MYRTLE BEACH — Chad White of Conway wonders if Tuesday is, at last, the day he’ll be able to get health insurance for himself, his wife and four children.
White, 37, works fulltime as a commercial estimator for a countertop business and studies in his spare time for an associate in arts degree at Horry Georgetown Technical College.
He said getting insurance was the next thing on his list to take care of, but up to this point, providing a roof and food for his wife and children came first in the budget.
If all goes according to the plan set out by the Affordable Care Act, better known as Obamacare, White and tens of millions of other uninsured Americans will at last be able to find affordable health care.
The federal government on Tuesday opens its marketplaces to applications from many of those currently without insurance. There will be subsidies for some people to help them buy coverage, but nearly everyone whose income is above 138 percent of the federal poverty level will have to get insurance or face fines for not doing so.
It is perhaps the most expansive government program undertaken in decades, and yet just days before the rollout, individuals and health care providers have questions about the program and what it will mean to them.
“How much is it?” asked Amanda Bevolet, 26, of Shallotte, N.C., as she waited with her husband John at Little River Medical Center.
That question is No. 1 on the minds of the uninsured that seek care at the community health center, said Celeste Bondurant-Bell, the center’s community development director. The answer will come on Tuesday when Blue Cross/Blue Shield of South Carolina and two other insurance companies announce their rates.
Last week, the federal government released the price South Carolinians will pay for one of the plans under Obamacare that showed those eligible for subsidies will pay as little as $145 a month for it.
But it is just one of 52 plans, and before consumers will know the final cost, they will need to create an account at www.healthcare.gov, read the information there, decide the level of coverage they want and submit an application. Those who need help sorting through the information can call the Health Insurance Marketplace Call Center at 1-800-318-2596; TTY users should call 1-855-889-4325.
Local assistance is available as well. The Little River Medical Center is a certified application center with four certified application counselors who have been trained to help people work through the process.
There are other counselors as well, said Becky Fowler, spokeswoman for the S.C. Primary Health Care Association. The state got money to train counselors from community health centers such as Little River and Health Care Partners in Conway. But she said that physicians offices and hospitals may also have certified application counselors.
A complete list is to be available at healthcare.gov. As of Tuesday, there is to be an icon that says “Find local help” or you can type “find local help” in the search bar. Fowler said updated lists of where counselors can be found is to be there.
Counselors are there to help guide people who want to apply for health insurance through the marketplaces, but they will not be able to advise consumers on which plan they should buy.
As a community health center, about half of Little River’s 23,000 annual patients are uninsured, said CEO Pam Davis, so the application counselors will have plenty to keep them busy through March 31, when the application period ends.
Davis said the Medical Center has hired a new dentist, nurse practitioner and internal medicine physician to serve an expected increase in business, but Davis can’t say for sure if there will be enough paying patients to cover the new costs
It has spent about $180,000 on the four application counselors and $400,000 on new medical personnel, and will need to attract new patients for new revenue.
Shortages likely will remain
The Affordable Care Act provides for paid coverage to be available for all of even the neediest patients, but that won’t happen in South Carolina and other states that chose not to take federal money in 2014 to expand Medicaid coverage to include those who are at 138 percent or less of the federal poverty level. As a result, Little River Medical Center and area hospitals that see a large number of uninsured patients will not necessarily see the reduction in free care costs the federal plan envisioned.
Davis said that 90 percent of the uninsured at Little River are below 100 percent of the federal poverty level, who will not be required to purchase insurance but will still need health care.
They may qualify for Medicaid, but not know it and not apply, John Supra, deputy director and chief information officer for the S.C. Department of Health and Human Services, said in an email.
The department said there are 169,000 South Carolinians who would qualify for Medicaid, but haven’t applied. Supra said HHS plans a drive to enroll all who are eligible.
Those who don’t get Medicaid probably won’t buy insurance.
“If you can’t afford $30 for a visit,” Davis asked, “how can you afford $200 to $300 (a month) for insurance?”
Hospitals could be hard hit by the state’s decision because as part of the new plan, the federal government will stop sending money it had given hospitals to help pay for indigent care.
Phil Clayton, CEO of Conway Medical Center, said the hospital estimates it will lose $3 million a year under Obamacare.
Clayton said the hospital is waiting to see what happens before it makes any decisions on what will need to be cut to cover the $3 million.
“We can withstand some of it,” he said. “But a $3 million impact will be significant to our bottom line.”
Davis said the state legislature has appropriated money to help hospitals and community care centers to fill the revenue gap. It will help, she said, but it won’t cover the total cost of ongoing free care. And she wonders what will happen when federal supplements run out in 2017.
Davis said the federal government should have realized that some states wouldn’t expand Medicaid (the ongoing costs to the state could be significant) and have made provisions for those who will remain uninsured.
Amanda Bevolet and her husband John Bevolet may be among them.
John Bevolet, 52, has a crushed spine and can’t work but has not been approved for disability payments. As a result, he must seek free care.
Amanda Bevolet works for a fast food restaurant and said it has cut the hours of all but management employees. Now she and most of her coworkers are part-time.
In 2015, businesses with 50 or more employees will start having to provide health insurance. Originally, businesses were to provide employee health insurance in 2014, but got a year’s reprieve because of the concerns about what it would cost them.
When it does happen, each part-time employee will be counted as one-half an employee for the federal threshold requiring employer provided health insurance.
As a part-time employee, Amanda said she takes home only $300 to $350 a week, not enough for life’s necessities, much less health insurance.
“It kills America,” John said of the new federal program, “because people can’t get a regular job.”
Amanda doesn’t think there’s any money in the family budget for health insurance.
“If it was more than a dollar, I wouldn’t get it,” she said.
Young and healthy to opt out?
Paul Reynolds, co-owner of Cowork MYR, also wants to know how much the new insurance will cost him. But unlike the Bevolets, he’s not thinking of the system being stacked against him.
He’s wondering if the cost will be more than the penalties for those who don’t sign up for a policy.
At 37, he’s in the prime group the federal government wants in the insurance pool. Young and healthy, he likely wouldn’t be needing a lot of care, and a significant part of what he pays for insurance could help ease the pressure on insurance companies to raise rates every year to cover increasing healthcare costs.
Reynolds has catastrophic health insurance that will cover him once he’s spent $10,000, and he feels comfortable with that as his fallback. He pays cash for his other healthcare needs.
And he said he’ll not buy any new insurance as long as the penalties for not doing so are less than the cost of insurance.
Like Reynolds, Barb Royal – an entrepreneur who rents computer space at Cowork – just had catastrophic health insurance until recently, when she became eligible for insurance under her partner’s plan.
But unlike Reynolds, Royal said that as a parent of three children, she constantly worried that she might get sick.
“Living without insurance and the fear of that,” she said, “it changes your day-to-day.”
Bernard Rhue, 53 and a student at HGTC, agreed with Royal that being without health insurance is scary.
“I’ve been without it the majority of my life,” he said.
Just recently, he got coverage through his wife’s policy.
But during the time he was uninsured, he had a stomach problem that put him in the hospital for three days. He got the care, he said, but he also got a $5,000 bill that he’s still paying off.
“It might have been more,” he said of the bill. “I don’t know.”
Thirty-year-old Khaled Khaled is another young, mostly-healthy person who is not inclined to spend money for health insurance. An employee of an outdoor food stand at Broadway at the Beach, Khaled is an Egyptian national who’s working toward his American citizenship.
He said all of his family in Egypt are doctors so he doesn’t worry about the lack of insurance. When he needs care, he heads home.
“It’s way cheaper to pay $1,000 for a ticket to get (healthcare) than it is to pay $20,000 t0 $30,000 for healthcare here,” he said.
‘Needs to be fixed’
Dee Chavan, 77 and the semi-retired volunteer coordinator at the Grand Strand Senior Center, said all she knows about Obamacare is that it’s controversial. She hopes, though, that the new plan will make insurance affordable for her 32-year-old son who makes $20,000 a year.
She thinks the government should help people with healthcare costs, but she’s not sure that the current path is the right one.
“I think the government’s role should be to try to cut the cost” of drugs, for instance, she said.
White believes that socialized medicine, as is present in most developed countries, is what should happen in America.
His wife had unexpected surgery several years ago and the hospital has so far taken about $5,000 of his tax returns to pay the bill.
“I feel a healthy nation is a strong nation,” he said.
Royal said that any hardworking person should be able to get affordable health insurance, but like Chavan believes that Obamacare might not be the right answer.
Rhue said it’s not OK to force people to buy insurance, as Obamacare does.
But, he added, “They’ve got to find some way for people to get health insurance. This is a situation that needs to be fixed.”
On Oct. 1, Americans can begin enrolling for health coverage in 2014 through the new state insurance marketplaces. The Affordable Care Act takes effect three months later, in January. Thats when most people must have health insurance or face a fine for noncompliance. Most of the roughly 260 million Americans with job-based, individual or government coverage probably have nothing to worry about. But if youre unsure or among the nearly 49 million uninsured Americans weve prepared a guide to bring you up to speed.
Other health care resources
- CuidadoDeSalud.gov (resource for Spanish speakers)
- Federal ACA information website for business owners
- "The YouToons get ready for Obamacare" video
- Kaiser Family Foundation subsidy calculator
- Department of Health and Human Services ACA hotline: 1-800-318-2596
- HHS hotline for hearing-impaired callers with TTY/TTD technology: 1-855-889-4325
Contact STEVE JONES at 444-1765.