Affordable Care Act: Access to insurance is no guarantee a person will have access to care

Steve Twedt:

Paul Vondra is just the sort of person the architects of Obamacare had in mind.

The 59-year-old Bellevue resident is a temporary worker contracted through a New Jersey agency to work as a mail clerk for a major local bank. He doesn’t own a car, so he bikes each day to his job in the Strip District.

His agency has offered him a choice of two Affordable Care Act-approved marketplace plans. But Mr. Vondra, who makes less than $25,000 annually and has no dependents, said the cheapest plan carries a monthly premium of $165, or $800 a year, and a yearly deductible of $2,500.

Also, the plan’s co-insurance — the amount he would be responsible for after he has met his deductible — is $4,500, while out-of-pocket hospital costs are capped at $10,000.

“It might as well be $10 million,” he said.

He’s not alone. Officials at local health centers and clinics say they’re seeing more people like Mr. Vondra whose access to insurance has not translated into access to care.

Annette Fetchko, administrator at the Catholic Charities Free Health Care Center, Downtown, said the center has helped secretaries, security guards, custodians, seasonal construction workers and others who have insurance but who still can’t afford to fill prescriptions or follow through on a doctor’s referral to see a specialist.

As a result, she said, the center has broadened its mission, with a focus on ensuring access to care regardless of insurance status.

“At the end of the day, the underinsured are no different than the uninsured,” she said.

Physician Edward Kelly, the Catholic Charities center’s volunteer medical director, believes there’s a public misperception that equates having health insurance to having access to care. “Most people think, ‘We’ve got X number of people who have insurance now.’ But we’ve also got X number who can’t afford their insurance.”

The federal marketplace was designed to offer health coverage to the millions of Americans who had no insurance, perhaps due to losing a job or having a pre-existing medical condition.

That part has worked, as the government estimates 20 million people have gained health insurance since the Affordable Care Act was passed in 2010, bringing the percentage of uninsured into single digits. But in the marketplace’s opening rounds, insurers have incurred major losses on their products, so many are narrowing their networks, dropping or redesigning some plans and raising the price on others.

“I don’t think anybody was expecting deductibles of this level when we went into it,” said Denis Lukes, chief financial officer for the Healthcare Council of Western Pennsylvania in Marshall, which represents the region’s hospitals and other health facilities.

The $2,500 deductible offered to Mr. Vondra, in fact, probably lands at the lower end of the scale. Some plans now post yearly deductibles of $5,000 or more. If you can only afford the monthly premiums of a low-cost plan, said Mr. Lukes, “you’re probably never going to be able to pay the deductible.”

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