Modesto man thanks the ACA for flimsy health plan and sky-high insurance rates

Bruce Pardini of Modesto refers to his health insurance plan as “this plastic card in my pocket”, which costs almost $1,000 a month. It has a $6,500 annual deductible and other costly terms such as a $75 copay for physician visits.

Pardini is among the middle class voices that are disenchanted with the promises of the Affordable Care Act. With a household income of $73,000 a year, Pardini and his wife are not eligible for tax credits to lower their premiums.

What he can afford, in this period of sky-high insurance costs, is a Bronze plan with a $13,600 out-of-pocket maximum for the household and 60 percent coverage for health care bills.

“Not a lot of doctors want to accept it,” Pardini said of the Anthem Blue Cross policy. “The middle class is always getting hosed.”

Republicans have resumed work this week on a replacement bill that may not have full support from the slim GOP majority in the Senate. They feel compelled to follow through with campaign promises to repeal Obamacare. Various actions could gut a program that provides individual market insurance for 1.2 million California residents, including more than 18,000 in Stanislaus County, some of whom were denied coverage due to preexisting conditions before the ACA.

Pardini can predict the reaction from Democrats and like-minded research groups to whatever the GOP proposes. And he knows what to expect from news coverage he sees as slanted to the left.

But what about the other facts? The average annual costs for employer-based health coverage was $18,142 last year; employees on average paid $5,277 for their benefits, according to a Kaiser Family Foundation survey.

People buying individual coverage on exchanges created by the ACA were met with 25 percent increases this year, though the hikes were more like 13 percent in California.

Former President Barack Obama’s health program has not delivered on promises to lower premiums for consumers unless they are eligible for financial assistance.

Family coverage offered to school teachers in the Modesto area costs about $20,000 a year. “The escalating cost of health insurance in this country is outrageous,” said Doug Burton, president of the Modesto Teachers Association, who thinks, however, that the GOP Senate health bill will make it much worse.

In the days before Obamacare, Pardini contributed $270 a month from his paycheck for family medical and dental benefits. He went to work for a small business, leaving employer-based insurance behind, and paid a subsidized rate of about $500 a month for a Silver-Plus plan, one of the better insurance policies on the Covered California exchange, insuring his wife, son and himself.

By mistake, the family was signed up for two insurance plans and it took almost a year to correct that, Pardini said. His adult son is no longer at home, and since their household income is not between $22,000 and $64,000 a year, the Pardinis are not eligible for a tax credit today. Bruce said they can’t afford a $1,300-a-month Kaiser Permanente Silver plan that would provide stronger coverage levels.

Another concern on his mind is a grandson with enlarged kidneys, and that his daughter and her husband have solid insurance to pay for tests and any needed treatment.

Pardini, a 58-year-old resident who voted for President Trump, said the Senate bill still needs revisions. In its present form, the bill would push costs higher for the Modesto resident and other adults in their late 50s. But he wants to have more choice, or a relaxing of requirements, so insurers can offer lower-cost options with a stronger network of doctors.

Pardini said he can do without requirements that health plans pay for contraceptives and rehab services for drug addicts. The government could encourage competition by eliminating state boundaries to selling insurance. Wasteful spending could be slashed by diverting people with routine medical issues from hospital emergency departments to urgent care clinics, he said.

Dennis Nasrawi of Modesto said he watched insurance rates increase from the time the ACA was signed into law in 2010 until Obamacare insurance went into effect in 2014, and they continue to rise. His health savings account was grandfathered in when private policies for other consumers were canceled in California. Today, the HSA costs him $400 to $500 per month and has a lower deductible ($3,000) than other products on the market.

“An equivalent plan would cost $800 to $900 a month if they offered one,” said Nasrawi, who lives on retirement income. “I believe health care costs were going up on their own and premiums were going up on their own, but neither was going to go up nearly as much without Obamacare.”

Sally Pipes, chief executive officer of the Pacific Research Institute, which promotes free-market policy solutions, said a better choice of health plans would persuade more young adults to buy insurance and create a healthier mix in insurance pools. “They want catastrophic coverage and that is why health savings accounts are good for them,” Pipes said.

Sen. Ted Cruz is pushing for more market-based repeal legislation and wants to let insurers offer less costly individual plans that don’t comply with the ACA. Fifty billion dollars could be spent over five years to stabilize state exchanges that have an imbalance of sicker people in their pools.

New legislation could maintain protections for people with preexisting conditions but take a different approach by giving them assistance for buying insurance, Pipes said. There are 6 million people with preexisting health conditions in the individual insurance market.

Nasrawi said a new health care act should have price transparency so that consumers know what they’re paying for health care and should encourage the use of health savings accounts. People should be able to determine the level of insurance that’s best for them and a new law should create financial disincentives for unhealthy lifestyle choices such as smoking and drug abuse, he suggested.

This story was originally published July 11, 2017 at 7:15 PM with the headline "Modesto man thanks the ACA for flimsy health plan and sky-high insurance rates."