give my Social Security number.’ After getting a $197 a month subsidized plan, which is supposed to pay for 90% of her medical costs, she was told it did not pay for the plasma transfusions she needs every three weeks, nor the thousands of dollars worth of medicine she needs each month to survive. She must also meet all of her deductibles before any payments kick in. ’Every time I went on the site I told them I had to take these treatments,’ she said. ‘I finally got signed up Christmas Eve. I thought it was going to work. The next day details started coming out of the woodwork. The paperwork didn’t match the promises. My treatment is excluded. They’re going to deny me until the day I die but I’m not going to give up.’ Under her doctor’s advice, she spent the New Year’s holiday in the hospital getting last minute treatment that is not covered by the ACA plan before her old plan ran out. Since then she has been trying to get in touch with her new insurer to clear up the matter before her next treatment becomes necessary. She has not gotten through; she is told wait times are 40 minutes or more. ’I have to be covered. If I didn’t get coverage by Jan. 1 I was going to be stuck,’ she said. ‘I’m getting shafted. If I don’t get my treatment I won’t survive. I can’t let that happen.’

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