A crucial ingredient as one young Michigan resident signed up for Obamacare

Like everyone I know who is a health policy junkie, I have been very excited about the launch of the health insurance exchanges. But my excitement is not just because of my professional interest—wanting to see how the exchanges actually work and how health care changes as a result—it is also for personal reasons. My 27-year-old goddaughter had to leave her parents’ policy after she turned 26 and purchase expensive—and pretty limited coverage—in the individual health insurance market. We have been looking forward to the new products, hoping they will give her more choices at better rates.

My goddaughter is exactly who everyone who cares about the success of the Affordable Care Act hopes will enroll. She is young, healthy and uses very little medical care. She knows that she should have coverage in case of a catastrophic event and she has some family history that inclines her that way. And, even though she uses very little medical care, she does care a lot about one thing: prescription drugs.

I went onto the Michigan Health Insurance Marketplace the day it opened to look for coverage for her. And, yes, I experienced all of the problems that have been widely covered in the press. It took me forever to get on. I started the application multiple times and it didn’t always save things or work smoothly or let me get to the finish before crashing. And, she has some unique circumstances that the application doesn’t clearly address. That is, she is a University of Michigan law student and has no income now, but will start a job in September 2014 that will give her a nice income (and, employer-sponsored health coverage). And, she is in Michigan now but will be moving to St. Louis in May. So, how do coverage and tax credits work in her case?

But the challenges of enrolling are not what I found most interesting about the experience (they eventually sorted themselves out by Saturday afternoon—maybe because everyone but me was watching the Michigan-Minnesota football game instead of going on healthcare.gov). Rather, what was most interesting to me was what tipped the balance for her to get health insurance on the exchange.

As we dug into the plans offered in the exchange (using some excellent health plan-sponsored websites in addition to healthcare.gov), we quickly realized that many of the plans offered in Washtenaw County have limited provider networks—HMOs or something similar. These would work fine for her while she is in Ann Arbor but starting in May, when she moves to St. Louis, it would make care more complicated. That left the Blue Cross Blue Shield of Michigan bronze, silver, gold and catastrophic plans because their PPO network provides coverage out of state as well as in Michigan. But, these plans all require that a deductible be met before prescription drug coverage kicks in.

The gold plan had the lowest deductible but the highest premium. For gold coverage, she would pay about $3,500 a year without a tax credit. After we realized how much gold coverage would cost, we actually did discuss whether it was really worth her getting coverage at all. After all, she is low risk and would only have a gap in coverage of about nine months and the penalty for not having coverage in 2014 is pretty small. And then we remembered something crucial: the drug she really cares about is a contraceptive. And, contraceptives are considered preventive benefits under the Affordable Care Act and must be provided with no cost-sharing. That means that she can get coverage under a bronze plan for about $2,200 a year with a high deductible but still get the drugs that mean the most to her at no cost. Her coverage will be comparable to what she has now but will cost her less than she is currently paying (even if she doesn’t get a tax credit) and give her a broader choice of providers.

While there has been much focus on the controversy around requiring contraceptives to be covered as a preventive benefit, there has been no focus on the important role they play in making health insurance coverage attractive to young women. And in the end, that part of the law may prove crucial to tipping the balance for young people like my goddaughter to get covered under the Affordable Care Act. And getting young people into coverage will, indeed, help to make health care coverage more affordable for those who need it the most.

Bridge welcomes guest columns from a diverse range of people on issues relating to Michigan and its future. The views and assertions of these writers do not necessarily reflect those of Bridge or The Center for Michigan.

About The Author

Marianne Udow-Phillips

Marianne Udow-Phillips is director of the Center for Healthcare Research & Transformation and a former director of the Michigan Department of Human Services.

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Comments

Linda Ferrell
Wed, 10/16/2013 - 10:19am
Is it just me, or is everyone missing one thing...you are paying more money, paying for mostly all of your doctor visits and prescriptions, through a ridiculously high deductible and just putting money into the system to protect the people who can't afford health insurance. You are getting NOTHING for your money with this new plan. Gone are the $250 and $500 deductibles. I will be paying more than double what I was paying for a $250 deductible, which will now be a $1000 deductible. I am just not going to get health insurance and save the $990 a month they want to charge me.
Ruth
Mon, 10/21/2013 - 9:14am
Thanks Marianne for describing your experiences. This weekend I helped a friend of mine start the application process. She is a self-employed single mother who has been buying private insurance for years. It has been fairly high deductible and it hasn't covered some things that are now covered. For instance, her daughter had a sports injury and needed physical therapy, and that wasn't covered. She's been paying privately for her daughter's, and her, dental visits and eye doctor visits. She was happy to find out that she would qualify for some subsidy; that she would end up paying less than she's been paying; and that her daughter's dental, eye, and primary care visits would all be covered.
Wed, 10/16/2013 - 10:35am
Am I understanding this right? You will no longer be able to go to the health department for birth control ? So the population will be going up along with Obama Care.
Rich
Thu, 10/17/2013 - 9:14am
My daughter does not get a healthcare benefit where she works, so she had a policy that was acceptable to her finances. With the advent of the health care exchanges, she was one of those that got a letter from her insurance company saying that her policy would no longer be available and that she would have to select one of the new Obamcare policies. Naturally, they cost more, have included benefits that she is no longer capable of ever using like maternity benefits, and have higher deductibles and copays. My guess is that there will be at least 146,000 others in MI who are in the same boat (Freepress, couple of days ago) and are just thrilled with Obamacare.
RW
Thu, 10/17/2013 - 9:35am
What should have taken place is look at other countries that experimented with socialized medicine and discover it does not work as well as it's touted. Several countries in Europe tried at and went bankrupt. A more pressing question is this, Is the quality of medical care really there or is it controlled by a bureaucrat who only looks at numbers and makes a decision to deny?
Jeff
Thu, 10/17/2013 - 9:51am
My daughter's BC/BS, though a relatively minimum plan, has been found non-compliant (I assume like every other BC/BS plan I've heard about) and it is unclear what her new premiums (which have already doubled since Obamacare became law) will be. Taking into consideration the law has already cost her about $2,000 in income due to her hours being reduced to under 30 (which the proponents of the bill had to know was going to happen and intended for it to happen), even with subsidies she will be at a loss. Well done. As to the writer's piece, since her daughter is low risk, and if there is a problem you can immediately sign up for insurance, why not pay the penalty and the out of pocket for the contraceptives? Unless of course contraceptives cost $2,200 per year which I find hard to believe. I'm missing the logic behind taking the insurance. Finally, everyone seems to think the subsidies appear out of thin air - they come from taxes being paid. That means eventually out of our pockets.
John S.
Thu, 10/17/2013 - 10:32am
It's human nature that few of us can look beyond the interests of ourselves and our own families. As a society, if we would like to think of ourselves as being generous, there's need for something like the Affordable Care Act (ACA) that allows those with preexisting health conditions to purchase insurance and get care. People love narratives (our ancestors were story tellers). Well, I know several people with chronic conditions (Type I diabetes; asthma, chronic depression). There's no way before the ACA that they could purchase affordable insurance on the individual market and get the care and medicine that they need to live a decent life. What did they do before ACA. One was on a parent's plan, but turned 27, and is on COBRA. COBRA doesn't last forever. Another had no insurance, not eligible for Medicaid, was homeless, and did odd jobs to get cash so he could buy inhalers and breathe. He visited the emergency room a lot. The third, also not eligible for Medicaid, simply gets no care, but is not getting better. We're all selfish, but sometimes we need to spend less time admiring what we see in the mirror.
Hardvark
Thu, 10/17/2013 - 11:20am
When you really think about the impact on so many people, the goal of the affordable care act could have been met in a so much better way with partisan participation and consideration of consequences before the rush to make political hay. As this disaster plays out, the people will find that the government is incapable of designing a system of this complexity and are too egotistic to call in the real experts to solve the mechanics of implementation. The ACA internet system was designed by a Canadian company and programed by labor in India based on an incompatible foundation for the capacity needed at 400% of the budget and now we a system that has deadlines for the consumer that will not be met. I guess that's why in the real world, "if it ain't broke don't mess with it" and if it needs a little tweaking modify for results don't scrap the system.
Sun, 10/20/2013 - 12:22pm
So the most important reason for ACA is for your god-daughter to have me, thru tax subsidies, pay for her contraceptives? You probably believe that conceiving a child is an accident then, not the direct result of participating in pro-creation. May God help us all if you truly believe this makes sense to you. Why not teach her that sex is not a recreational pastime instead? Pregnancy is not a disease. Sex should not be treated as a sport with conception being equal to an injury. What people who need healthcare most need is a good job and some help with their medical problems, not more sex and contraception.
David Maxwell
Sun, 10/20/2013 - 12:29pm
So your 27 year old goddaughter is concerned about free contraceptives? And she is a student at UM? Why don't her parents just pay? or she can go to WalMart for $10/month. Why should I pay for a professional student?
Bob
Sun, 10/20/2013 - 1:35pm
This promiscuous woman wants me and all the other taxpayers to pay for her to go out an f**k around? Why not take responsibility for herself and just keep her legs together or better yet, just go get her own birth control? Oh that's right, she is probably a Barry supporter and can't function without someone holding her hand & giving her everything because the working folks owe her everything. Go out and get a job You spoiled brat. Get out from under Your messiah (BHO) and see life . Ah yes, educated way beyond Your intelligence. Simply just another drain dead democrat sucking off the system so she can go screw around and complain that we aren't being fair. Why doesn't the writer of the article take care her own goddaughter if she is so concerned about her? Oh yeah, another democrat. The way she makes it sound, she the writer was doing all the work for the Adult (spoiled rotten) goddaughter. Is she the goddaughters madam (pimp)? What a joke.
Jonathan Ramlow
Sun, 10/20/2013 - 6:48pm
Dear Bob, I'm guessing you never saw the movie "Bambi". If you had, you might have remembered the classic line, "If you can't say something nice, don't say anything at all." Then again, perhaps you are simply as mean-spirited and bitter as you sound. If so, then I am very sorry to learn of your spiritual malady. Having said all that, I have to ask: What is the matter with you? Were you born this nasty or did someone smaller than you repeatedly shake you down for your penny candy on the playground? This particular forum was intended for reasonable discussion of the author's experience with and point of view towards the Affordable Care Act. It was certainly not intended for someone like you to make the low-life, cheap-shot, ad hominem attacks you have been permitted to make on the author and her goddaughter. You are certainly entitled to your opinion of the ACA, and you were certainly entitled to weigh into this discusion with that opinion. You were not entitled (but permitted, apparently) to be verbally aggressive towards someone you don't know, whose background and experience are unknown to you, and whose personal politics are also unknown to you. More specifically, you were definitely not entitled to make repugnant personal allegations about the author's goddaughter for which you cannot possibly have any admissible evidence. So it seems that you might just be someone who gets off on throwing hand grenades left and right with no thoughts for civil behavior or consequences. Please, for all our sakes, go back to frequenting townhallDOTcom and freerepublicDOTcom, where hateful speech and spiteful invective are just so much bread and butter.
Sun, 10/20/2013 - 1:46pm
Evidently my last comment was "lost" because it was too nice of a rebuttal of pregnancy being treated like a disease of unknown origin. Go figure.
Sun, 10/20/2013 - 1:49pm
It did appear, after the post below it. How long does the policing unit take to approve a post here? Can my comments be that controversial?
Nancy Derringer
Sun, 10/20/2013 - 8:38pm
Dan: Thanks for your comments. To answer your question, reader comments are set to a "once approved, approved ever after" status. Which is to say, if you've been approved once, your subsequent comments do not go to moderation. As to the delay in approval -- it's a Sunday. I try to check our moderation queue a few times over the weekend, but sometimes a few hours pass between checks. I do apologize.
Sun, 10/20/2013 - 10:36pm
Thanks for the clarification.
ALE
Sun, 10/20/2013 - 9:13pm
All y'all do know that birth control pills are used to treat hormonal conditions, right, not just to prevent pregnancy? Some folks take them to prevent cysts on their ovaries. Others take them so they aren't bleeding for insanely long periods of time. Hormonal imbalances effect psychological and physical function. I do know women who would be unable to be fully productive workers if they didn't have that little pill to keep their bodies in check. So let's lay off the slut-shaming, shall we? The attitude of "everyone else can go die, those leeches" does not teach the value of life. It teaches that others are disposable and worth less than the speaker. When people are continually told they are worthless, they start to believe it, and within a few generations they are hopeless and shooting each other in the street. And then we wonder how those people over there ever went so wrong. Sorry, but the "ME ME ME" that is coming out of all this, the "I am the only one who matters" that I keep seeing, is what leads there. SO yes, I will pay for your ED meds with my taxes. I will pay for the CPAP for the guy who smoked all his life. I will pay for the heart meds for the gal who made poor dietary choices. And yes, I will pay for contraceptives. Because I believe that all people have worth, even the ones who make decisions that are different than mine. Even the ones who I think make crappy decisions.
Sun, 10/20/2013 - 10:45pm
Use of contraceptives for non birth control applications are not "birth control" are they? We are not talking medical use, we are talking personal life choices. Note the key words "personal" and "choices".
Reba
Tue, 10/29/2013 - 11:53am
Dan -- just be quiet!
Reba
Tue, 10/29/2013 - 11:56am
BOB -- you too....this is for discussion on what to do!!