I don't think
Obamacare will help us. I don't want anything to do with it," Stephanie Recchi told me a week after the launch of
HealthCare.gov
on Oct. 1. "I hear a lot of bad things about it--that it doesn't cover
pre-existing conditions and it's too expensive," she added, referring to
what she said were "television ads
and some politicians talking on the
news. Just a lot of talk that this is a bad law."
Recchi's
interest in health insurance is anything but casual. Those who read
TIME's special report in March on health care costs ("Bitter Pill: Why
Medical Bills Are Killing Us") may recall that when Stephanie's husband
Sean, then 42, was diagnosed with cancer a year earlier, the couple--who
together were drawing about $3,500 a month from the small business they
had just started in Lancaster, Ohio--had to borrow from her mother and
max out their credit cards to try to save him.
MD
Anderson Cancer
Center in Houston had told Stephanie that their insurance (for which
they paid $469 a month) was virtually worthless. So the hospital
demanded $83,900, in advance, just to develop a treatment plan for Sean
and cover his first $13,702 transfusion, along with simple items like
gauze pads at $77 per box and routine lab tests for which he was billed
tens of thousands of dollars.
As I reported, Stephanie recalled
that her husband was "sweating and shaking with chills and pains. He had
a large mass in his chest that was ... growing. He was panicked."
Nonetheless, Sean was held in a reception area and kept from seeing a
doctor for about 90 minutes until the hospital confirmed that the
Recchis' check had cleared.
All of which explains why despite the
negative--and in this case, completely inaccurate--scuttlebutt she says
she had heard about Obamacare, Stephanie Recchi visited
HealthCare.gov repeatedly after it launched. But, she said, "I just never got anywhere ... It kept freezing or crashing."
That
Obamacare crashed on
Stephanie and Sean Recchi, of all people, amid a
torrent of misinformation about what the law could or could not do for
them, epitomizes the calamity of the failed launch. But what has
happened to the Recchis and their health care options more recently
might be emblematic of the law's potential.
The key provisions of
Obamacare seem as if they were drafted by someone sitting next to Sean
Recchi in that MD Anderson holding room. Under the law,
insurance companies can no longer turn away people with pre-existing conditions or
even take those conditions into account when determining what people
like the Recchis pay for their coverage. When Stephanie logged on in
October, she was shopping for a family facing the ultimate pre-existing
condition--cancer. Although Sean is now in remission, he is regularly
seeing doctors in Ohio and taking drugs costing hundreds of dollars a
month.
Stephanie, Sean and their two children are also a perfect
match for the demographic that Obamacare was designed to serve: a family
of four earning less than
$40,000 a year, unable to get insurance from
an employer because the Recchis had just started their own business.
Another feature of Obamacare is those much heralded online
insurance
exchanges, meant to enable those without job-related coverage to log on
and find an array of competing products, none of which would be allowed
to have the bait-and-switch limits that had left Sean unprotected when
he needed lifesaving care. (When he was diagnosed with cancer, Sean's
policy limited his coverage to $2,000 a day in the hospital, which at MD
Anderson barely covers an opening round of blood tests.) And all
policies would be presented on the exchanges in plain English for easy
comparison. Or, as President Obama often put it, buying health insurance
would now be like going online to buy an
airplane ticket.
Finally,
people with incomes below 400% of the poverty line (up to about $94,000
for a family of four like the Recchis) would get subsidies from the
government, so that it all would be more
affordable. If they were at or
below the poverty level, they would be enrolled in Medicaid for free.
The
Recchis now know all that, and they're fully insured for 2014. But it
took a while. When we spoke in October and Stephanie told me she didn't
"think Obamacare will help us," I suggested that she might be
mistaken
and that if she was unable to get information from the then sputtering
website she should consult an insurance broker. (Insurers pay the
brokers' fees, not consumers.)
"When they came to my office,
Stephanie told me right up front, 'I don't want any part of Obamacare,' "
recalls
health-insurance agent Barry Cohen. "These were clearly people
who don't like the President. So I kind of let that slide and just asked
them for basic information and told them we would go on the Ohio
exchange"--which is actually the Ohio section of the federal Obamacare
exchange--"and show them what's available."
What Stephanie soon
discovered, she told me in mid-November, "was a godsend." The business
that she and her husband had launched--which sells a product that
enables consumers to store their DNA or that of family members for
future genetic testing--had recently received investor interest after
being featured on an episode of the television series CSI. So she
estimated to Cohen that their income would be about
$90,000 in 2014. But
even at that level, her family of four would qualify for a subsidy
under Obamacare.
The Recchis and their agent soon zeroed in on a
plan with a $793 monthly premium that provided full coverage, though
with a deductible of $12,000 for the entire family, meaning the Recchis
would pay the first $12,000 in expenses. After the deductible was
reached, there would be no co-payments for anything, including all
drugs. However, the Obamacare subsidy, assuming a $90,000 income,
brought their cost down to $566 a month. If their income was the same
$40,000 Stephanie had estimated for 2013, the subsidy would increase and
their premium would be just $17 a month.
"They had
budgeted
insurance at $1,200 for each of them for their new business," says
Cohen. "That's $2,400 for the two of them, compared to $566, so they
were thrilled ... They had seen all those stories on television, and
because of their views about Obama, they believed what they wanted to
believe--until they saw these policies and these numbers."
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