South Side man living proof that new federal health insurance exchange site can work


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Man buys auto insurance? Not a news story. Man buys homeowner's insurance or a life insurance plan? No. But when a man buys a health care policy through the new federal health insurance exchange -- one of only 2,200 or so Pennsylvanians to do so and one of just 27,000 nationally -- that qualifies as a bona fide news story.

Joseph Lucas is a South Side house painter who has spent much of his adult life without health insurance coverage. In his 20s and 30s, health coverage was an abstraction, and annual physicals were more of a worry for the white-collar set.

"I'm a blue-collar sort of person," said Mr. Lucas, who is single. But, "I turned around 40, and figured it was something I should look into."

He did it using the federal health insurance website that has been frustrating thousands of people, as crashes and delays have plagued the site since its Oct. 1 launch.

Last week, the U.S. Department of Health and Human Services reported that while 106,185 people had signed up for an exchange-based health plan, most came from states that are operating their own websites and only 27,000 had selected a plan through the federal marketplace at HealthCare.gov.

The federal government has said it hopes that 7 million people will have purchased exchange-based plans by spring 2014, with an additional 8 million newly eligible for expanded Medicaid programs.

In other words, enrollment is way off pace.

Mr. Lucas is an exception, someone who got help using the website and signed up for a plan. He had been waiting for the opportunity.

Through a previous employer, he had obtained health insurance -- then dropped it several years later as his premiums increased. What had been a $90-a-month premium contribution eventually grew to $450 a month.

"It became totally unaffordable for me," he said.

Going without coverage is a calculated risk that many in his financial position take, particularly if they don't have dependents. And, as with many others, the gamble did not pay off.

Three years after dropping coverage, on Oct. 10, 2010, he was hospitalized with an aortic aneurysm. Eleven days after that, he was given his discharge papers and a hospital bill for $69,000.

He was also given, going forward, a pre-existing condition in the eyes of health insurers. Not only did he have a hospital tab he could not pay, but he also was looking at annual follow-up CT scans that would cost $11,000 or so a pop without insurance.

"I was finding out I could not purchase insurance" following the aneurysm treatment, Mr. Lucas said. "I was either refused" or, in the case of Highmark Inc., steered toward a guaranteed-issue plan. Such plans do not take into account a patient's medical history, but it would have cost Mr. Lucas more than $900 a month in exchange for the absence of underwriting.

That's when he learned about the provision of the 2010 Affordable Care Act that created a new "high-risk" insurance plan, meant to provide coverage for uninsured people with pre-existing health conditions. Pennsylvania's version, called PA Fair Care, began offering coverage in September 2010. The premiums for PA Fair Care were $283 a month.

That policy lasted through this year. Coverage responsibility shifted from the state to the federal government on July 1, and now, with the federally subsidized high-risk plans about to sunset on Dec. 31, those 300,000 or so still receiving coverage through the high-risk pools must find a new policy through the federal exchange or some other avenue.

"I'm not very computer-savvy," Mr. Lucas said, and navigating the healthcare.gov website took him time over a few days. The first day he tried to review health plans, the website crashed.

He tried again the next day, aided by "navigators" affiliated with the Allegheny Intermediate Unit, one of several organizations statewide that had hired trained aides to help customers shop for and buy health insurance.

Mr. Lucas had a choice of more than 30 plans from Highmark, UPMC Health Plan and HealthAmerica, he said. Ultimately, he selected a "silver-level" plan from Highmark. After a federal tax credit of $233 a month is factored in, his coverage will cost about $150 a month -- a great price, he said, for a 50-year-old man with an aortic condition.

While finding coverage took a few log-in attempts and two days of research, in his mind, that wasn't a turnoff. He describes himself as a centrist Democrat who was "on board" with Obamacare from the beginning, for reasons less to do with his party registration and much more to do with his life situation and health bills.

The Affordable Care Act benefited him twice, he says, first with the high-risk coverage, then with the health exchange and the new rules that say policies offered on the exchange can't account for a person's health.

About 700,000 people have signed up for accounts on the federal exchange, suggesting some may be taking their time in reviewing plans, or waiting for the website to be fully repaired before revisiting.

In Pennsylvania, 32,000 Pennsylvanians submitted applications for coverage for more than 57,000 people, including spouses and children -- but most have not yet selected a plan.

"I think a lot of people need to realize you have to put a little bit of thought and effort into this," Mr. Lucas said. "It's not like buying a newspaper."

Bill Toland: btoland@post-gazette.com or 412-263-2625.


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