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Congress adds fuel to debate over whether consumers can keep old policies

This article first appeared in the St. Louis Beacon. - The latest wrinkle in the Affordable Care Act centers on whether consumers should be allowed to keep health insurance plans that may offer less coverage than the minimum benefits envisioned in the health-care law.

The issue has generated so much controversy that U.S. House members have scheduled a vote for Friday on a variation of HR3350, legislation to let consumers rather than the federal government decide whether to keep the old plans. In addition, the Obama administration has hinted of changes in the law in response to consumers' complaints.

On the eve of the House’s vote, a local group, Women’s Voices Raised for Social Justice, is sponsoring a public discussion about the ACA at 7 p.m., Thurs., Nov. 14 at the Center of Clayton, 50 Gay Ave. While the discussion will focus on how the law changes the way health care is delivered and financed, some members of the group warn that consumers should be careful what they ask for in seeking to retain their old policies.

These members point to one of their late associates, Melanie Shouse, a small-business owner who died in 2010 of breast cancer.  “She and her partner had started a business in St. Louis,” said Barbara Finch, a member of the women’s group. “Money was tight. They knew they needed insurance, so she bought this catastrophic policy because she thought she was healthy and they needed the extra money to plow back into the business they were trying to grow.”

That worked well, Finch said, until Shouse discovered a lump in her breast and found that the care she needed wasn’t available through her policy.

“Her policy didn’t cover any kind of preventive care at all. By the time she went to the doctor, it was stage 4 breast cancer. When she needed care the most, it was not there for her. ”

For more info: licensed health insurance agents and brokers website on "Obamacare."

Finch regards Shouse’s experience as a warning that people “may have purchased a policy that is not going to help you. One of the wonderful things about the ACA is that it requires policies to protect us against things that we tell ourselves will never, never happen to us.”

This is a debate in which neither side is totally correct, said Tim Teicher, a local insurance broker. In an even-handed assessment, he says, he could appear on a conservative show on Fox News one day and on a liberal program on MSNBC the next, and make equally persuasive cases of why consumers should or shouldn’t be allowed to keep their health insurance.

Premiums of many young people, he said, are certain to rise under the health-care law but that they should get used to it. “It is called the Affordable Care Act, not the Less Expensive Care Act," said Teicher, "and the reason it can be both more expensive and affordable is the federal subsidy.” Even some who are complaining about the cost, he said, will be eligible for subsidies to reduce what they will pay.

At the same time, he said, the math behind the ACA makes it inevitable that some young people will have to pay more. The law forbids insurers to charge a person aged 64, for example, more than 300 percent of what someone aged 21 pays in premiums. Although older people tend to be sicker and require more care, the 3:1 ratio means some cost to cover care for older people will be borne by younger people, some of whom will see their insurance cost triple their current rates, he argues. The idea is to help keep health insurance affordable for everyone.

The higher rates are among reasons economists such as Susan Feigenbaum, a professor at the University of Missouri at St. Louis, has argued that ACA is unfair. She speaks of her own children, saying she couldn’t in good conscience support a law to impose higher debt on them. At the same time, she distances herself from conservatives who would ignore government’s obligation to help those who cannot help themselves.

On the other hand, Finch, the Social Justice member who lives in University City, said, “People sometimes have to pay for things that they don’t use. I don’t have any children in school now, but I am paying for schools. I’ll just say that you may not have to use every feature of it (ACA), and good for you if you don’t. You’re lucky if you don’t have to use insurance. But when you do, it had better be comprehensive.”

The complexity of the debate hasn’t been lost on President Barack Obama. He has apologized for the fact that what’s happening contradicts one of his own promises, that people who like their existing insurance plans can keep them. His promise was made before insurers decided it would be cheaper for them to scrap existing policies than change them to meet the coverage required by ACA. 

One issue lost in the debate, said Teicher, the insurance broker, is the fact that consumers who like their old plans might not have to do anything immediately. He says they can keep those old policies, under presumably lower rates, until December 2014. 

“Basically you get a free pass to opt out of Obamacare for 2014, but you must act soon,”  he said.

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.