Covering Oregon

Robert and Susan Lowe of Gold Hill are eagerly awaiting an opportunity to sign up for health insurance through Cover Oregon, the health care marketplace set to launch Tuesday.

Janine Bennett of Shady Cove, on the other hand, is saying thanks, but no thanks.

In between are countless others who will decide where they stand after sorting through the many options awaiting them on the other side of the health reform portal.

There was little doubt the Lowes would want to know more about what health care expansion and Cover Oregon will mean for them.

At 63, he's retired from the freight brokerage industry. Susan, a graphic artist, has been sidelined for the past two years by fibromyalgia.

Following retirement a year ago, he acquired a high-deductible, catastrophic coverage plan, but her only option was to go into the highly expensive Oregon Medical Insurance Pool.

"I'm hoping, when the exchanges go online, to see competition and affordable insurance, particularly for my wife," Robert Lowe said. "I'm guardedly optimistic that I can find affordable coverage for both my wife and myself."

He handled information technology services at work, so he doesn't anticipate any difficulty navigating Cover Oregon's website. That means he'll have to wait until Oct. 15, when consumers will be able to sign up without the assistance of a "community partner" or insurance agent.

The Lowes are hoping they'll qualify for tax credits, which are available to people who earn between 139 and 400 percent of the federal poverty level.

"Unless you have a really complex financial environment, it's fairly easy to determine what that figure is," he said after attending a Cover Oregon town hall meeting last week in Medford.

"I still have some concerns about the financial viability (of Cover Oregon), because it's predicated on the healthy younger folks joining in," Lowe said. "Maybe it's a matter of them not being interested and sitting on the sidelines for as long as they can. Hopefully there's enough marketing to them to draw them into the program."

The penalty for people who go without insurance next year will be $95 or 1 percent of their taxable household income.

"You hate to go in from a punitive aspect," Lowe said. "The law says you've got to have it. It will probably be a little hairy at first."

'The devil's in the details'

Luke and Kori Acosta of Medford see the arrival of the exchange system as just what the doctor ordered.

"It's a huge opportunity," said Luke Acosta, who operates a landscaping business. "It will be a huge thing for both of us to have health insurance. The cost of several hundred dollars a month is a big barrier to getting insurance. If you have any health conditions or problems whatsoever, you haven't been able to buy insurance because the underwriting was so strict. If you are 15 to 20 pounds overweight or have high blood pressure, you can still be disqualified, even if you have the money."

With an untimely fall or other mishap posing the threat of financial disaster, Acosta said he won't waste a moment in signing up.

"We'll probably use an agent," Acosta said. "I've worked in the industry and have a good understanding how benefits work, but I don't have time to go through and figure out the details of every benefit and the fine print. The devil's in the details when it comes to out-of-pocket and lifetime maximums, and that's not necessarily on the front page. It can make all the difference in a catastrophic event."

'I am holding my breath until I can get true health insurance'

A series of life-changing, personally catastrophic events have made Betsy Lewis grateful for an opportunity to have affordable health insurance.

"For years I have been playing the health care insurance game as best I could — moving here and there, trying to make strategic moves, but not knowing the future," said Lewis, 58, who owns a Rogue Valley consulting firm. "Post-divorce, I had Cobra, then working I had insurance through my job. Following a car accident, I could no longer work at this job, so after a short Cobra period, I was offered astronomically expensive insurance."

She went on and off temporary plans, which did not cover pre-existing conditions, and Lewis was without insurance when she was diagnosed with uterine cancer.

"Because I hadn't had insurance in six months, I got assistance with the Medical Insurance Pool, which paid my $40,000 bill," Lewis said.

Although there seems to be little risk of her cancer returning, and she's recovered fully from the car accident, pre-existing conditions still work against her, she said.

"I make too much to get Oregon Health Plan coverage and too little to afford the astronomical insurance I have been eligible for from time to time," Lewis said. "So, I am holding my breath until I can get true health insurance in January. I have lived in fear about this for years."

'There is a problem, but this is not the solution'

Not everybody in Southern Oregon is as happy about health care reform as Lewis and the Lowes.

For Janine Bennett, it all boils down to personal choice.

"First and foremost, I don't wish to be told what I have to do," Bennett said. "I don't like mandatory health care. I would get it if I wanted it and could afford it."

Bennett, 60, who worked in the service industry for much of her life, has been unemployed for two years. She and her husband, Daniel, moved to Southern Oregon four years ago to be closer to family. Daniel was a small-engine mechanic until five years ago, when a work-related accident left him disabled.

"I've had phone calls saying you will get information in the mail from the Oregon Health Authority," Bennett said. "They tell me you will need to sign up for this, this and this — or you will be penalized."

She admits she might have been spoiled during the days when she got Rogue Valley Physicians Service coverage 30 years ago, "when it was $10 a paycheck and it covered 100 percent of everything."

But Bennett considers a penalty for not participating to be coercion.

"I understand the philosophy of wanting everyone to have medical care, but in my book, it's not going to be what I consider affordable," Bennett said. "It should be a person's individual choice. We live in a free country and we should decide what we want and what we don't want. If we don't choose something, we shouldn't be penalized for it."

Bennett has decided she is going to forgo insurance until she reaches Medicare age. She doesn't believe mandatory insurance will guarantee she'll get to see a doctor.

"That would be the icing on the cake," she said. "Not only would it be mandatory, but it's something you can't afford and there's no guarantee to see a doctor. ... There is a problem, but this is not the solution. This has got to be made comprehensible at every level. I've been to college, and I can't understand it. That's a major issue."

'It shouldn't be complicated'

Central Point residents Eric and Julie Furrer, both in their early 30s, fall into the age category targeted by the designers of the Affordable Care Act. They have three daughters, ages 4 to 9, who are on the Oregon Health Plan. But Eric and Julie haven't been insured for nine years.

"I'm going to reluctantly look at it," Eric Furrer said. "We don't make a lot of money, so I don't know where we will fall when it comes to mandates and penalties."

His job involves working on the Internet, so he has taken time to glance at the Cover Oregon website.

"If there is something beneficial, it would be nice," Furrer said. "There just hasn't been a lot of clear information about what people are going to get out of this. It shouldn't be complicated. From listening to NPR news, nothing seems likely to work out for me. I assume I'll have to pay a penalty."

'That thought terrifies me'

Like the Furrers, Kathy Olson of Ashland isn't ready to rush headlong toward Cover Oregon, but she's willing to investigate.

"We're kind of waiting to see the stuff that comes online, and if I don't understand it, or if something is not clear, I'll probably seek out one of the seminars," said Olson.

Before the recession hit, Olson and her husband, Bryan, were doing well, thanks to the building boom.

"He was pulling in $65,000, and I was working for Greg Walden," she said. "We had two teenagers, my husband was working 80-hour weeks, and I was 45 (hours a week). We made the decision we could easily live off what he was making. We didn't need six figures, and we could live more reasonably."

Then came a surprise pregnancy, coupled with delivery complications, followed by the housing downturn. The family was paying $1,200 a month — more than their mortgage — for insurance.

"When I gave birth, the baby was breech, and I had to have a cesarean," Olson said. "The medical bill was around $10,000. Our deductible was $2,500, then the insurance company charged us co-insurance, where the insured and the insurer share the cost. This added another $2,500 onto our bill."

Even with insurance, their bill came to $5,000, and it took the couple three years to pay it off.

When the building industry collapsed, the Olsons survived on unemployment benefits, but there wasn't enough to cover insurance premiums.

"Where we had been a solidly middle-income family, we now hovered right above the poverty level and stayed there," Olson said.

In 2011, she cobbled three or four part-time jobs together, none of which provided benefits, but they were taxed at the self-employment rate.

"All my hard work gained us nothing," Olson said. "We are still paying off that tax bill."

In 2012, the Olsons' adjusted gross income was $26,000. Both husband and wife had serious medical issues during the past year, and without help from family, she said, "we probably would have lost our home."

The Olsons' dilemma is simple: Will the exchange make insurance affordable?

"Once we get insurance, how much more are we going to have to come up with every time we need care?" she said. "If our income goes up, will we have to pay back any (tax credits) we got? And that thought terrifies me."

'Will I be able to afford to stay alive?'

Although few people covet access to affordable insurance more than Kitty Mackay of Medford, she's going to wait a few days before going shopping on Cover Oregon.

"I have breast cancer and it's hard to get insurance, and the Oregon Medical Insurance Pool is ending Dec. 31," Mackay said. "OMIP costs me quite a bit, but at least I know what I'm getting. I'm so frightened by them taking away the state's program, and I don't know what the program is going to cost."

Even after attending a Cover Oregon informational meeting at Asante Rogue Regional Medical Center last week, she didn't have a good feel for what her costs will be.

"Nothing made me feel real secure or calm," Mackay said. "They have different metal levels (gold, silver, platinum, bronze), costing from $300 to $700 per month and a deductible of $3,000 to $4,000. Right now, I'm paying $767 monthly, and it doesn't cover my previous cancer."

The rub, she said, is that after adding dental and vision insurance to her medical coverage, it would eat up a third of her pension and part-time work income.

"I was hoping it would be affordable health care for everyone, but from looking at the charts, I just can't see that," Mackay said. "At 59, I won't be seeing (Medicare) for a long, long time. I almost feel like I should quit working at all, but I want to contribute to the economic health of the country. I know devastating things can happen, but will I be able to afford to stay alive?"

Reach Mail Tribune reporter Greg Stiles at 541-776-4463 or Follow him on Twitter @GregMTBusiness.

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