Congressman Jeff Fortenberry

Representing the 1st District of Nebraska

Omaha World Herald: Nebraskans and Iowans are Divided over Health Care: Which Plan will Help or Hurt the Most?

Jun 25, 2017
In The News

WASHINGTON — Moses Ward is part of the problem facing health insurance in America today, and he knows it.

The 46-year-old small-business owner from Lincoln works hard to keep himself in good health, but he has a rare genetic disorder that causes parts of his body to randomly swell up. It’s a potentially life-threatening situation that requires a shot — sometimes once a month, sometimes once a week.

Each shot costs $10,000.

Insurers under the Affordable Care Act are required to sell him coverage, but that raises their costs and drives up premiums for others who aren’t facing serious health problems. Ward feels their pain given that his own family plan isn’t exactly cheap, with its $1,500 a month premiums and $14,000 deductible.

As Capitol Hill Republicans push forward on health care legislation, many Nebraskans and Iowans have mixed feelings about both the current situation under the Affordable Care Act, or Obamacare, and the proposed changes.

Advocates worry that children and disabled individuals relying on Medicaid would be harmed by capping the growth of that program. Others warn that granting states and insurance companies more regulatory flexibility could erode protections for older, sicker Americans.

On the other hand, middle-class families seeing premiums rise under the ACA wonder why they’re paying more for

insurance with deductibles so high they hardly see a benefit.

The House wrote a health care bill that passed with the support of the five members, all Republicans, representing Nebraska and western Iowa.

Senate Republicans just unveiled their proposal and hope to pass it this week. So far, Nebraska and Iowa senators, all Republicans, have said little about its merits.

Both bills would cut taxes, particularly for wealthy Americans, limit the growth of Medicaid funding and give states and insurers more flexibility from ACA regulations, including a requirement that all plans cover 10 “essential services.” Both also would repeal a mandate that requires people to buy policies.

Pam Weldin, 60, of Minatare, Nebraska, said ACA regulations are part of the reason she lost her insurance four times in three years. Weldin noted that people say if the ACA is repealed, many individuals will lose insurance.

“Do they not realize that there are many people, not just me, who have lost their insurance multiple times because of Obamacare?” Weldin said, adding that she expects to lose it again at some point. “I’m kind of holding my breath until I get to Medicare age.”

One plan she had came with a $20,000 deductible that she said wasn’t disclosed upfront. Now she has a plan that costs $1,400 a month with a $400 deductible. Subsidies bring her premium down to about $200 a month.

From her perspective, she’s always been a smart consumer of health care and taken personal responsibility by exercising, watching her weight, not smoking and not running to the doctor for every sniffle.

She finds it ridiculous that a 60-year-old woman like her must have insurance that includes maternity care.

She expressed skepticism of analyses suggesting that the Republican proposals could cause costs to rise for some Americans, particularly the elderly living in rural areas.

But she also said she would support repealing and replacing the ACA even if the result was higher costs overall. At least she’d have choices, she said, and that’s how the free market works.

Weldin said she believes in personal responsibility and doesn’t want the government taking money from some and giving it to others. She characterized the subsidies she gets through the ACA as offsets for those struggling to pay for higher premiums that have resulted from the law.

“The offsets are being provided by law to help pay for the premiums that went sky high specifically as a result of that law,” she said.

The argument in favor of ACA requirements is that, prior to the law, many Americans had coverage that ultimately proved inadequate. But not everyone is satisfied with the ACA-compliant plans either.

Marcie Strahm, 46, of Lincoln recalled twisting her ankle so badly it swelled up to the size of a softball, but she didn’t want to incur the cost of an emergency room visit or an X-ray, so she never had it checked out.

She’s a director of admissions at a for-profit college. Her husband works on designing bridges and roads for an engineering company. Neither employer provides health insurance.

Before the ACA they had a catastrophic coverage plan through Blue Cross Blue Shield of Nebraska that cost about $230 a month with a $10,000 deductible. The plan didn’t meet ACA requirements, however, so it went away.

They make too much to qualify for subsidies, and even with a high deductible, they saw their premiums shooting up, eventually reaching nearly $800 a month.

“That’s a mortgage payment,” Strahm said.

Her husband, whose 22 years in the military left him with a partial disability, has been able to get coverage through the Department of Veterans Affairs, and Strahm now has a policy for just herself that costs $500 a month. Her daughter is forgoing insurance for the time being.

“It’s priced us out of health care,” Marcie Strahm said.

She stressed that she’s a strong opponent of “government health care” and said she’s not sure about the Republican proposals working their way through Congress. She concedes she’s not an expert on what they would do or even the actual provisions of the ACA itself.

“I don’t know what the answer is, but it’s not working for middle-class people,” Strahm said. “It’s a disaster.”

Sen. Joni Ernst, R-Iowa, has cited the impact of the ACA on Weinrich Truck Line in Hinton, Iowa, which has about 65 employees.

The company’s vice president, Brenda Dittmer, told The World-Herald that every year since the ACA passed, rates to cover the company’s employees have gone up double digits for a total of more than $120,000 a year. And employees’ contributions also have risen, along with their deductibles and out-of-pocket costs.

Those rising costs put a strain on both employees and the country’s small businesses, Dittmer said. She wants to see parts of the ACA — such as protecting those with pre-existing conditions — preserved. Experts say requiring insurers to cover people with pre-existing conditions has contributed to premium increases, but Dittmer said she feels the real problem is pharmaceutical and health insurance companies. She suggested looking at the executive compensation packages at major health insurers.

Ward, the Lincoln man with the rare condition, believes the goal should be for everyone to have access to health care, and he’s not seeing where the Republican proposals now on Capitol Hill will solve anything.

To the extent they would stabilize the insurance market, he said, they would do so by pushing older and sicker people out of the market and simply selling skimpy insurance to young, healthy people.

That requirement that insurers sell him coverage?

That would remain in both the House and current Senate bills. But states could waive other insurance rules that weaken protections for medical conditions or, in the House bill, states could opt out of requiring that insurers charge everyone the same regardless of pre-existing conditions.

Ward said high-risk pools and reinsurance mechanisms might help address high-need individuals.

He questioned, though, whether universal coverage can ever happen in a system aimed at ensuring profits.

“That’s why they wouldn’t touch me beforehand, and going back to that just seems a little crazy,” he said.

He worries that if the ACA protections are rolled back, he and his family could end up as “medical refugees” forced to leave Nebraska for a state with robust regulations. He worries about his eldest son, who has the same genetic disorder.

But he also realizes it’s complicated.

“I’m just a dude in Nebraska living in a cornfield,” he said. “I don’t have the answers.”

Rep. Jeff Fortenberry, R-Neb., said that in a perfect world, people would be “held harmless” in any transition to a new health care law.

He said an under-discussed portion of the Republican health care proposal basically sets up a government reinsurance program aimed at addressing the dynamic of high-need people driving up costs in ways that chase out younger, healthier individuals.

Those provisions would give insurers an incentive to sign up individuals such as Ward because the government would be backing up the excess costs.

The question is whether Congress will authorize enough money to achieve that goal. Fortenberry said it’s not clear how much is required.

He also said the country needs to deal with a flawed delivery system that leads to unnecessary costs and less desirable outcomes for patients.

What is clear, he said, is that the issue is intense for many people.

“It’s not about some remote policy,” Fortenberry said. “It’s very personal.”

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