Laura Schuch has joined the ranks of the insured, and she couldn't be more thrilled.
"I feel like I won the lottery!" says Schuch, 36, who recently purchased a plan on the insurance marketplace created under President Barack Obama's Affordable Care Act.
The Madison resident had been uninsured for the last five years. Before that, she had spotty coverage depending on her and her ex-husband's employment status. She currently works a few part-time jobs, including in-home senior care, for which she earns $9 an hour.
Schuch signed up for her plan in early December. Others have until the end of open enrollment on April 1 to find something that works for them. On that day, some low-income residents in Wisconsin will lose their BadgerCare coverage, and others will gain access to it.
As the nation transforms citizens' access to health care, complications and controversy accompany the transition. The Patient Protection and Affordable Care Act, better known as Obamacare, was signed into law on March 23, 2010. Among its goals was to provide health coverage to uninsured Americans like Schuch.
The law gave states the option of creating their own "marketplace" or "exchange," where the uninsured could go to purchase plans that are theoretically competitive. Gov. Scott Walker, however, along with some other Republican governors who are opposed to the law, refused to set up an exchange, leaving it to the federal government to do so.
The exchanges were required to be open for business by Oct. 1. Unfortunately, the website for registering for insurance was not ready for prime time, and the glitches that occurred while trying to sign up for Obamacare made headlines for weeks.
Eager to sign up as soon as possible, Schuch logged on to healthcare.gov on Oct. 1. But the troubled website wouldn't let her register. She tried 40 to 50 times in the next few weeks. She also tried calling the help line as well as the BadgerCare number and Access Community Health Centers, but no one could give her clear answers.
"There was so much information being held back from not just the public, but from people who work in health care, that nobody really knew what to tell me," says Schuch.
An 'experiment'
Schuch was especially confused about how Gov. Walker's Medicaid decisions would affect her. Obamacare expands Medicaid to cover adults with annual incomes up to 133% of the federal poverty level. But Gov. Walker rejected billions in federal aid to expand the program, and is instead sending people above the poverty line to the marketplace to purchase insurance.
Whether individuals making 100% to 133% of the poverty line -- $11,490 to $15,282 annually -- will be able to afford the available options is an "experiment," says Donna Friedsam, director of the health policy group at the UW Population Health Institute. "We don't know yet if this will work," she says. People in this category will not be considered in violation of the requirement to obtain insurance, known as the "individual mandate."
It took Schuch about six weeks to register on healthcare.gov and then another three wrestling with the site to accept her application. Finally, she was able to review her plan options. She found the choices to be more than adequate. "Oh my God, dental!" she says, of one part of her new coverage.
Schuch also found she was eligible for tax credits and subsidies covering most of her $268.11 monthly premium. Her premium share is $42.11 per month, and the deductible she has to pay for services before insurance kicks in is $50. The coverage pays for office visits, preventive care, medications and hospitalization. Her co-pay for a doctor visit is $20. Schuch chose a plan that allows her to keep her current doctor at the Access Community Clinic.
Schuch benefits from living in Dane County, which according to Friedsam has the lowest insurance plan prices in the state. It also has a larger network of providers than many rural areas of Wisconsin.
For some low-income Wisconsinites, however, even subsidized premiums may leave them with unmanageable co-pays and deductibles. Schuch feels the squeeze from her $42.11 premium but found help through another option available only in Dane County, the United Way's Health Connect. This pilot program helps very low-income individuals by paying the premium portion left after federal cost-share reductions.
Medical bills
Schuch takes medication for a diagnosis of depression and anxiety. When she tried to get insurance before Obamacare, private insurance companies wanted to charge her a higher rate for her "preexisting condition." Obamacare prohibits such discrimination.
Schuch also tried over the last few years to get coverage through BadgerCare, but she gave up last year when told there were over 100,000 people ahead of her on the waiting list.
Schuch's struggles to get insurance before the Affordable Care Act were not unusual. Friedsam calls Schuch a "very good example of the challenges people face in getting covered."
Starting in 2009 Schuch found an option for primary care through Access Community Health Center, which operates on a sliding-scale fee system. There, for $10 per visit, she was able to see a doctor to monitor her medications. The center doesn't include specialists, however, and Schuch would have still been responsible for any hospitalization costs she incurred.
This was a huge fear. Schuch had fainted suddenly in 1998 and again in 2006. Both times she was taken to a hospital emergency room, where a series of tests and follow-up visits to a neurologist and cardiologist found nothing wrong. Luckily the episodes happened at a time when Schuch had insurance. After she lost that insurance, though, she instructed her friends and family not to call an ambulance if it happened again.
"I'd rather be dead than wake up to potentially hundreds of thousands of dollars of medical bills."
Perseverance pays off
Schuch finds peace of mind knowing that she would not be financially ruined by a medical emergency with her new insurance coverage. She's also taking advantage of the health care she's put off for years, starting with a dental cleaning.
Schuch is one of the 40,752 Wisconsin residents who have enrolled for Obamacare, according to the latest numbers from the U.S. Department of Health and Human Services. There's still a long way to go to get coverage for all who are eligible. A 2012-2013 U.S. Census survey put the number of uninsured in Wisconsin at 10% of the population, or more than 570,000 people.
Dane County residents looking for in-person help enrolling in the marketplace can go to the Dane County Job Center Monday through Friday, 8 a.m. to 4 p.m. Madison and Dane County Public Health will also be providing free assistance at area library branches through the end of March. And people can call 211 to find out whether they are eligible for the United Way's Health Connect or other resources.
While Schuch's experience signing up for insurance on the marketplace was at times confusing, frustrating and painfully slow, she's relieved to finally have reliable coverage and wants others to know that perseverance pays off.
"If you give up, you lose," she says. "We have fought for this for too long and too hard for people to just give up when it gets a little hard."
