National Edition

Health care is no game, but will your family win or lose under Obamacare?

Published: Thursday, March 27 2014 5:30 a.m. MDT

Lindsey and Kirk Stephens play with their 11-month-old son Jack in their home on Thursday, March 20, 2014.

Matt Gade, Deseret News

It’s a story of two moms in search of health insurance: Single mother Melanie Thomas and young wife and mother Lindsey Stephens each separately went online recently to sign up for health care coverage as part of the looming Obamacare mandate.

It’s also the story of Obamacare itself. Though loud voices on both sides are working to characterize it as either a brilliant triumph or a complete failure, the experiences of these two moms sum up the one thing families know for certain about this foray into health care reform: How well it works depends on where you live and your individual situation. Even people who live close to one another, like Thomas and Stephens, can have very different experiences with the Affordable Care Act.

Thomas, of Midvale, Utah, has four mostly grown children and works for a company that does not offer insurance. She tried to sign up in December and ran into glitches right away, including poor communication between agencies that were supposed to see if she was eligible for Medicaid. She wasn’t, so she went back to the individual insurance marketplace, where she had to start over twice, including with a broker helping her. The problems, she said, delayed her coverage taking effect by more than a month.

Lindsey and Kirk Stephens of nearby Salt Lake City are among the so-called “young immortals” whose participation in the insurance marketplace is crucial if the Affordable Care Act (ACA) is to work. They and their peers are more likely than other groups not to buy insurance, citing youth and good health as justification. Enough of them must buy, though, to spread cost and risk, or coverage will become very expensive for others.

Kirk has been on his parents’ policy under a provision of Obamacare, but will lose that option soon when he turns 26. Lindsey, 28, had insurance until she stopped working to care for baby Jack and then could not afford other coverage. Jack is covered by the Children’s Health Insurance Program. Last week, the Stephenses found a policy on the federal insurance exchange at Healthcare.gov that’s affordable because they’ll get a subsidy. It provides good coverage and puts them on the same policy. The hunt wasn’t so bad, Lindsey said, although it took her awhile to figure out the site and find what they needed.

On March 31, the first open-enrollment period closes. Although about 86 percent of Americans have health insurance, usually through employer plans, Medicare or Medicaid, millions of Americans are exploring new health coverage options — some frantically, since those who have not arranged coverage by the deadline face moderate tax penalties. Figuring it out is complicated because the rules have exemptions and deadlines that keep changing. An array of provisions, prices and subsidies determine whether individuals come out winners or losers — and examples of both clearly exist. There are also questions about how the new legislation both aids and inhibits further innovation in the health care sector, and cutting through the political posturing on both sides to get at the real effects is an ongoing challenge.

The goal of reform has been making health care accessible and affordable, said Len M. Nichols, a health economist at George Mason University. The attempt is possible now, where it failed in the 1990s, he noted, because “a critical mass of people in the (health care) system now agree we have to do this. Almost in spite of the government, it’s moving forward. But the process has been embarrassing and unfortunate.”

What’s in it?

The law confuses people. Public opinion polls have found as many as a third of American adults don’t know the “Affordable Care Act” and “Obamacare” are the same thing. Parts of the law have also changed or been delayed, adding to the confusion. Many appear not to know the ACA is law, perhaps confused by the debate that has raged since before it passed in 2010.

Still, families need to be aware of key provisions:

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