Americans who buy health insurance through a job may take for granted the protections of employer-based plans. All eligible workers, whether triathletes or cancer survivors, are offered coverage. A coworker is not denied benefits because he’s had four heart attacks. In group policies, insurers do not single out people with health problems. Everyone is pooled together and everyone shares the cost. The employer usually kicks in a good chunk of money, too.
But millions of Americans are not offered insurance at work. Perhaps they’re unemployed or self-employed or early retirees.
Now is the time for them to sign up for health insurance through a marketplace created by the Affordable Care Act. They’ve likely seen the advertisements to visit www.healthcare.gov. The 2017 open enrollment period for private coverage that qualifies for federal subsidies is underway. As of last week, more than 12,000 Iowans had enrolled in a plan, an increase from last year. The premium is less than $75 per month for 65 percent of Iowans.
These individuals are not among the tens of thousands of Iowans who gained coverage under the law’s expansion of Medicaid. They are using the website to buy private plans from companies including Wellmark Blue Cross and Blue Shield. Before Obamacare, many shopped for coverage in the so-called “individual” health insurance market.
That market is a nightmare. Considering Washington Republicans want to repeal the reform law, that nightmare may become the country’s reality again. As anyone who previously shopped on their own for insurance knows, you need a healthy body and pocketbook and a dose of luck.
Insurers refused to sell plans to people with serious illnesses. Or they offered policies written to specifically exclude coverage for needed medications or any complication related to the illness. The premiums were sometimes unaffordable. Insurers canceled plans when customers got sick. Many of the victims of this individual market joined the ranks of the uninsured. Some paid a fortune to join a "high risk" plan overseen by the state.
Then along came Obamacare.
The law establishes marketplaces where participating private insurers are required to cover all applicants, regardless of health. Premiums are set based on age, geography and smoking status. Federal subsidies help pay for it. Because the law requires all Americans to be insured or face a penalty, younger, healthier customers help offset the cost of older, sicker ones.
Granted, Obamacare is not perfect. Among its flaws is it relies too heavily on private insurers and includes no option for government coverage if companies don’t participate. But since the health reform bill was signed into law, the rate of uninsured Iowans decreased from 9.3 percent to 5 percent. And Iowans have more freedom to make major life choices.
Workers are no longer forced to stay in dead-end jobs because they need employer-based health insurance. They can retire early. They can start their own businesses. A parent can stay home with young children.
If the law is repealed, these Iowans will be making different life choices. Perhaps they’ll return to work until age 65 when they’re eligible for Medicare. Maybe they will join the ranks of the uninsured. Or they will once again shop on their own for coverage in the dreaded individual insurance market.
And they will have their elected representatives to thank.
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