Insurance Customers In Pennsylvania Look To Trump To Ease Their Burden | KUOW News and Information

Insurance Customers In Pennsylvania Look To Trump To Ease Their Burden

Jan 10, 2017
Originally published on January 12, 2017 12:53 pm

Abra and Matt Schultz, both 32, recently built a house in a middle-class neighborhood in Pottsville, Pa. Matt works as a carpenter foreman for a construction company. He and Abra, his wife, are right in Trump's wheelhouse — Republicans in Republican Schuylkill County.

The couple spent December trying to decide whether to buy health insurance or skip it for 2017. They voted for Trump because they were fed up with how much they are paying for health insurance.

In mid-December in the couple's kitchen, Abra was sizing up their health insurance options. She showed off a thick notebook, along with a file folder with policy documents and notes piled as high as a stack of pancakes. "Don't touch my paperwork — don't even try to touch it," Abra joked to Matt. "I get so stressed out about it. I'll not pick one until the very last minute, like that deadline day."

Matt makes good money, but he usually gets laid off in the winter when construction slows down. For the past few years, he and Abra have bought coverage on HealthCare.gov, the Affordable Care Act exchange.

But they're in a tough spot. They make too much money to get a subsidy to help them pay for insurance. Subsidies are available only to those who make under 400 percent of poverty, or about $97,000 for a family of four. But while the Schultzes don't qualify for help, paying full price for health insurance stretches their budget to the limit.

Two years ago, when they first signed up for insurance on the exchange, they were paying $530 a month for a plan they liked, Abra says. The price rose a little for 2016, but the options for 2017 went up a lot — about 30 percent on average in Pennsylvania.

"We have one for $881, one for $938, one for $984, like the deductibles are — look, these are insane," Abra said, as she checked the exchange website for monthly premiums. "The one that we would be stuck with would be the silver. This is $881.50, and our deductible would be $7,000."

It's frustrating, she said, because she and her husband are relatively healthy and haven't needed that much care. Add to that the cost of a separate partially subsidized insurance policy for their two children, and the family is expecting to pay at least $14,000 in health premiums.

Abra resented the mandate to buy health insurance from the beginning. And she liked what Trump said about the Affordable Care Act on campaign stops, like one in King of Prussia in November, just before the election.

"Obamacare has to be replaced, and we will do it and we will do it very, very quickly," Trump said in his speech. "It is a catastrophe."

Abra said she wouldn't mind being in health insurance limbo while Trump and lawmakers debate the future of Obamacare.

Larry Levitt, with the Kaiser Family Foundation, said he understands her frustration with the law. "These are people who are playing by the rules, and doing the right thing, and they feel like they're getting the shaft," he said.

No one likes higher and higher premiums, he says, but there's a trade-off. "Before the ACA, to get insurance on your own, you had to fill out a medical questionnaire, and an insurer would only take you if you were reasonably healthy," Levitt said. "That kept premiums down, but it's because sick people were excluded from the market altogether."

Levitt said the law's goal was to to get insurance to a point where premiums only increase slightly every year while everyone can still get coverage, no matter their pre-existing condition. And, he says, any replacement plan devised by Republicans will have upsides and downsides, just like the Affordable Care Act. "If this were easy, it already would have happened," he said.

Abra said she understands the broader picture, but she needs to focus on what's best for her family — affordable health insurance.

"[Trump] just wants to fix what needs to be fixed, which I think is wonderful news," she says.

Abra did decide on a policy for her and her husband — she selected the plan that costs $938 a month because she wants to keep her current doctor. But if lawmakers eliminate the penalty for people who don't get insurance, she might take a risk and drop the coverage.

This story is part of a reporting partnership with NPR, WITF's Transforming Health project and Kaiser Health News.

Copyright 2017 WITF-FM. To see more, visit WITF-FM.

AUDIE CORNISH, HOST:

Many people who buy health insurance on the Affordable Care Act exchanges have seen the prices go up. In Pennsylvania, rates went up 30 percent on average for 2017. Now, most people who use the exchanges qualify for government subsidies. But for those who don't, the increases can take a large bite out of their budgets. Ben Allen of member station WITF spoke with one Pennsylvania family that hopes President-elect Donald Trump's promise to repeal Obamacare will save them money.

BEN ALLEN, BYLINE: Abra and Matt Schultz recently built a house in Pottsville. It's a typical middle-class neighborhood in rural Schuylkill County. And Matt works as a carpenter foreman for a construction company. They're right in Trump's wheelhouse, Republicans in a Republican county.

ABRA SCHULTZ: Don't touch my paperwork. Don't even try to touch it.

ALLEN: There's a thick notebook in front of Abra in her kitchen, a file folder with health-insurance options and notes as high as a stack of pancakes.

SCHULTZ: I get so stressed out about it. Like, I literally - I'll not pick one until the very last minute that I have - like, that deadline day...

ALLEN: Abra's husband, Matt, makes good money. But he usually gets laid off in the winter when construction slows down. He and his wife buy insurance on the Affordable Care Act exchange. But they're in a really tough spot. They make too much money to get a subsidy to help them pay for coverage but not enough to easily afford paying full price. They bought insurance for 2015 on healthcare.gov and paid $530 a month for a plan they liked. It went up some in 2016. But the options for this year...

SCHULTZ: So, basically, we have - let's see - one for $881, one for $938, one for $984 with - like, deductibles are, like - look at it. Like, these are insane.

ALLEN: That's just for her and her husband, who, she points out, are relatively healthy and usually need very little medical care.

SCHULTZ: The one that we would be stuck with would be the silver. This is $881.50, and our deductible would be $7,000.

ALLEN: Add the cost of a separate insurance plan for their two kids, and they're expecting to pay about $14,000 in health-care premiums this year. That added up to a vote for Trump.

SCHULTZ: His plan is to work with the insurance companies to hopefully, you know, get it down where it should be.

ALLEN: What Trump said about Obamacare on campaign stops, like one in King of Prussia, resonated with her.

(SOUNDBITE OF ARCHIVED RECORDING)

DONALD TRUMP: Obamacare has to be replaced. And we will do it. And we will do it very, very quickly. It is a catastrophe.

ALLEN: Schultz says, so what if she's in limbo while Republicans try to deliver on their repeal-and-replace plan? Larry Levitt with the nonpartisan Kaiser Family Foundation understands her frustration.

LARRY LEVITT: These are people who are playing by the rules and doing the right thing. And they feel like they're getting the shaft.

ALLEN: But, he says, there's a tradeoff.

LEVITT: Before the ACA, to get insurance on your own, you had to fill out a medical questionnaire. And an insurer would only take you if you were reasonably healthy.

ALLEN: And inexpensive plans often didn't offer many benefits. Levitt says any replacement lawmakers consider will have its own upsides and downsides.

LEVITT: If this were easy, it already would've happened.

ALLEN: Abra Schultz says she understands the larger picture. But she's counting on Trump to make it more affordable for her family.

SCHULTZ: He just wants to fix what needs to be fixed, which I think is wonderful news.

ALLEN: Schultz settled on a plan that costs $938 a month. But it's a real strain on her family's budget. So, she says, if lawmakers drop the penalty for people who don't get covered, she might take a risk and drop the insurance. For NPR News, I'm Ben Allen in Harrisburg.

CORNISH: This story is part of a reporting partnership with NPR, WITF and Kaiser Health News. Transcript provided by NPR, Copyright NPR.