For Obamacare enrollees, Obamacare repeal is already real

About two months ago, Tony Cahn made a decision against his doctor’s advice: He started skipping doses of his antidepressant, Wellbutrin, and his anti-anxiety medication, Klonopin.

Cahn doesn’t really like to skip his medications. He feels agitated without them, particularly when he’s at work. “It makes it harder to focus and obviously affects my mood quite a bit,” he says. “Work gets harder, and so does maintaining personal relationships.”

Cahn (not his actual last name, as Tony asked to keep his identity private to discuss personal medical details) decided to begin stockpiling his pills when the House passed its bill to repeal and replace the Affordable Care Act.

He gets health insurance through the Obamacare marketplace. He’s nervous he might not be able to buy health insurance a few months from now — premiums might skyrocket if the individual mandate goes away, or the return of preexisting conditions might mean his depression would render him uninsurable. So he figured he should start saving pills now, just to be safe.

Cahn’s psychotherapist recently recommended that he increase his medication dosage. But right now, Cahn feels more comfortable doing the exact opposite. He sat there during his appointment thinking, “That is not really feasible at this moment.”

The debate over repealing and replacing the Affordable Care Act is moving into its seventh month in Washington. Legislators can’t decide whether they want to repeal Obamacare — and, if they do, what policies ought to replace it.

Obamacare enrollees aren’t waiting to see the end of this story. The uncertainty has forced those who rely on the health law for coverage to change their lives — to move to a new state (or even a new country), to hunt for a new job, or to lower contributions to retirement accounts in order to stash away the money they might need for future medical bills.

Uncertainty can be a powerful policy in itself, and Obamacare enrollees struggle to know how much energy to put toward their backup plans — how real of a threat they should consider Obamacare repeal.

The Obamacare enrollees preparing for repeal are often the higher-income participants. These are people who don’t use public subsidies to purchase coverage — who have the means to move or stash away savings. To be sure, there are millions of Affordable Care Act enrollees who do not have these means, particularly those in the Medicaid program.

But those who do say they’re watching the Senate debate closely, and not wasting any time.

“I’m not the only self-employed person I know who spends a lot of time trying to figure out: When do I hit the escape button, and where do escape to?” says Stacie Boschma, a 41-year-old freelance copywriter in Atlanta who relies on the marketplace for coverage.

Boschma has Type 1 diabetes and doesn’t think she could afford her insulin and other medical equipment without health coverage. She and her wife have recently begun exploring the obscure Dutch American Friendship Treaty (with the unfortunate acronym DAFT), which appears to allow Americans to spend two years in the Netherlands as long as they open a small business. It would also mean health insurance through the Netherlands’ universal system.

The couple is serious enough about the plan that they are working out a meeting with an immigration lawyer about the possibility this fall. They have never visited the Netherlands before. “I know it sounds extreme,” Boschma says, “but right now, it feels like an extreme situation.”

The Obamacare enrollees I spoke with did not love their plans. Many complained about the high deductibles and premiums. One family I spoke with had a premium of $13,000 — one they never hit with minimal health care usage.

This frustration with the high cost sharing under the Affordable Care Act shows up in lots of survey research, too. The Kaiser Family Foundation has found that 47 percent of marketplace participants are at least somewhat dissatisfied with their deductible level.

Boschma, for example, spends about $400 on her monthly premium and it still comes with a $5,000 deductible. Her wife is currently uninsured because they simply don’t have the money to afford coverage for both of them. Boschma keeps her plan to cover the high costs often associated with diabetes.

“I felt like the law worked really well a few years ago, when I could get a plan for $175 [monthly premium],” Boschma says.

Erin Etten, 45, pays an $1,050 monthly premium for a plan that also covers her husband. They also live in Atlanta but purchased the most comprehensive plan with higher costs. Still, it has a large enough deductible that Etten has ended up paying for MRI scans — which she gets each year as a breast cancer survivor — completely out of pocket.

“I’m not a superfan of my insurance; I agree there is a lot of room for improvement,” Etten says. “Ripping it away from people is not going to magically fix my problems.”

Etten and Boschma have their gripes with the Affordable Care Act, but the Republican health plans won’t fix those problems. The Congressional Budget Office estimates that the GOP bills will cause premiums to go up, not down. The House passed a bill that allows some states to apply for a waiver that lets insurers charge sick people more — a change that worries Etten as a breast cancer survivor, and Boschma as a diabetic.

Etten doesn’t want to live in one of those places. So she and her husband plan to move from Atlanta to New York City later this year; they just had an offer on an apartment accepted this past week. The move is all about health care, as they expect New York would work to keep Obamacare intact in a way that Georgia would not.

“It’s okay. It’s not what we were planning on. It feels like we’re having to change our plans just because I had cancer,” she says.

Still, Etten knows that even New York might not be able to keep Obamacare intact. In that case, she or her husband would likely try to find more traditional employment at a large company that offers health benefits.

“There is no guarantee at this point,” she says, “and that weighs on me a lot.”

Tracy Craig was on vacation in Iceland this spring — a trip to celebrate her boyfriend’s birthday — when she started seeing headlines that the House had resurrected its health care bill.

“I’m on this wonderful trip and then all of a sudden I’m worried,” Craig, 51, says. “It’s like, should I be spending money on this? It’s not the kind of thing I want to worry about at my age.”

Craig is a communications consultant in Washington, DC, and a cancer survivor. This has made her familiar with how quickly medical bills can pile up, and she doesn’t want to be left in the lurch.

She buys coverage through the DC Health Link, the local Obamacare marketplace. She wants to prepare for a future without health coverage and, lately, has started contributing less to her tax-advantaged IRA savings account in order to have more cash on hand should she encounter large medical bills.

“I make the decision week by week, will I put things in my retirement account or should I leave it in my bank account, in case I lose my health insurance,” Craig says. “I do my budget week by week, watching the news.”

Craig is the first to admit this is a crazy way to manage her personal finances, by watching the news and making her best guess about whether Obamacare will be repealed. But then again, she doesn’t know how to do any better.

“I get up, I look at the news, I’m reading Twitter, and I’m making decisions day to day based on what I’m seeing,” she says. “I watch the news and I shift my spending. It all feels nuts.”

Emily Frayson, a 34-year-old mother of two who works part time, is taking a different approach: She’s looking for a full-time job with benefits. (This is not Emily’s real last name, she also asked for privacy to speak openly about her situation.)

Frayson finds that working part time suits her family better. She’s able to spend time with her two young daughters, one of whom has autism. Her husband owns a small business, and the family purchases coverage through the marketplace. They receive a subsidy and pay a $350 premium each month for their policy.

Frayson made the decision to go full time just this Tuesday, when she saw the Senate move forward on its motion to proceed. It seemed like repeal was getting real, but she didn’t want to wait until it passed — she wanted time to job search.

“I made the plan this week because we cannot have this stress anymore,” she says. “It’s been hard; I go to sleep at night stressed out about it. I manage my family’s finances, I go to bed stressed about headlines, I wake up and think, ‘How will we pay for health care if it goes away?’”

Frayson lives in a conservative area of the country. On Facebook, she sees friends writing posts rooting for Obamacare repeal. She watches her elected officials vote for repeal, too.

“You get this kind of complicated mixture of anger and sadness,” she says. “You get this feeling they don’t care about me. It’s hard to get your head around.”

But Frayson isn’t alone: In Chicago, 39-year-old Kelly Dwyer is considering closing the nonprofit consulting firm she opened last year, after which she purchased Obamacare coverage. She wants to stay open — she loves the work and feels she has more impact working with many nonprofits, than within one — but it tugs at her a bit when she accepts long-term contracts these days.

“I really don’t want to close down my business,” she says. “It’s stressful personally. I think about how to message this to my clients, as I take on contracts. We’re getting so much done and I don’t want to have to call and say, I’m shutting down and you’ll need to find another way to do this stuff I started.”

For now, Dwyer is taking those contracts; she figures the worst-case scenario is she’ll find a job with benefits and do the work on the side.

“I don’t have intensive needs — I’m 39, I’m not planning to get pregnant — but that is a thing that could happen,” she says. “Still, I feel like I need coverage. I’ve watched people go through terrible things when they didn’t have insurance. I’m just risk-averse and don’t want to go without coverage.”

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