ST. MARYS — Residents of Auglaize and Mercer counties hoping to obtain health insurance through the Affordable Care Act’s online marketplace will only have one option from which to choose, one which does not include the Grand Lake Health System in its network.
When the Affordable Care Act was first passed, it was touted as a way to help Americans gain access to health insurance while also saving money. In September 2013, a fact sheet was published on the U.S. Department of Health and Human Services website making the case for how this new law would help rural Americans.
“The Health Insurance Marketplaces are expected to increase competition in the insurance market in rural areas — especially in the 29, mostly rural states, where a single insurer currently dominates more than half the insurance market,” it read.
Since its enactment, an estimated 20 million people have gained access to health insurance because of the Affordable Care Act, according to the Department of Health and Human Services, with pre-existing conditions no longer a barrier to obtaining coverage. However, along with facing double-digit premium increases next year, many insurance shoppers are finding fewer options available.
A choice of one
For independent contractor Brian Morris, of St. Marys, only one provider, Anthem, had a plan available for purchase in Auglaize or Mercer counties. However, the Grand Lake Health System, which includes Joint Township District Memorial Hospital in St. Marys, is not included in network in individual or family plans, which he said would cost him $1,100 per month with a $12,000 deductible.
“Our premiums have increased and the plans have gotten worse over the years,” Morris said. “You handle it, but now we’re stuck with this only option, according to my insurance agent, which doesn’t cover my local hospital or the Grand Lake Health System.”
Grand Lake Health System referred questions concerning the Affordable Care Act, but administrative secretary Carrie Widman emphasized that Joint Township District Memorial Hospital is there for anyone in the community.
“Grand Lake Health System’s doors are open to everyone,” she said.
Anthem did not issue an official statement on the matter.
While Morris has no desire to incur up to a $2,500 penalty on his taxes for refusing to sign up for insurance, he admitted it is a temptation, given what he has to pay today.
Paying the penalty “is better than ridiculous premiums and deductibles for zero local coverage,” he said. “Still, being legally required to choose between purchasing insurance that has no local coverage or accept a financial penalty is borderline criminal.”
Morris’ situation is not unique when it comes to a lack of insurance options. According to the Ohio Department of Insurance, 20 counties will have only one insurer selling on the federal exchange for next year, with 27 more having just two options. By comparison, all 88 counties had at least four options available during open enrollment for 2016. Nationwide, 21 percent of exchange enrollees will only have one insurer available in 2017 compared to 2 percent this year, according to the Kaiser Family Foundation.
What's the remedy?
One of the bigger talking points of President-elect Donald Trump’s campaign was repealing and replacing the Affordable Care Act, with one potential piece of legislation seeking to replace the program with health savings accounts and the ability to purchase health insurance across state lines, according to National Public Radio. U.S. Rep. Jim Jordan, R-Urbana, remains optimistic that this can be done within Trump’s first 100 days in office.
“This is one of the issues that played so big in the election,” he said. “I would love to see repealing this be one of the first things that is done in the next Congress. I believe it can happen pretty quickly.”
Tim Shook, vice-president of individual and Medicare markets for Cincinnati-based Cornerstone Broker Insurance Services Agency, is also hopeful that something will happen quickly to address this situation, one which he described as “unsustainable.”
“What’s really going to be interesting is next year, because as part of the ACA, Obama had come out and said that if you have a plan, you can keep it,” he said. “So they allowed some of these plans that were purchased prior to Jan. 1, 2014, and those rates are significantly less than what the ACA plans are. But a lot of these ‘grandmothered’ plans will be forced to the marketplace for Jan. 1, 2018, and that’s when you’re really going to see the outcry from the public, saying, ‘I’ve been paying this amount, and it’s going to go up 60 or 70 percent compared to what I’m paying now.’”
One option that healthy customers without pre-existing conditions could consider, according to Shook, is health share ministry plans, which are recognized in 30 states as distinct from health insurance organizations, thanks to safe harbor laws. Often faith-based, ministries do not use actuaries or make guarantees, but they pool funds together among members to pay for health expenses.
In the meantime, however, Morris continues to look ahead to next year with apprehension.
“We’re talking about paying more for our health insurance than our own mortgage,” he said.
Reach Craig Kelly at 567-242-0390 or on Twitter @Lima_CKelly.