Possible repeal of the Affordable Care Act leaves patients in limbo

As Californians, along with the rest of the nation, brace for a possible repeal of the Affordable Care Act, Marshawn Harris, an Oakland-based health care insurance broker, had been trying to sign up as many people as possible.

“My goal is to get everyone enrolled and make sure they understand that Covered California [the state’s version of the Affordable Care Act] will be around at least until the end of 2017,” Harris said, referring to the state’s version of the Affordable Care Act.

Harris calls herself a health care enthusiast. She works as a private contractor, with no benefits, on a $100 commission for each person she signs up. That’s usually five or six people a month and up to 30 during open enrollment periods, which run from November 1 to January 31 and are the busiest times for agents.

“I’m very passionate about what I do, about helping people, and the pay—it is what it is,” Harris said.

Helping clients choose and better understand the health care plans they purchase through Covered California can be a challenge. Customers often come to Harris with complaints, like last month during a “pop-up” enrollment event in the Richmond City Hall basement, when 65-year-old Richmond resident Senya Means demanded her money back.

Means was in a dispute with her insurer over an unexpected $1,000 charge. After talking with her, Harris realized it was because Means had not filed documents needed to prove her income, which disqualified her from receiving a tax subsidy and a lower, $250 premium.

Harris explained that Covered CA always mails the instructions and necessary steps to its customers. “You just have to open up your mail and read the documents that being sent to you. Reading solves a whole lots of problems,” Harris said.

But not all of them are so cut and dried. Harris admits that the law is complicated with “many details in it.” And it’s this lack of understanding the details that often prompts those who oppose the legislation to call for its repeal.

Overall, according to a 2015 Covered California consumer tracking survey, opinions of the healthcare system are split. Fifty percent of people who used the state’s marketplace said they were extremely satisfied with how it works, 34 percent were somewhat satisfied and 15 percent were “not very” or not satisfied at all.

Yet even a customer like Means, who calls Covered California “a disaster” because of its bureaucracy, cumbersome structure and customer service that “keeps her on hold on the phone indefinitely,” thinks losing it will be “a double disaster.”

Hundreds of people that took to the streets all over the country on January 20 to protest President Donald Trump’s inauguration felt similar frustration.

Oakland resident Wendy Ormiston, the mother of a 5-month-old, attended the rally in downtown Oakland on the inauguration day, was not thrilled about some maternity care services she received through the Affordable Care Act, but Covered California gave her an option to choose a plan that lowered her premium from over $500 a month to about $100.

“A lot of progress was made to try to get people covered. It is very disconcerting who is getting defined as deserving and belonging of rights and equities. And if that gets extended to a repeal of healthcare, it’s tragic,” said Ormiston.

The new president and the Republican Congress have long promised to repeal and replace the Affordable Care Act, better known as “Obamacare,” although the exact steps towards this goal remain unclear. Soon after taking the oath, President Donald Trump signed an executive order paving the way to dismantling the law.

It will not disappear overnight, but the new administration plans to gradually take its major provisions down. Republicans in Congress are eager to get rid of the individual mandate that requires Americans to purchase health insurance or pay a penalty, and to give more flexibility to states to set up their own health care programs and cut federal subsidies. Many Americans are worried this could leave millions without health insurance, especially because the “replace” part of Trump’s plan is quite vague.

The Affordable Care Act was signed into a law in 2010, but took effect only in 2014. The long anticipation of affordable healthcare created “a pent up demand” among customers, said Covered California information officer Larry Hicks. “The enrollment was robust and we topped a million in our first year. Now, about 1.4 million people are signed up for Covered California,” Hicks said.

Among them, as Covered California surveys show, there are more women then men. Harris said the largest groups include people between ages 45 and 65 who work, but don’t have benefits; youth from age 18 to 25 who are employed part-time and don’t want to join their parents’ health care plans because of their high cost; those who retired before the age of 65 and are not yet qualified for Medicare; and those in between jobs, who need insurance temporarily.

The most popular are the Silver and Bronze plans with Kaiser Permanente, Anthem Blue Cross of California and Blue Shield of California. Silver plans are highly subsidized and cover up to 90 percent of customers’ health care expenses if they qualify for a cost reduction. Bronze plans have the lowest monthly premiums.

According to the U.S. Census Bureau, California has cut its uninsured population down to the lowest level on record, from 17 percent in 2013—before the Affordable Care Act took effect—to slightly over 7 percent in the first half of 2016.

Ninety percent of Covered California members rely on federal funding to pay for their insurance. So if the Affordable Care Act gets repealed, it will deeply affect the state’s most vulnerable customers, according to Sarah de Guia, executive director of the Oakland-based California Pan-Ethnic Health Network. “The current concept that Republicans are promoting as an alternative to Covered California will cut the state’s funding to Medi-Cal, [the insurance for low-income,] by at least $20 billion,” Guia said.

And the idea of privatizing Medicare—which provides health insurance for retired people—so they could instead buy their plans on private market could be “catastrophic for middle-income seniors,” she said.

“We are pushing Republicans to delay those kind of decisions until we have a concrete proposal that maintains or furthers coverage,” she said.

But Republicans have criticized the cost of Obamacare as a major flaw. Federal subsidies that gave insurance companies financial support to help them ramp up their health care services have ended, according to Hicks. Because of that, in 2017, customers’ rates will jump up over 13 percent statewide, Hicks said, which is a steep increase from the 4 percent price hike last year.

Covered California surveys show that 60 percent of its customers have raised concerns about health plans’ affordability and rising costs, far outnumbering the 30 percent that worry about the future of the Affordable Care Act.

Martha Kuhl, a registered nurse at UCSF Benioff Children’s Hospital in Oakland and the treasurer of the California Nurses Association, is pushing for an alternative system: repealing and replacing the Affordable Care Act with a Medicare-like system that “will cover everyone from cradle to grave,” Kuhl said.

“Medicare for All was hugely popular. It was Bernie Sanders’ platform. The idea is that all of us pitch in to the publically-administered health care fund and our heath coverage get paid for out of this fund,” she said.

Similar attempts were made in the past. In 2006 and then again in 2008, when the California State Senate considered but did not pass the California Universal Healthcare Act, a single-payer healthcare bill that aimed for universal, affordable health coverage.

But with lingering frustration and uncertainty over the future of healthcare, today Medicare for All might have a better shot, according to Kuhl. “We are working with labor unions, with health advocates groups, legislators, with Democratic Party platforms … to provide [Californians] with a better health care system, when the Affordable Care Act gets repealed,” Kuhl said.

But overall, Covered California is a success story, according to Hicks, and is serving “as a model for how health care should work.” He said it has a “patient-centered” design with no deductible for primary care visits, medical specialists, lab tests, and X- rays, and it guarantees health coverage for people with pre-existing conditions and low-income residents.

“Behind [the] politics, there are real people who are getting care,” Hicks said, adding that he met many of those who had lived for years with untreated illnesses, but “today they are getting quality care for heart disease, for breast cancer, for stroke.”

Harris knows it all too well, and not only from her customers’ personal stories.

In 2013, Harris got laid off from a job with a private health insurance company, where she worked as an underwriter. After losing her job, she lost her medical coverage and had no option for renewal because of her pre-existing condition, asthma. This changed in 2014, when the Affordable Care Act kicked in, prohibiting health care providers from denying coverage to such individuals.

Now, like millions of other Americans, Harris may lose her health insurance again.

“I’m disappointed, but we’ve got to take it day by day,” Harris said.

Although open enrollment ended on January 31, people can still sign up for health insurance in case of special circumstances, such as a loss of a job, a change in family or marital status, or relocation from a different state.

“The more people we enroll now, the more people are there to say: “No, I have it. No, you should not take it away,’” she said.