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Contrasting cases


Nearing enrollment’s end, lots of North Carolinians still uninsured

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    Jennifer Busco started NoDa Yoga in 2010. She got health insurance through the Affordable Care Act for $27 a month after qualifying for a federal subsidy of $422.

    Steve Griffith, a self-employed sales representative in Matthews, says his health insurance premium would have doubled but for President Barack Obama’s extension for individual market policies.

  • Who’s eligible for subsidies

    In North Carolina, about 869,000 of the 1.5 million uninsured are eligible for federal premium assistance. Subsidies are available to those whose household incomes are from 100 percent to 400 percent of the federal poverty level. (See table). Under the Affordable Care Act, those under the poverty level were intended to be covered by the expansion of Medicaid. But North Carolina lawmakers chose not to accept the Medicaid expansion, leaving about a half million residents in a “gap.” They don’t qualify for subsidies to make insurance affordable. They are not subject to penalties because the Medicaid option isn’t available.

    2013 Federal Poverty levels

    Family size100%138%200%250%400%
    Each additional person$4,020$5,548$8,040$10,050$16,080

    Source: U.S. Department of Health & Human Services

  • Enrollment assistance

    •  10 a.m. to 4 p.m. Saturday, Children & Family Services Center, 601 E. Fifth St., free meetings with navigators and application counselors, sponsored by Get Covered Mecklenburg. Make appointments anywhere in the state by calling 1-855-733-3711. Walk-ins also accepted. Bring Social Security number, proof of employment and income, policy numbers for current insurance coverage (if applicable)

    • Blue Cross and Blue Shield of North Carolina has opened a store in Whitehall Commons Shopping Center, 8156-B S. Tryon St., 704-527-4220. The other Charlotte location is in Northlake Commons near Northlake Mall, 9325 Center Lake Drive, 704-768-1888;

    •  9 a.m. to 9 p.m. Thursdays, C.W. Williams Community Health Center, 3333 Wilkinson Blvd., free meetings with navigators and application counselors, no appointments necessary.

    • For information and insurance estimates: Kaiser Family Foundation,

    • Federal marketplace:; 800-318-2596.

  • More information

    Canceled policies

    Some Charlotteans blame the Affordable Care Act for higher, less affordable insurance costs.

    “I’m the first to agree that health care needed reforming, I just don’t think this was well thought out,” said Steve Griffith, 56, a self-employed sales representative in Matthews. “I get that it’s a good deal for some people, but it’s a terrible deal for a whole lot of other people.”

    Griffith is one of about 15 million Americans who buy insurance in the individual market because they don’t work for companies that provide group insurance. He received a letter last fall from Blue Cross and Blue Shield of North Carolina notifying him that his current policy would be discontinued because it did not meet requirements of the new federal law.

    During 2013, Griffith paid $595 a month for a catastrophic plan with a deductible of $10,000 for his family of four. Blue Cross suggested a replacement for $1,156 per month. “I’m willing to pay a little bit more so that everybody can have quality health care, but not 100 percent more,” Griffith said.

    President Barack Obama, who had famously promised people could keep their insurance plans if they liked them, responded to complaints about those cancellation letters by granting a reprieve. That allowed insurers to continue those plans for another year, even though they don’t meet the law’s minimum requirements. As a result, Griffith’s family was able to keep its catastrophic plan for a premium of $736 a month.

    Last week, the Obama administration announced another reprieve for two more years. Critics say the decision is politically motivated, timed to avoid a wave of cancellations and premium increases before the fall mid-term elections.

    Problems with checks

    Continuing problems with the federal website and the inability to get answers from government and insurance representatives have led to frustration.

    Forest Featherston, 36, of Charlotte was one of the lucky ones who bought insurance through the federal website last fall. She paid the January premium of $245.41 by check. But in February, she got a notice from Blue Cross and Blue Shield of North Carolina that her insurance was about to be canceled because she hadn’t paid the January premium.

    Featherston got a copy of the canceled check, which had been deposited by Blue Cross. Despite phone calls to Blue Cross and paying her February premium, Featherston got a second “notice of fees due.” A Blue Cross representative told her she still has insurance, but Featherston is concerned: “I’m gonna be nervous every day that that policy’s gonna get canceled, and it’s gonna be the same day I’m in a car accident.”

    Ryan Vulcan, a Blue Cross spokeswoman, said problems arose because the website wouldn’t always allow customers to make payments at the same time they enrolled. Blue Cross began receiving checks that had to be manually matched with accounts created by the government. Vulcan said about 100 checks that couldn’t be matched to an account have been returned. She said she couldn’t comment on Featherston’s case. “It certainly was not as smooth a process as we would like to have had,” she said.

    ‘Trying to do the right thing’

    While many people had trouble signing up for insurance, David Carpenter, 64, of Kings Mountain had a different problem.

    He enrolled through the federal website in December and paid the premium so he and his wife would be covered starting Jan. 1. But Carpenter learned later that he had also qualified for benefits through the Department of Veterans Affairs. When he found out he couldn’t collect both VA benefits and a federal premium subsidy for private insurance, he tried for weeks to get his name off the policy.

    “We’re just trying to do the right thing,” said Carpenter, who along with his wife was laid off last year from Ultra Machine & Fabrication in Shelby.

    Carpenter got help from Stephanie Sheffield, a Gastonia insurance agent, who eventually got his name dropped from the Blue Cross and Blue Shield of North Carolina policy – but not until April 1. They worry that he may have to pay back three months’ worth of federal subsidies for insurance he didn’t use and tried to get rid of earlier.

    Ryan Vulcan, a Blue Cross spokeswoman, confirmed what Sheffield had been told, that Blue Cross cannot make changes to policies purchased through the website. “If you buy on the marketplace, you have to cancel through the marketplace.”

    ‘Almost like Christmas’

    Some consumers give the Affordable Care Act glowing reviews.

    Phyllis Longshore, 62, who moved to Charlotte in 2012, had been without insurance for about four years because she was unemployed or her employers didn’t provide insurance. Now, she has coverage that costs her nothing.

    With a pension, Social Security and a part-time job, Longshore earns about $25,000 a year. She qualified for a federal premium subsidy of $542 a month, which covers the entire premium for her policy with Coventry Health Care of the Carolinas.

    “It’s almost like Christmas,” Longshore said. “It’s been a long four years of wondering what I was going to do.”

    Pat Edwards, 62, of Charlotte works two part-time jobs in food service and earns about $15,000 a year. She qualified for a subsidy that allowed her to buy insurance for $680 a month, but she pays only $77. “Now I can go to the doctor,” said Edwards, who had been without insurance for four years. “I feel safe and secure.”

    And Kimberly Tonyan, 41, a Charlotte native, also bought health insurance for the first time in four years.

    A single mother of twin daughters, Tonyan recently finished a degree in applied science at ECPI University, but she hasn’t been able to find full-time work as a medical assistant. Her annual income is $20,000, mostly from part-time work as a caregiver. She qualified for a federal subsidy of $279, and with that, she pays only $28 per month.

    “Now I can sleep at night,” she said. “I believe that people deserve health insurance. It shouldn’t be a political issue. It should be a human issue.”

  • Do I have to buy coverage in the exchange?

    No, if you have insurance through:

    • Your employer

    • Medicaid or CHIP (Children’s Health Insurance Program)

    • Tricare or veteran’s health program

    • Medicare

    • Private insurance you bought, at least equal to the Bronze coverage level

    • A grandfathered plan from before the Affordable Care Act was enacted

    No, if you’re a member of one of the following exempt groups:

    • Part of a religious group opposed to accepting health insurance benefits

    • An undocumented immigrant

    • In prison

    • Part of an Indian tribe

    • Too poor to file a tax return ($10,000 single/$20,000 family)

    • Paying more than 6 percent of income for health insurance, minus employer contribution or tax credits

    Source: Kaiser Family Foundation

With two weeks left to enroll in health insurance for 2014 through the Affordable Care Act, tens of thousands of uninsured residents in North Carolina could face penalties if they don’t meet the March 31 deadline.

Despite a horrendous roll out – with the federal marketplace website malfunctioning for almost two months – about 4 million people nationwide had signed up by the first of February. That included more than 150,000 in North Carolina, the fifth-highest among states for enrollment.

Enrollment numbers through the end of February are expected to be announced this week. So far, they have been well below the Obama administration’s expectations. Problems with slowed enrollment in the 36 states – including North Carolina and South Carolina – that chose to rely on the federal site instead of creating their own.

The goal of the new law – often referred to as Obamacare – is to reduce the number of uninsured, estimated at 1.5 million in North Carolina, 49 million nationally last year. The law provides federal premium subsidies to make insurance more affordable for many.

“Can it work? Will it work? I don’t know,” said Michael Matthews, associate professor of health care management at Winthrop University. “It will take some political will and people wanting it.”

March 31 is the last day to buy insurance for 2014 and meet the law’s mandate that most Americans have coverage. Individuals who don’t comply will face a fine of $95 or 1 percent of household income, whichever is greater, when they file their income taxes next year. For families, the fine is $285 or 1 percent of income, whichever is greater. Fines will increase in subsequent years.

Some uninsured people are exempt from the insurance mandate and won’t face penalties. They include undocumented immigrants, prisoners and people with incomes below the threshold required for filing taxes ($10,000 for an individual, $20,000 for a family.)

No official source has estimated how many North Carolinians may face penalties. But given enrollment so far, and allowing for a variety of exemptions, it’s possible that a couple hundred thousand could owe fines if they don’t meet the deadline. Penalties will be collected by the Internal Revenue Service from income tax refunds.

“If you don’t have a refund, they can’t throw you in jail. They can’t put a lien on your property,” said Timothy Jost, a law professor at Washington and Lee University. But unpaid penalties could remain on a person’s record for years to come. “I think it’s going to be learning process,” Jost said.

In Charlotte, Brian Burnaby, 61, met with an insurance agent last week to check out the federal marketplace, but he left without signing up. “I decided I might as well pay the penalty for this year.”

Burnaby has been uninsured since he was laid off in 2008 from his auto parts sales job. This year, he expects to earn about $14,000 from part-time jobs, making his penalty about $140. Based on his income, the agent told him he’d be eligible for a $200 deductible plan with a subsidy that would make his premium $10.66 a month, or $128 a year. He compared $328 in insurance costs to the $140 penalty and chose the latter.

He thought he’d wait to buy insurance in 2015. By then, he will have turned 62 and begun collecting Social Security, raising his income to $25,000. In that year, his penalty for not having insurance would increase to $500.

After reviewing the numbers with an Observer reporter, he said he’ll meet again with the agent. “Maybe I should think about this a little more,” he said.

After March, the federal marketplace will be closed until Nov. 15 unless consumers experience a qualifying life change, such as marriage or divorce. In North Carolina, two insurance companies, Blue Cross and Blue Shield of North Carolina and Coventry Health Care of the Carolinas, sell plans through the marketplace for 2014. Together, they offer 51 different options, but not all are available in every county.

“We really want people to take advantage of this,” said Dr. Marcus Plescia, director of the Mecklenburg County Health Department. “They don’t have access to care if they don’t have any way to pay for it.”

Plescia and other advocates for the federal law made a final push for enrollment during a recent news conference at Legal Services of the Southern Piedmont, one of 15 county locations where consumers can get enrollment help.

They showcased some success stories, including Jennifer Busco, who had been without insurance since 2010 when she left a full-time job as a bartender at the Westin hotel to start a business, NoDa Yoga.

With help from a Legal Services navigator, Busco bought a Coventry policy with a monthly premium of $449. Based on her income, she qualified for a federal premium subsidy of $422, and pays only $27 a month for insurance.

“Now I can sleep at night,” said Busco, who has a 2-year-old son. “I’m not tied to one employer for health insurance.”

Garloch: 704-358-5078
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