DURHAM The Clodfelters saw their copays and deductibles double when they bought insurance on the exchange. Now they are worried about what costs are still to come now that Blue Cross Blue Shield is their only option. The Clodfeltters are retired, but among the minority of folks who do not qualify for any federal subsidies to offset the cost of insurance.”It’s ridiculous. We used to have competition and health insurance was available,” said Dru Clodfeltter. “When the federal government stepped in and Obamacare kicked in, the market just dried up. The restrictions on your doctors, the coverage they require you to have, so many things changed and now nobody wants to cover you in Obamacare.”According to N.C. Insurance Commissioner Wayne Goodwin, the Clodfelters are not alone. UnitedHealth Group and Aetna pulled out of North Carolina and the online marketplaces selling the subsidized plans, citing bigger-than-expected financial losses. Now BCBS is the only option in 95 of the state’s 100 counties.”Ultimately these are private businesses that make business decisions,” said Goodwin. “The various insurance companies who voluntarily chose to write ACA insurance plans were promised by the federal government that there would, essentially, be insurance for them should there be losses during the transition period. But the federal government only paid 14 cents on the dollar to these private businesses. That’s why many of these companies have pulled out of states like N.C., because Washington didn’t keep its word.”Critics say that had North Carolina started a state-based exchange, rather than relying on the federal one, perhaps there would be more competition and control over rates at the state level. However, others point out that two-thirds of the 23 states who started state exchanges have had their system collapse, taking with them nearly $2 billion in federal money they got to set up the programs.Nationwide, not enough young and healthy people have signed up to provide a revenue stream that offsets the costs of covering members with serious illnesses. Monthly premium prices are on the climb, which further discourages some people from signing up. Analysis conducted by the nonpartisan Kaiser Family Foundation suggests at least 16 million people need to enroll before the online Affordable Care Act insurance marketplaces stabilize.Former President Bill Clinton said this month that while millions more Americans now have insurance coverage under President Barack Obama’s signature 2010 health care law, small businesses and some families are still “getting killed” by surging health care costs.According to health care analysts, Clinton’s comments put a spotlight on an uncomfortable truth: after six years, billions of dollars and a sweeping reform that stands as Obama’s single biggest domestic policy achievement, health care is still unaffordable for many Americans. As the U.S. population ages, U.S. spending on health care $2.9 trillion in 2014 is projected to rise to more than one-fifth of the nation’s gross domestic product.”I have extreme frustration with what’s happening on both the federal and state level on this and am hopeful that changes in the law, that both political parties are aware are needed, will be acted upon as soon as possible no matter who the next president is, who is in charge of Congress or, frankly, the legislature as well,” said Goodwin.Whoever wins the presidency on Nov. 8 will likely face pressure to move quickly to reshape a health care initiative that affects millions of Americans.Republican presidential nominee Donald Trump has proposed getting rid of the exchanges and setting up tax-free health savings accounts for people with high-deductible insurance plans. He has also said he would set up state-based high-risk pools for people with medical conditions that make it hard to get coverage on their own. He also wants to allow companies to sell insurance across state lines to boost competition and drive down prices, and implement a refundable tax credit to help Americans buy individual plans.His opponent, Democrat Hillary Clinton, says she would build on the Affordable Care Act by expanding tax credits for people shopping on the individual marketplaces, letting Americans buy into Medicare at a younger age, and adding a “public option,” or a government-run insurance plan, to compete with private insurers on the exchanges.For the Clodfelters, the struggle is not just in Washington, but at their kitchen table.
