Hate Obama, Love Obamacare

How a skeptical Ohio family found plenty to like in health care reform

By Steven Brill Monday, Jan. 27, 2014
    • Claudia Susana for TIME

    When Sean Recchi was diagnosed with cancer, he and his wife Stephanie were billed $83,900 by the hospital, in advance. Now he has insurance.

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    "Here I get full protection for $566, compared to no protection for almost $500," Stephanie says, referring to her old plan that had cost $469 monthly and that MD Anderson had scoffed at. "This is wonderful."

    It ended up even better than that. Because Cohen could enter only the Recchis' actual reported 2013 income onto the website, not their anticipated income when and if the investment deal is completed, and because that reportable income turned out to be significantly less than the $40,000 Stephanie had estimated, the website moved them automatically into Medicaid--meaning their coverage, for now, is free. That's because Ohio Governor John Kasich decided to buck a majority of his fellow Republican governors and accept Obamacare's subsidies so he could expand Medicaid coverage.

    Kasich's decision, however, illustrates one of three aspects of the Recchis' story that throw cold water on this fairy-tale ending.

    First, if Kasich had followed the lead of Obamacare resisters like Texas Governor Rick Perry, the Recchis would have been in the following through-the-looking-glass situation: If, as it turned out, their income was below the poverty level, they would have had to pay the full $793 for this insurance if they lived in Texas (but nothing in Ohio). But if their income was actually $90,000, they would pay only $566. That's because the law as written required all states to accept the government's subsidy for Medicaid to be extended to everyone with incomes below the poverty level. As a result, no premium subsidies in the exchange plans were provided for people below the poverty level, because they would presumably go into Medicaid. But in June 2012, the Supreme Court ruled that the states' expansion of Medicaid had to be voluntary. That left the poor in states such as Texas or Florida that did not expand Medicaid faced with having to pay more than those who are not poor. Unlike the middle class, they could buy only health insurance without subsidies, because they were supposed to have been sent into Medicaid.

    Here's the second asterisk to the Recchis' happy ending: even once the website was fixed, Sean and Stephanie still needed help from Cohen, their insurance agent, to make sense of it all. Buying health insurance is exponentially more complicated than buying a plane ticket. The exchanges have "bronze," "silver," "gold" and "platinum" levels of coverage, each featuring multiple variations of premiums, co-pays, co-insurance and deductibles. There are also the hard-to-find and harder-to-understand lists of which hospitals and doctors are in the insurance company's networks. And those lists are models of clarity compared with the lists of drugs that are covered by each plan.

    "There is no way the Recchis or anyone else can figure out what they're buying without someone who has been trained sitting with them," says Cohen. Sure, that's a self-serving assessment, but in interviews across the country with people who have signed up for Obamacare (and from my own experience), I found no one who fully understood the benefits, the costs or, most important, the limits of what they were buying unless they were helped by agents or by "navigators"--enrollment assistants trained and certified by officials operating the exchanges.

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