Friday, April 18, 2014
FAIRFIELD-SUISUN, CALIFORNIA
99 CENTS

Skimpy health law plans leave some “underinsured”

By
January 04, 2014 | Leave Comment

WASHINGTON — For working people making modest wages and struggling with high medical bills from chronic disease, President Barack Obama’s health care plan sounds like long-awaited relief. But the promise could go unfulfilled.

It’s true that patients with cancer and difficult conditions such as multiple sclerosis or Crohn’s disease will be able to get insurance and financial help with monthly premiums.

But their annual out-of-pocket costs could still be so high they’ll have trouble staying out of debt.

You couldn’t call them uninsured any longer. You might say they’re “underinsured.”

These gaps “need to be addressed in order to fulfill the intention of the Affordable Care Act,” said Brian Rosen, a senior vice president of the Leukemia & Lymphoma Society. “There are certainly challenges for cancer patients.”

“Cost may still be an issue for those in need of the most care,” said Steven Weiss, spokesman for the American Cancer Society Cancer Action Network. That “makes it critically important for patients looking at premiums to also consider out-of-pocket costs when choosing a plan.”

Out-of-pocket costs include a health plan’s annual deductible, which is the amount before insurance starts paying, as well as any copayments and cost-sharing.

A few numbers tell the story. Take someone under 65 with no access to health insurance on the job and making $24,000 a year — about what many service jobs pay.

Under the health care law, that person’s premiums would be capped below 7 percent of his income, about $130 a month. A stretch on a tight budget, yet doable.

But if he gets really sick or has an accident, his out-of-pocket expenses could go as high as $5,200 a year in a worst-case scenario. That’s even with additional financial subsidies that the law provides people with modest incomes and high out-of-pocket costs.

The $5,200 would be more than 20 percent of the person’s income, well above a common threshold for beingunderinsured.

“Chronically ill people are likely to be underinsured and face extremely high out-of-pocket costs,” said Caroline Pearson, who tracks the health care overhaul for Avalere Health, a market research and consulting firm. “While the subsidies help, there still may be access problems for some populations.”

Under the law, insurance companies competing in new online markets like HealthCare.gov can offer four levels of coverage.

All plans cover the same benefits; the difference is in financial protection. A bronze plan covers 60 percent of expected costs, silver covers 70 percent, gold covers 80 percent, and platinum covers 90 percent.

Bronze plans have the lowest premiums but provide less insurance. Gold plans are the closest to employer-provided coverage. Indeed, members of Congress and staffers who will now get their coverage through the health care law have been steered to gold plans.

Silver, however, is the standard for most consumers. The law’s tax credits to help with premiums are keyed to a benchmark silver plan in each geographical area. And the law’s subsidies to help with out-of-pocket costs are only available to people who get a silver plan.

Avalere found that the average annual deductible for silver plans is $2,567, more than twice what workers in employer plans currently face. Additionally, many silver plans have high cost-sharing requirements for prescriptions, particularly “specialty drugs” to treat intractable conditions such as severe forms of arthritis.

Some plans may offer limited relief by covering certain services before a patient has met their annual deductible. Those services can include primary care, some prescription drugs and routine care for common chronic conditions such as high blood pressure and diabetes.

But Pearson says that won’t help people with high-cost illnesses. “Chronically ill people may still experience significant financial challenges,” she said.

Platinum or gold coverage may be the better option for people with serious health problems. They’ll pay more in premiums, but reduce exposure to out-of-pocket costs.

Obama administration spokeswoman Joanne Peters said the new system is still “night and day” from what patients faced for years, because insurers can no longer turn away those with pre-existing medical conditions, and because the new plans cap out-of-pocket costs. While that limits medical debt, it doesn’t eliminate it.

One of the leading advocates of the health care law says most people will still come out ahead.

“If the question is, will some people find that coverage and care remain unaffordable, the answer is yes,” said Ron Pollack, executive director of Families USA. “There will be some people who feel that way. The overwhelming majority will be far better off, even if what they have is not perfect.”

The Associated Press

The Associated Press

LEAVE A COMMENT

Discussion | No comments

The Daily Republic does not necessarily condone the comments here, nor does it review every post. Read our full policy

.

Solano News

Puppies to take part in Vallejo dog show

By Adrienne Harris | From Page: A1 | Gallery

 
‘Same Time, Next Year’ opens in Benicia

By Amy Maginnis-Honey | From Page: B1

‘We Got Next’ Comedy Tour stops at Dimitri’s

By Amy Maginnis-Honey | From Page: B1

 
Man to stand trial in rural Vacaville killing

By Jess Sullivan | From Page: A1, 5 Comments | Gallery

 
Afisivalu announces run for Fairfield council

By Ryan McCarthy | From Page: A3, 1 Comment | Gallery

 
Tonnesen seeks Fairfield City Council seat

By Ryan McCarthy | From Page: A3 | Gallery

Family matriarch celebrates 100th birthday

By Ian Thompson | From Page: A3, 1 Comment | Gallery

 
Barbecue brings big crowd, progress to Parkway Gardens

By Ryan McCarthy | From Page: A3, 5 Comments | Gallery

Town hall on crime set in Fairfield

By Ryan McCarthy | From Page: A4, 3 Comments

 
Assist-A-Grad wraps up interviews

By Barry Eberling | From Page: A4 | Gallery

 
Napa County bridge to close for work

By Barry Eberling | From Page: A4

 
Crash shuts I-80 offramp to Highway 12

By Barry Eberling | From Page: A5, 2 Comments | Gallery

Weather for April 18, 2014

By Daily Republic staff | From Page: B12

 
Suisun City police log: April 16, 2014

By Susan Hiland | From Page: A12

Fairfield police log: April 16, 2014

By Susan Hiland | From Page: A12

 
.

US / World

Putin’s choice of words shed light on Ukraine

By The Associated Press | From Page: A1

 
Who gained, and what, at Ukraine talks

By The Associated Press | From Page: A1

Ukrainian unity on display with peaceful rallies

By The Associated Press | From Page: A1

 
Deal reached on calming Ukraine tensions – for now

By The Associated Press | From Page: A1

Salmon released in California river restoration

By The Associated Press | From Page: A4

 
Astronomers spot most Earth-like planet yet

By The Associated Press | From Page: A5

Jury convicts husband in Iraqi woman’s death

By The Associated Press | From Page: A5

 
1 dead, 1 injured in California boating accident

By The Associated Press | From Page: A5

BART fined $210,000 for worker deaths

By The Associated Press | From Page: A5, 1 Comment

 
Military shell prompted evacuation of hundreds

By The Associated Press | From Page: A5

Obama: 8 million signed up for health care

By The Associated Press | From Page: A6, 3 Comments

 
California health care sign-ups exceed projections

By The Associated Press | From Page: A6

Dirty creek, old purse solve four-decade mystery

By The Associated Press | From Page: A7

 
Man said to be homesick for prison gets 3 1/2 years

By The Associated Press | From Page: A8

Chelsea Clinton expecting first child this fall

By The Associated Press | From Page: A8

 
Holder: Hate crimes ‘an affront to who we are’

By The Associated Press | From Page: A8, 4 Comments

Spate of Mideast virus infections raises concerns

By The Associated Press | From Page: A10

 
Samples collected from oil slick not from plane

By The Associated Press | From Page: A10, 1 Comment

S. Sudan: 12 die after mob attacks UN base

By The Associated Press | From Page: A10

 
Peru volcano prompts evacuation of 4,000

By The Associated Press | From Page: A10

Nigeria: Fate of 115 abducted girls unknown

By The Associated Press | From Page: A10

 
Tiny power plants hold promise for nuclear energy

By The Associated Press | From Page: A13

Confused, chaotic scene described on sinking ferry

By The Associated Press | From Page: A13

 
.

Opinion

Internationally out of touch

By Letter to the Editor | From Page: A11, 4 Comments

 
Watch out for grandson scam

By Letter to the Editor | From Page: A11, 7 Comments

Why so much spent to find a plane?

By Letter to the Editor | From Page: A11, 1 Comment

 
Editorial Cartoons for April 18, 2014

By Daily Republic Syndicated Content | From Page: A11

Food brings back fond memories

By Bud Stevenson | From Page: A11

 
.

Living

Today in History for April 18, 2014

By The Associated Press | From Page: A2

 
Community Calendar: April 18, 2014

By Susan Hiland | From Page: A2

My husband tells our sons that they don’t need to listen to me

By Kathy Mitchell and Marcy Sugar | From Page: B13

 
Horoscopes for April 18, 2014

By Holiday Mathis | From Page: B13

.

Entertainment

Week in preview April 18-24, 2014

By Amy Maginnis-Honey | From Page: B1

 
Review: ‘Heaven Is for Real’ heartfelt but dull

By The Associated Press | From Page: B2

 
Lost radio program featuring Hank Williams found

By The Associated Press | From Page: B3

 
‘Real Housewives’ TV star faces battery charge

By The Associated Press | From Page: B3

Ill, hospitalized Miley Cyrus postpones more shows

By The Associated Press | From Page: B3

 
Garcia Marquez, Nobel laureate, dies at 87

By The Associated Press | From Page: B3

Entertainment calendar April 18, 2014

By Susan Hiland | From Page: B4

 
TVGrid

By Daily Republic Syndicated Content | From Page: B6

.

Sports

Badminton update: Rodriguez, Armijo head toward post season

By Brian Arnold | From Page: B7 | Gallery

 
MEL boys roll to easy win over SCAC

By Paul Farmer | From Page: B7 | Gallery

Short-handed SCAC girls ‘gut out’ all-star win over MEL

By Paul Farmer | From Page: B7 | Gallery

 
Sharks beat Kings 6-3 in Game 1

By The Associated Press | From Page: B7 | Gallery

Dodgers get to Bumgarner early for win over Giants

By The Associated Press | From Page: B7 | Gallery

 
Clippers-Warriors series billed as must-see TV

By The Associated Press | From Page: B8

Kuchar builds on Masters momentum, shares Heritage lead

By The Associated Press | From Page: B8 | Gallery

 
War of words in Northwestern-athletes’ union fight

By The Associated Press | From Page: B8

Shumenov gets big chance in ring against ageless Hopkins

By The Associated Press | From Page: B8

 
Montreal team sign Chad Johnson to 2-year contract

By The Associated Press | From Page: B8

Seattle 1B Choi banned 50 games for positive test

By The Associated Press | From Page: B8

 
Dodgers’ Puig focuses on baseball despite issues

By The Associated Press | From Page: B8

Miguel Angel Jimenez set for Champions Tour debut

By The Associated Press | From Page: B8 | Gallery

 
Sponsorship woes put Swan Racing future in doubt

By The Associated Press | From Page: B8

Ex-quarterback McNabb spends day in Arizona jail

By The Associated Press | From Page: B8

 
Season wrapup: Sacramento Kings’ ‘new era’ off to slow start

By The Associated Press | From Page: B8 | Gallery

 
Boston Marathon makes room for more runners

By The Associated Press | From Page: B9

Stanford takes lead at LPGA LOTTE tournament

By The Associated Press | From Page: B9

 
Vanden clinches at least share of SCAC boys tennis title

By Daily Republic staff | From Page: B10

 
.

Business

Toyota Camry gets a top-to-bottom makeover

By The Associated Press | From Page: C1

 
Hot models at this year’s New York Auto Show

By The Associated Press | From Page: C2

Judge won’t order recalled GM cars to be parked

By The Associated Press | From Page: B6

 
Cyber cops: Target hackers may take years to find

By The Associated Press | From Page: B6

Walmart jumps into the money transfer biz, loudly

By The Associated Press | From Page: B6

 
.

Obituaries

Sealwyn Shirley Brucefield Shepherd Malkiewicz

By Nancy Green | From Page: A4

 
.

Comics

Baldo

By Daily Republic Syndicated Content | From Page: B12

 
Beetle Bailey

By Daily Republic Syndicated Content | From Page: B12

B.C.

By Daily Republic Syndicated Content | From Page: B12

 
Rose is Rose

By Daily Republic Syndicated Content | From Page: B12

Pickles

By Daily Republic Syndicated Content | From Page: B12

 
Blondie

By Daily Republic Syndicated Content | From Page: B12

For Better or Worse

By Daily Republic Syndicated Content | From Page: B12

 
Wizard of Id

By Daily Republic Syndicated Content | From Page: B12

Baby Blues

By Daily Republic Syndicated Content | From Page: B12

 
Dilbert

By Daily Republic Syndicated Content | From Page: B12

Peanuts

By Daily Republic Syndicated Content | From Page: B12

 
Zits

By Daily Republic Syndicated Content | From Page: B12

Frank and Ernest

By Daily Republic Syndicated Content | From Page: B12

 
Get Fuzzy

By Daily Republic Syndicated Content | From Page: B12

Garfield

By Daily Republic Syndicated Content | From Page: B12

 
Sally Forth

By Daily Republic Syndicated Content | From Page: B12

Cryptoquote

By Daily Republic Syndicated Content | From Page: B13

 
Sudoku

By Daily Republic Syndicated Content | From Page: B13

Bridge

By Daily Republic Syndicated Content | From Page: B13

 
Word Sleuth

By Daily Republic Syndicated Content | From Page: B13

Crossword

By Daily Republic Syndicated Content | From Page: B13