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November 9, 2013

As many as 250,000 Pennsylvanians could be losing health plans

HARRISBURG — For many Pennsylvanians, the Affordable Care Act is proving to be anything but affordable.

State regulators say that 250,000 Pennsylvanians are losing health coverage due to changes required by Obamacare. Many others are dealing with sticker shock from dramatic premium increases.

That’s putting people like Jason Martin, of Sunbury, in a bind. Martin had been responsible for managing the health plan for the five employees in his family’s small business. That’s a responsibility Martin no longer has to worry about: They have dropped the plan because none of the workers will be able to pay their share. If they had kept the plan, their premiums would have increased 50 percent.

Martin now has a new worry: finding a health care plan for himself, his wife and their four children.

Martin said he knows his family will qualify for a government subsidy for health coverage, but because of problems with the federal healthcare.gov website, he can’t discern how much his subsidy will be.

He has until Dec. 1, when his old plan runs out, to figure it out.

“It’s a tight time frame,” Martin said.

President Barack Obama apologized this week for repeatedly pledging that health care reform would not force people to give up their existing insurance plans. But in a speech this week, Obama said the problem was limited to about 5 percent of Americans enrolled in “cut-rate” plans that don’t meet the minimum standards set in the health care reform law.

Some health plans have outright announced that they are dropping certain types of coverage. Earlier this fall, Highmark announced it was dropping special insurance plans for 40,000 people with pre-existing conditions. The plans were obsolete because Obamacare bars any insurance plan from denying coverage due to pre-existing conditions.

Many other plans have quietly sent notices to customers indicating that their benefits have changed and premiums are increasing, as a result.

The biggest factors in this shift are Obamacare requirements mandating that all health insurance include maternity care and prescription drug coverage, said Chris Fanning, vice president of sales for Geisinger Health Plan, based in Montour County.

Athena Ford, advocacy director for the Pennsylvania Health Access Network, said that many people with these bargain-basement plans were probably unaware that they had health insurance that wouldn’t cover maternity care.

In other cases, those without maternity care would likely include men who saw no need for the coverage, Fanning said. Now they have no choice but to pay for it.

Fanning said that somewhere between 45,000 and 50,000 people in small group or individual plans offered by Geisinger Health Plan must be shifted into new plans. Those plans are going to have higher premiums because they have “enriched benefits,” Fanning said. Those affected amount to about 10 percent of the small group and individual plans offered by Geisinger Health Plan.

Steve Fisher, an insurance agent in Crawford County who is president of Pennsylvania Association of Health Underwriters, said Obamacare was supposed to narrow the gap between the amount paid by people with low-cost insurance and those with more expensive insurance. It might be accomplishing that, but people on both ends of the scale are seeing higher premiums.

“For the 24-year-old male, the rate increase would be 167 percent. For the 64-year-old male, the rate increase would be 59 percent,” Fisher said after comparing existing plans to comparable plans offered on the state’s health exchange. “Where is the affordability with these rates?”

Ford said the cases being highlighted by critics are not typical and that overall, the health reform law will help rein in insurance premium increases. Forbes Magazine’s analysis found that the average 27-year-old woman in Pennsylvania will see her insurance premiums decrease 8 percent. Insurance premiums for most 40-year-old women will decrease 13 percent.

Obamacare has also added a layer of control to rate increases. That’s important because Pennsylvania has some of the most lax regulation of health insurance rate increases, Ford said.

John Finnerty works in the Harrisburg Bureau for Community Newspaper Holdings Inc. He can be reached by email at jfinnerty@cnhi.com or on Twitter @cnhipa.

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