‘Uninsurables’ look forward to Obamacare exchanges

DENVER — Vicki Tosher, now 61, knows a lot about cancer. She has survived two kinds of breast cancer and she was a University of Colorado researcher in cancer prevention. She lost her job in 2009, and 18 months later, she lost her health insurance.

“After my coverage ran out I had to buy my own insurance,” Tosher said. “I absolutely fall into that pre-existing condition category. No one would insure me.”

Tosher scrambled to find coverage and eventually succeeded with CoverColorado, a state-subsidized plan for what had come to be called the “uninsurable.”

Even with governmental support, it’s not cheap. Tosher currently pays a monthly premium of about $800.

For decades, health care reformers have placed priority on lowering costs and providing more coverage for people who need it, especially for people with pre-existing health conditions, who have been effectively frozen out of the private market, where the bottom-line considerations control service calculations.

Indeed, in 2011, as Republicans made moves to defund the 2010 Affordable Care Act, the department of Health and Human Services reported that as many as half of the American population was either ineligible for health insurance or priced out due to pre-existing conditions.

Even though she now has insurance, Tosher said she still avoids going to the doctor when she doesn’t feel well, because the co-pay costs can be daunting on top of her monthly premium.

She also said she’s far from the worst off.

“I know people who don’t have insurance because they can’t afford it. And they may have serious problems: gastrointestinal issues, lumps — I don’t deal well with lumps. But they won’t go to the doctor because they’re afraid that if it’s something serious they won’t be able to feed their kids. These are people who might be able to afford a couple hundred a month on insurance, but not six hundred.”

Tosher became aware of the Affordable Care Act or “Obamacare” not just through the news but also through groups like the National Breast Cancer Coalition. She worked with the group during the drafting of the new law to try to win coverage for various forms of cancer treatment.

When Obamacare passed, Tosher was thrilled.

“I knew it meant so much, not only for me personally, but also for an enormous number of people not just with cancer but other conditions,” she said. “It’s not just acute issues like cancer, multiple sclerosis or muscular dystrophy, but much simpler things like arthritis or asthma that have caused people to be denied insurance.”

Tosher also helped shape Connect for Health Colorado, the website where Coloradans will be able to shop insurance policies off the Obamacare exchange next month.

“You can’t just have insurance and organizational people involved in what’s going to be on those plans or how they’re explained,” Tosher said. “They also needed us folks who’ll use it.”

Tosher admits the signup process might be a little complicated, particularly for those who, like her, qualify for a federal premium subsidy; that is, anyone making below 400 percent of the poverty line, which is about $12,000 for an individual and $24,000 for a family of four.

Adam Fox, the Director for strategic engagement at the Colorado Consumer Health Initiative, said people looking for Obamacare coverage and applying for financial assistance will need to call the new exchange’s customer service center, at least until early November.

Those who aren’t applying for the assistance, or who have the financial flexibility to take the subsidy at the end of the year with their tax returns, can enroll in policies online beginning in October.

With four days till the exchange website rollout, no one expects there won’t be glitches. But organizers say the policy-purchasing process is designed to be as time consuming and as complicated as buying an airplane ticket online.

Colorado also won additional federal and local grant funding in order to provide “health coverage guides” for the rollout. The guides will be real life human beings available to talk with consumers over the phone or even to meet in person to discuss insurance options on the exchange and to assist in enrollment.

Fox said the guides are crucial, particularly for Coloradans who have little to no experience with health insurance. Guides will also give on-the-ground assistance in communities where few people are plugged into digital life.

Tosher feels that she’s part of a major group of Obamacare beneficiaries.

“If my income stays at the same level it’s been for the last two years, the subsidy will continue, which means I’ll be able to actually afford my health insurance until I’m eligible for Medicare. That’s one of the most exciting things for me.”

In October, Tosher won’t just be choosing between CoverColorado and no coverage at all.

“People keep complaining that [the government] is ‘taking away my choice,’ but when I worked for a company, my employer made the choice,” Tosher said. “They chose what provider and limited my options to either a [health maintenance organization or a preferred provider organization]. Maybe I could choose between two or three plans. Now, I have a choice between almost 200 plans.”

Connect for Health Colorado notes that so far “Ten carriers requested approval to provide about 150 health plans,” on the exchange. When Tosher purchases one of those plans, she expects to cut her monthly premiums at least in half.

“To me that just takes the lid right off the pressure cooker,” she said. “Now I can just cook.”

[ Image by Jamelle Bouie. ]