Affordable Care Act Plans Carry Added Costs

Dec. 27--ERIE, Pa. -- Lisa Kelleher was happy in 2014 when about 50 of the patients at St. Paul's Neighborhood Free Clinic bought health insurance through the federal government's Health Insurance Marketplace.

Getting health insurance is a goal for many patients of the clinic, which only treats low-income Erie County residents who are uninsured. Insurance gives them access to physicians and hospitals throughout western Pennsylvania.

But 12 of those 50 patients have since dropped their health insurance and returned to the Erie clinic.

"They came back due to the out-of-pocket deductibles they had to pay," said Kelleher, the clinic's executive director. "They couldn't afford them."

The Affordable Care Act has been a godsend for many uninsured residents across Erie County, offering health insurance plans with low monthly premiums -- especially if the person's income qualifies for tax credits.

But the out-of-pocket costs of some of these plans can exceed $6,000 a year -- far too much for someone on a limited income, Kelleher said.

"For some of them, it came down to paying their deductible or paying rent," Kelleher said. "So they stopped their insurance and started coming back to the clinic for their medical care."

More than 394,000 Pennsylvanians have signed up for health insurance in 2016 through the marketplace.

Michelle Robertson, a certified marketplace navigator for Erie County, said she discusses out-of-pocket costs with people when they apply for coverage.

"We talk about how the premium is only one of the potential costs," Robertson said. "Many of them realize that, but some don't."

Michael Murnock was fully aware of the out-of-pocket costs when Robertson helped him purchase health insurance through the marketplace for 2015.

The 63-year-old McKean Township man is satisfied with his current health insurance, but was dismayed to learn his current Highmark Blue Cross Blue Shield plan will not be offered for 2016.

"Highmark sent me a letter telling me the new plan would have a lower premium," Murnock said. "But I found out it has huge out-of-pocket costs, including that I would have to pay the first $6,000 of a hospital stay."

Murnock worked with Robertson to select a different Highmark plan for 2016 that costs about $70 a month more than his current plan, but covers more medical costs.

"I can deal with the higher premium but if I was hospitalized and slammed with all of those out-of-pocket costs, I would have to talk with the hospital about a payment plan," Murnock said.

The St. Paul clinic has seen a decline in patients since the marketplace opened. It treated 431 different patients in 2015 (through Nov. 20), compared with 477 in 2014.

But Kelleher said the drop is due more to increased enrollment in Medical Assistance than to the marketplace.

"I don't know what will happen next year," Kelleher said. "I know the penalty for not having insurance will be higher ($695 or 2.5 percent of the household's income, whichever is higher), but it's difficult to judge what people's behavior is going to be. We will be here, providing medical and dental services."

DAVID BRUCE can be reached at 870-1736 or by e-mail. Follow him at twitter.com/ETNbruce.

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