My experience with the ACA

a followup to: Health insurance cancelled

I called the third party agency my job recommended to sign up for new insurance. At first I was frustrated that I waited all this time to call this third party when all she's gonna do is hold my hand while I move through the website. I almost hung up on her and just did it myself. Almost.

Glad I didn't, for the website wouldn't let me past the identity verification part. My appointment was on a weekend and the website still gets bogged down on weekends. Thanks to Ohio for not setting up its own exchange. So she did a three-way call with their helpdesk, and they answered some questions for me. Two different agents at the same time, but I got through. My application is processing right now.

This Blue Cross plan would cost $291 a month without my income-based subsidy. With the subsidy, it costs $73 a month. Total deductible is $1,150, and then the plan pays 90% of just about everything after that.

It's better than what [retail] offers, which has a $2,500 deductible and 80/20 coverage after that. What made [retail]'s plan seem cheaper is the HRA dollars [retail] contributed every year, which was usually about 500 dollars, and they carried over from year to year if unused. All medical costs were deducted from those dollars up front until they ran out, which applied to the deductible, after which I had to pay the rest. It gave the illusion of cheap health coverage because for a while I paid nothing out of pocket with all the HRA dollars I had saved up over the years.

Overall, it is better, and more affordable. This plan offers better rates, though without the HRA dollars, I still have higher up front costs. (This is also why [retail] is actively reducing the number of covered employees, like me. The less money [retail] has to contribute to those HRA plans, the more profit for shareholders.) I don't like that it comes with more up front costs, but really [retail]'s insurance was no better--it was only the HRA account that made it seem better.

Now the catch is that if in the future I get more hours and do qualify for [retail]'s healthcare plan again (and if it costs less than 9.5% of my annual income), I must sign up for my employer's plan, or lose the subsidy that reduces my monthly premium. This is regardless of how much money I actually make.

Furthermore, that subsidy depends on my income for this year, so if I make more money than anticipated, I could end up owing more federal income tax next year. On the other hand, if I took less than I qualified to receive, I'll get a bigger return, so it works both ways. I have the option to adjust my subsidy credit any time during the year, either through, or by calling, to prevent a tax shock next year.

I don't like that I had to do this at all... I mean, what if a book succeeds and I end up making quite a bit of money? I don't want to be hit with a penalty for unexpected success.

I don't like the idea of possibly having to bounce back and forth between different insurance plans as my hours fluctuate, or getting hit with a tax surprise next year if I unexpectedly make more money than I anticipated this tax year. I don't think we should be penalized for turning down our employer's insurance plan if the one we get on the marketplace is better.

Wouldn't it be better to stay on the same policy than have to jump back and forth between my employer's plan and one on the marketplace as I qualify? It doesn't seem like a good thing for the insurance market if people have to keep switching or else lose the subsidy.

(I don't think [retail] will ever let me work enough to qualify for their benefits again. I'm betting on that.)

This is certainly not perfect. What if I get a job that pays more? Or a job that pays less, but offers health insurance that isn't as good as the one I signed up for on my own? Why should I have to switch insurance plans if I like the one I got on the marketplace? The longer you're on a plan, the better, and just because I'm employed full-time doesn't mean my employer's plan is worth taking, or I can now afford the marketplace insurance plan without the subsidy. Shouldn't eligibility for the subsidy be based on income alone, and not on whether your employer offers a plan? I think our insurance should be independent of our job. I really do. The ACA could have made that easier.

According to the website (, if my employer's plan requires me to pay more than 9.5% of my income, I can still sign up for a plan on the exchange and receive a subsidy. I'll cross that bridge if I ever come to it.

I suppose the ACA will do until America gets with the rest of the world and cuts out the complications. The copays and deductibles and coverage traps and gaps and tax credits and qualifications. I yearn for that day when corporations do not control everything, healthcare among them, and America switches to a national plan. It's refreshing that the government is giving subsidies to the people for once, and not to the corporations, but I'd rather not be forced to take my employer's insurance plan. What is the point of that?

All things considered, this is better than the alternative. Before the ACA, an insurance company would turn you down for any reason. People wanted insurance, but these companies denied service if you were so much as prescribed depression medication in the past. This is a health plan I would never have been able to afford otherwise, it's better than [retail]'s current coverage, and I have Obama to thank for it.

Healthcare is still ridiculously expensive, but now it's within reach. I hope for these finer points to be adjusted soon. In the distant future, I hope a national plan comes along to replace it, but the ACA is still rolling out for now. It hasn't "failed" yet. I'm willing to give it a chance.


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