Making the Affordable Care Act more affordable

Althea Miller took a big step moving from Los Angeles to Madison to attend University of Wisconsin–Madison for her undergraduate degree. In 2011 she was diagnosed with asthma, and two years later was diagnosed with fibromyalgia.

When she faced an unplanned diagnosis, Althea Miller found support in Madison to cover uncovered portions of her health care. (Photo courtesy of Althea Miller)

Miller, now 26, is a graduate student studying multicultural education. She divides her time between school, working two jobs and taking care of her health.

The United Way HealthConnect program, which is operated by the United Way of Dane County, has helped Miller pay her monthly premiums for her insurance plan selected on the government’s Health Insurance Marketplace.

“Being able to have the health care paid for and not having to worry about being able to go to the doctor or afford medication — that’s really important so I can function as the human being I want to function as,” she said. 

Miller found out about United Way HealthConnect when she began seeing health specialists at the nonprofit Access Community Health Centers in Madison. The Program, Miller says, saved her life.

“I think I would have been bedridden. When I was diagnosed with fibromyalgia and also Vitamin D deficiency, I could have been walking down the street and just broken a bone,” she said. “I wouldn’t have known I had the deficiency if I didn’t have access to health care due to United Way’s program to help pay those premiums.”

Health insurance access and the knowledge gap

Paying for healthcare can be a real challenge, as Miller discovered. Despite the increased access provided by the 2010 Affordable Care Act, costs and confusion can deter some from enrolling in health insurance.

According to a November 2015 report by Public Health Madison and Dane County, an estimated 23,000 - 25,000 Dane County residents are still without health care coverage. Susan Webb-Lukomski, the lead author of PHMDC’s report, works to improve access to care.

“Ideally people would all have a medical home and a primary care doctor - that’s how it should be,” Webb-Lukomski said. “But for people who don’t have health care coverage, that is often not the case.” 

Webb-Lukomski said it’s hard for uninsured individuals to get into Access Community Health Centers, the federally qualified health center in Dane County.

“Access Community Health Centers provides excellent care and they meet a lot of the need, but they don’t have an unlimited capacity to take care of everybody that’s uninsured,” she said.

Some people who remain uninsured are undocumented immigrants who are not eligible for government health care coverage or Marketplace plans. The rest include people who are eligible for BadgerCare Plus (Medicaid) and not on it and individuals whose income is too high to qualify for BadgerCare Plus (Medicaid) but who cannot afford a Marketplace plan or think they can’t.

Even though Wisconsin residents with income just over the poverty level are eligible for federally subsidized Marketplace plans that does not mean that they can afford those plans.  

“The reality is that low income people who haven’t been accustomed to budgeting money for health care, almost any monthly premium is too much,” Webb-Lukomski said.

“Other people reject the Marketplace plans because they perceive the cost to be too high because they haven’t applied. There’s no way to find out the federal discounts and actual cost until you apply, and the cost is often much lower than they thought it would be.”

The United Way Health Connect Program is just one program based in Madison that helps individuals, like Miller, with income just over the federal poverty level pay for certain Marketplace plans. But many people who are eligible are not aware of the program.

Advocacy and Benefits Counseling for Health, Inc., more commonly known as ABC for Health, is another group that works to help with healthcare access for children and families, particularly those with special needs or who are at risk. Bobby Peterson is the founder and executive director of the nonprofit public interest law firm.

“For lots of people, trying to understand the rules and requirements of the healthcare system is overwhelming, especially if you’re sick or if you have a sick child,” Peterson said. “You have to have some very specific knowledge to guide people through the process, and in my view, nobody does it better than ABC for Health.”

Peterson said there is a false assumption that hospitals or social workers know how to line people up with proper medical care. “But in reality no one knows the system as well as they should because the system is too complicated,” he said.

ABC aims to use their experience with clients to learn what’s wrong with the healthcare system and translate individual cases into larger scale changes. One way they are doing this is through their technology startup company. Peterson received a grant from the National Institute of Health to build software he described as “TurboTax for health benefits.”

“As a client of ABC for Health, we could take down your information and put it into the software. Algorithms would start figuring out your eligibility for the Affordable Care Act and BadgerCare Plus and then guide you in the direction towards the best plan for you,” Peterson said.

ABC hopes to use their new tech company to help improve and speed up the health care sign-up process. 

Weighting immediate vs. delayed costs for ‘young invincibles’

Another group who remains uninsured are young people who don’t want to pay for what they think they won’t need.

The Affordable Care Act has enabled young adults to remain on their parent’s health insurance until they turn 26. After that, they have 60 days to register for a Marketplace Insurance Plan. However, many face challenges paying for health insurance once they turn 26.

Lindsay Swindall tries to reach out to this group through her work at Covering Wisconsin, a federally-designated Affordable Care Act Navigator entity.

“One of the most important factors is money. Young people might be working part-time jobs and don’t have money to spend. It’s great that you’re healthy now,” Swindall said. “But it’s really important to think of preventive care and to have this safety net in place in case of an accident,” she said.

Many young adults don’t think about the high costs without coverage. 

“They think in terms of insurance not being worth the cost,” Webb-Lukomski said. “$100 a month for a young adult who is healthy may be hard for them to justify. But to them I would say it only takes one accident — one surgery — to put you in medical debt that you’re going to be digging out of for a long time.” 

Peterson of ABC Health also said he had concerns about young adults going without health insurance.

“You can roll the dice, but at a certain point, you end up with a lot of medical bills,” Peterson said. “You end up in sort of a modern-day debtor’s prison because it’s your credit score that’s affected.”

Miller, who learned these costs firsthand, recommends that young people at least get catastrophic healthcare that they can rely on in an emergency.

“You’re not invincible,” Miller said. “You can only push the body so far before it pushes back.” 

Health insurance’s impact beyond individual policy holders

Peterson said individuals who don’t have access to coverage actually impact all of us.  When individuals without coverage go to the emergency room, their bills become uncompensated care.

According to the Kaiser Foundation, the cost of uncompensated care in 2013 was $84.9 billion.  

“That’s all money that’s lost in the system,” Peterson said.  “It doesn’t just go away - it gets socialized and redistributed to every other healthcare expense.  So your expenses get raised to help address the uncompensated care.  It’s a big driver of healthcare costs.” 

“To me the inefficiencies in the system are mind-numbing in some ways,” Peterson said