Shaffer believes she’s not on Obamacare—understandably so, since she didn’t go through Healthcare.gov to buy her plan. But Medicaid expansion was yet another little-heralded element of the Affordable Care Act. Shaffer, an independent, didn’t vote for Trump, but she still wants Obamacare “radically changed or eliminated.”
“It would be nice to have this health-care thing off of me,” she said. “For small businesses, I wish they would revisit how we’re dealt with.”
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Few people I met pined for old days of the untamed individual insurance market, in which people could be denied coverage for acne or thrown off their plans when they needed them most. Lynn Keltz, a health-care navigator in Harrisburg, said Obamacare enrollees in the area were most concerned about rising deductibles—as are marketplace enrollees around the country.
Deductibles are rising because not enough young, healthy people signed up for Obamacare, mandate be damned. But the plans that Republican leaders have proposed so far wouldn’t necessarily address high deductibles, according to Sara Rosenbaum, a professor of health policy at George Washington University. Both Rep. Tom Price, Trump’s nominee to lead the Department of Health and Human Services, and House Speaker Paul Ryan have proposed expanding the use of health savings accounts—essentially a subsidy, not tied to income, that can be used to pay the deductibles on health plans. (Price’s proposal, in fact, would simply change the name ‘‘high-deductible health plan’’ to “HSA [health saving account] qualified health plan.”)
But right now, even people with the income-based subsidies of Obamacare are struggling to pay their deductibles. Back in Gettysburg, I talked to Debra Starry, a woman who manages an art gallery that sells idyllic landscape paintings. At first, she thought Obamacare was meant for people like her. She’s single, she works full-time, and she struggled to afford insurance before the Affordable Care Act was passed. At 59, getting covered isn’t cheap.
The first year she signed up, her premium was $267. The second year, it went up to nearly $292. “I crunched my budget and made it work,” she said. This year, the premium was the same, but her deductible rose from $1,700 to $4,500, she said. Every year, her plan has been cancelled, and this year, there were only four options to choose from.
Unlike some of the others I met, Starry has relied on her insurance. In the middle of the summer, she woke up bleeding and with terrible stomach cramps, and she ended up needing a colonoscopy. She’s had swollen lymph nodes biopsied and a mammogram that cost $300. (Some, but not all, mammograms are covered without a deductible on Obamacare.) She’s still paying two hospitals back in installments for $2,300 in medical bills.
“When Obamacare came along, I thought, it's going to be signed in, I'm going to take advantage of it,” she said, tearing up. “And I’m no further ahead going into the fourth year than I was at the beginning. I haven't gotten what I hoped for.”