The View From Your Obamacare

Andrew Sullivan —  Apr 17 2014 @ 1:42pm

Readers begin to share their stories:

Being left out of the official statistics are people like me who purchased new policies directly from insurance carriers. Pre-ACA, they would not have insured me for any amount of money due to a long list of pre-existing conditions.  As of January 1, they can no longer ask me those questions.  I do not qualify for any subsidies, so there was no need for me to purchase insurance through the exchange.  Instead, I bought insurance without the government middleman, courtesy of the ACA.


I’m a 29-year-old woman and a self-employed writer. Before the ACA passed, I was rejected by every health insurer in California because I had an abnormal pap smear and was diagnosed with HPV, which can cause cervical cancer. I was shocked – not by the diagnosis, which is very common, but by the fact that I could not get any coverage (I am otherwise very fit and in perfect health). I am eternally grateful for Obamacare – not because of the cost (which at $181/mo for a $2000 deductible is much cheaper than the Freelancer’s Union insurance in had in NYC of $270/mo for a $10,000 deductible), but because it allows me to get health care at all.

What troubles me about the health politics of the Republican party is that they seek to dismantle both Obamacare and Planned Parenthood, thus rendering a woman in my position without any sort of affordable preventative care. And there are a lot of women in my position. HPV is not a rare disease. According to the CDC’s website:

About 79 million Americans are currently infected with HPV. About 14 million people become newly infected each year. HPV is so common that most sexually-active men and women will get at least one type of HPV at some point in their lives.

But many women, myself included, do not like to talk about these details in public. I paid attention to the way people reacted to Sandra Fluke, and I am not interested in engaging in a public conversation about my sexual choices (though if you must know, I’m heterosexual, monogamous, and am engaged to a man I have been dating for five years). This, I think, is one of the reasons we don’t hear an outpouring of good publicity for Obamacare: the people who benefit most from it (self-employed, with a pre-existing condition) are less inclined to talk about their success stories because the subject matter is often too sensitive for a public forum, or for a name to be attached to it. 

Another shifts focus:

The law has been helping my family in one key way since just a few months after its passage in 2010: my 19-year-old-sister gets to stay on my mom’s plan. My dad died in late 2012. If Obamacare hadn’t given us this option, keeping my sister insured would be an all-hands-on-deck financial effort by myself, my mom and probably my little brother. It would be a huge drain on the incomes of my entire immediate family.

Now? She’s had coverage consistently since exceeding the age of 18 and apparently can continue to have coverage for another six years. In the meantime, she’s getting a degree and starting her first part-time jobs, so she’s probably on track to be pay for her own insurance by the time she is 26. In a world without ACA, she couldn’t have this college experience. She’d have to go to school part-time and work more. Obama is helping my family help my sister have the kind of college experience she deserves and I am tearing up just typing this to you.

Update from a reader:

As you know, I’m an advocate of Obamacare. However, I have to point out that your third reader is apparently either mistaken or doesn’t know about one huge change in the marketplace due to the ACA. Now this may differ from state to state, but here in CA, prior to 2010, children could stay on their parents ONLY IF they are full-time students. Only if she was a part-time student would she have had to carry her own insurance.

There is one huge change to the law that affects parents. Prior to 2014, here in CA, one child’s premiums paid for all children. So if you were Kate whatshername and had 8 children, you’d still only pay for one. I think this is what your reader meant by not having a “huge drain on the incomes on my entire immediate family.”

Starting in 2014, with all new ACA plans, a parent has to pay for up to three children’s premiums, as long as they are under 18. Any child over 18 will have their own premium. So, if a parent had six children, three under 18 and three over 18, that parent will have to pay six premiums along with the parents. If the scenario was five children under 18 and one over, that parent would have to pay for four children’s premiums.

So that third reader? She may be in for a huge surprise when the mom renews. It sounds like the mom had to pay for two premiums before, and now will be looking at three, four if the writer is under 26.

You know what surprises me? I haven’t read one story in the media about this change. And I think it’s because parents have known all along, that the old way was a very nice free ride.

Another provides some supplemental info on the subject:

This link has state-by-state laws on eligibility. Looks like 19 is the youngest a kid would no longer qualify for parents insurance. But there were lots of exceptions to that age depending on the state. Often a kid could remain on insurance longer if they were a student. Here is a key part of an issue brief (pdf) on the subject from 2010: “Young adults covered as dependents on their parents’ employer policies often lose eligibility for that coverage at age 19 or upon graduation from high school, particularly if they do not go on to college.” And here’s part of a useful Kaiser brief (pdf) from 2010:

Approximately 25 states have extended the age that young adults can remain on their parent’s health insurance plan, but policies regarding who is eligible for this coverage vary widely. Most of the states that have these policies in place extend coverage to young adults up to age 25, but some states extend dependent coverage to age 24 or 26 and New Jersey extends the dependent age to 30. Some states mandate that eligible young adults be unmarried, be students, or be living in the same state as their parent with private coverage. State requirements to extend coverage to dependents do not apply to insurance plans that are self-funded. The federal requirements in the health reform law are designed to apply to these self-funded plans, along with other private insurance plans.

The new federal health reform law will be applied to all states, including those who have already expanded dependent coverage to some young adults. Young adults in states with narrower eligibility criteria than the federal law will now be able to take advantage of the federal law. States that have broader eligibility for dependent coverage will be able to continue their current state policies, which will enable more young adults to qualify for dependent coverage in those states than would qualify under the federal law.