Some Of Obamacare's Biggest Winners Know Little About The Law

Obamacare's Biggest Winners Could Miss Out

Bonnie O'Brian faced a rude awakening just after her 55th birthday last May: Her insurance premium soared 38 percent to $611 per month.

O'Brian was told by her insurance company that she'd reached a milestone, the age where her rates would jump up much more than those of younger people enrolled in the same health plan.

"I was like, 'Well, happy birthday to me,'" said O'Brian, who lives outside Seattle in Renton, Wash., and has been buying her own insurance for more than a decade. "If this is what 55 feels like, what is going to happen in the next 10 years?"

If President Barack Obama's health care reform law lives up to its promises, O'Brian's insurance picture could brighten considerably in the coming decade.

Now 56, O'Brian makes $62,000 a year doing marketing and communications work for an attorneys' association that helps pay for her health insurance. Under Obamacare, O'Brian and her 22-year-old unemployed son could both get covered by a so-called silver plan designed to cover 70 percent of their medical expenses for $491 a month, according to an estimate from her state's health insurance exchange. That includes a $48 discount because their household income qualifies them for tax credits.

Still, O'Brian isn't that excited about Obamacare yet. Like many Americans, she feels doesn't understand the health care law well enough to know if it will make things better. "I would have to have the variables, what this includes versus what I've got," she said.

Though much of the conversation around Obamacare has focused on the law's impact on young adults, it's Americans like O'Brian -- older but not yet senior citizens and eligible for Medicare -- who might stand to gain the most from the law.

The current health insurance market in most states can be downright inhospitable for older Americans. Since insurance companies don't profit by paying medical claims, they often seek to sign up the most healthy people and keep out those likely to rack up big medical bills.

New Obamacare rules will do away with a lot of the barriers older people face in gaining and keeping health coverage. Under the law, health insurers are prohibited from turning down anyone, regardless of their health or medical history -- and they can't charge them more than healthier people. Older people can't be made to pay any more than three times what younger people pay and women won't see higher prices than men.

This marks a stark change from the way things typically work today. Under current law in most states, health insurance companies are free to reject applications and charge sky-high rates to people who are older or who have chronic health conditions or so-called pre-existing conditions. Insurers can make older people pay five times or more compared to younger customers. Health insurers also can sell people plans that cover everything but the health conditions for which patients will most likely need care.

"I don't want to call it the Wild West but it was a challenging situation to try to figure out, to try to pay for -- and that's if you could qualify," said Nicole Duritz, vice president for health education and outreach for the Washington, D.C.-based AARP, a membership and advocacy organization for people over 50.

Middle-aged people are especially at risk, Duritz said. "When you get into your 50s, you in all likelihood have some pre-existing conditions."

And health insurance companies can broadly define those conditions, Duritz said. "It could be that when you were in high school -- this is my husband -- you had a knee injury. That's a pre-existing condition. It could be that you went in and had acne treatment and that can be a pre-existing condition," she said.

As many as 129 million Americans have something in their medical history that could qualify as a pre-existing condition, the Department of Health and Human Services estimated in 2011. Yet many of these adults so far haven't received adequate information about the changes to come under Obamacare.

Nationally and through its network of state affiliates and partnerships with patient advocacy groups, the AARP is trying to get the word out to the over-50 set. Duritz expects the Obama administration will devote a portion of its outreach and advertising to attracting older people and people with pre-existing conditions to the new Obamacare health insurance exchanges during their enrollment period, which runs from October through March.

"The folks who have been left out in the cold, they're eager for this. I really believe that. So they're seeking this information out," Duritz said. "They're already thinking about their health coverage in a way that's very different than a younger person thinks about it."

Tom Lloyd, 59, is one of the 14 percent of Americans between the ages of 55 and 64 who was uninsured last year. Lloyd, a cabinet designer who works as an independent contractor in Culver City, Calif., near Los Angeles, hasn't had health insurance for more than 15 years.

The last time he even tried to shop for health insurance was in 1998, when a company offered to sell him a plan with a $5,000 annual deductible for about $750 a month.

"I got the sticker shock with $9,000 a year and I thought to myself, 'Well, there's really no way I can afford that. I just don't make that kind of money,'" said Lloyd, who expects to earn about $66,000 this year.

Lloyd has several chronic medical conditions, including diabetes, depression and anxiety, that require regular doctor's visits, prescription drugs and medical supplies. The diabetes diagnosis in 2010 made him feel even less likely to find affordable health insurance, he said.

While he can pay his monthly medical expenses, Lloyd worries a serious illness or injury could wipe him out, as it could anyone who is uninsured, he said. "There are millions of other people that are just like me, that are just one accident away from losing everything," he said.

A bout with pancreatitis and resulting complications landed Lloyd in the hospital twice six years ago -- and resulted in a $36,000 bill, giving him a glimpse of his insecurity, although the hospital soon went bankrupt and he's never been called on to pay the debt.

"It's just too terrifying to think that you're just one step away from having somebody take the house, or be in the poorhouse," Lloyd said. "Sometimes it's just better not to think about it. It's the only way you can get through the day. If you start thinking about it, you end up in the fetal position underneath your desk."

Lloyd is hopeful he'll find coverage on the health insurance exchange in his home state, dubbed Covered California, that he can afford and that will protect him against a financial catastrophe.

According to a premiums calculator provided by Covered California, Lloyd could purchase silver level coverage for $599 a month, though his income is too high to qualify him for a tax-credit subsidy. Silver plans are the second-least generous of the four "metal" levels of coverage -- bronze, silver, gold and platinum -- available on the exchanges from various insurance companies.

That's a lower price than he was quoted in 1998, and it amounts to a little less than Lloyd spends out of pocket for health care each month now, he said.

"I'm chomping at the bit here for October to come through so I can start looking at these exchanges," he said. "This is a deal of a lifetime for me."

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