As health care overhaul nears, many consumers still feel in the dark

Chad Terhune / Los Angeles Times /

Like many others, Scott and Danielle Nelson are anxious about what President Barack Obama’s health care law will mean for them.

While government officials tout the broad benefits of the Affordable Care Act to drum up enrollment, many consumers are eager to know how the overhaul will affect them personally, from pocketbook concerns to worries about whether their local doctor and hospital will be included.

And so far, there have been considerably more questions than answers, as officials and insurers scramble to get ready and clarify many of the details that people care about the most.

The issue hit home for the Nelsons several weeks ago when their current health insurer, Aetna Inc., said they were among thousands of customers in California whose coverage will be canceled at year end. As a result, they will need to buy a new policy just as the federal law reshapes the market.

The surprising news came at a rough time for the Aliso Viejo, Calif., couple and their two young children. Danielle Nelson, 42, was diagnosed with cancer in March. She began sobbing as she shared the insurance company’s letter with her husband. Her 7-year-old daughter, Taylor, saw something was wrong and handed her parents a pink purse where she had saved up $27.

“All of this has turned our lives upside down,” said Scott Nelson, 49. “The uncertainty in health insurance really has us scratching our heads.”

The Nelsons aren’t alone in searching for answers as the biggest change to health care in nearly half a century prepares to kick in Jan. 1. About half the public says they don’t have enough information about the health law to understand how it will affect their own family, according to a recent poll by the Kaiser Family Foundation.

Huntington Beach, Calif., resident Brad Miller said he and his wife pay about $1,200 a month for their health insurance. The 60-year-old says he’s concerned that comparable coverage will be expensive next year and federal subsidies won’t be available to help.

Steven Aispuro, a 50-year-old father of three in Whittier, Calif., is uninsured and eager to find out how much family coverage will cost, and whether his family qualifies for government aid. “You hear a lot of negative things about Obamacare on TV. I don’t really know what’s true about the law,” he said.

The federal health law requires most Americans to have health insurance starting next year, and many consumers will qualify for free or subsidized coverage based on their income.

While subsidies may make insurance more affordable for some, state officials have already warned that premiums could rise an average of 30 percent for many middle-income residents who don’t get their insurance through their employers.

How individuals and families fare will vary based on their age, household size, income and where they live. Explaining the nuances of a complex law and various insurance options is a daunting task.

The Nelson family said they feared the worst after the Aetna cancellation notice, particularly as they incurred medical bills related to the cancer diagnosis.

“Are we going to lose our house? That was really where my mind went,” Danielle said.

In the days and weeks that followed, they learned they stood to benefit from certain provisions of the health law, while other questions surrounding cost and choice of doctors were harder to pin down.

Scott is a philanthropy and communications consultant who left a corporate job with health benefits about 18 months ago. Danielle previously worked as an assistant vice president for financial firm Lehman Bros. in Southern California.

Under the health care overhaul, insurers must accept all applicants regardless of pre-existing medical conditions. That was a huge relief for the Nelsons after her diagnosis of non-Hodgkin’s lymphoma, a blood cancer.

Danielle had a tumor in her jaw removed. But thus far, she doesn’t require further treatment beyond regular testing. She still worried her premiums would be higher next year because of the cancer, but the health law forbids that as well.

The Nelsons pay $667 a month now for their health policy. But a midlevel “Silver” policy from California’s new insurance exchange — along with the federal subsidy for which they are eligible —would cost them $593, or 11 percent less, according to an online calculator provided by the state exchange.

The family says they might want more coverage than a Silver plan offers, but for now, the state calculator only cites general rates for that level of benefits.

Starting next year, health insurance premiums are based on a person’s age and location. Separately, premium subsidies hinge on household income and size. Individuals earning less than $46,000 a year and families below $94,000 annually may qualify for subsidies.

Another crucial part of the insurance math for consumers are the co-payments, deductibles and other medical expenses they’re responsible for until a health plan starts picking up the tab.

As part of the health law, California set limits on what residents will have to pay for care out of their own pockets. For instance, Covered California requires Silver plans to have a $2,000 annual deductible, and the maximum out-of-pocket expense for a family is $12,700.

The Nelsons said they were encouraged by those cost estimates, but they worried whether the new health plans would include her doctors and hospitals.

To hold down premiums in the exchange, some insurers have limited their roster of medical providers. For instance, Blue Shield of California said its exchange customers will be restricted to 36 percent of its regular physician network statewide.

“We have good doctors now,” said Scott, who plans to check on the medical providers before picking a policy. “When my wife needs care, I want her to have the best.”