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Four stories: After Obamacare 'fix,' many are still left out

By Laura Koran, CNN
updated 3:54 PM EST, Wed December 11, 2013
STORY HIGHLIGHTS
  • Many have been dropped by insurers after Affordable Care Act went into effect
  • President Obama announced a fix to allow some to get policies back
  • Several people have fallen through the cracks

Washington (CNN) -- In the face of mounting criticism, President Barack Obama announced last month that he would allow insurance companies to renew so-called "subpar" plans for existing customers. But nearly a month later, not everyone is seeing the benefit of this policy change.

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CNN spoke with four people in the days and weeks that followed the president's announcement to see how they have been affected. Their results are varied, and for some of them, the future remains uncertain.

Catherine Franklin

46, Winston-Salem, North Carolina

Catherine Franklin: \
Catherine Franklin: "A 280% increase in premiums."

It was September when Catherine Franklin received her letter. The much-maligned HealthCare.gov website had yet to be launched and approval ratings for the President's signature health care reform law were on an upswing.

Franklin knew she would have to sign up for a new insurance plan under Obamacare, but she didn't expect her options to be so costly.

The mom and Navy veteran is employed part time as a nurse. Her husband, David, is a small business owner. Franklin's employer offers insurance plans, but because she's not working full time, getting a policy to cover her family of three is expensive.

Unfortunately for Franklin, a provision in the new health care law states that, since her company offers plans that she could afford to cover herself, but not her family, she does not qualify for a subsidy through the federal government, even though she is below the income threshold.

She's therefore subject to an unusual loophole that requires her to pay the full premium on a new policy if she wants to cover her family, or leave her job to get the subsidy.

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Franklin's current policy -- through Blue Cross Blue Shield of North Carolina -- is basic, but affordable, and meets her family's needs.

In its cancellation letter, the company told Franklin that she would be automatically transferred to a comparable plan when her current one expired, unless she opted to buy a new plan on the private market or the federal health exchange.

That plan would increase her premiums from $261.82 a month to $735.56 starting January 1, 2014 — an increase of 280%. Her family deductible would be $11,000. The plans she found on the exchange were equally costly.

When Obama announced that companies could potentially renew canceled policies, Franklin followed the news with interest.

The very next week, North Carolina's insurance commissioner and Blue Cross Blue Shield of North Carolina both endorsed the fix.

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The insurer e-mailed Franklin, saying, "You can now keep your current plan for another year. You don't have to do anything. BCBSNC will automatically renew your current plan to extend into 2014. You can expect a rate increase typical to what you have received in the past."

Franklin is grateful that she can keep her policy, but she also worries about what she'll do when the extension runs out. She is also frustrated by her experience with the Affordable Care Act, which she had always supported.

"I feel very conflicted about this law," she said in an e-mail to CNN. "On one hand, I realize that our current health care system is broken, and it is unfair for people who have medical problems to be unable to obtain affordable health insurance. I appreciate that the basis of the law was intended to fix this, and in all honesty I would not mind paying a REASONABLE amount more for insurance that allows everyone access to health care."

Valentina Holroyd

58, San Ramon, California

Valentina Holroyd: \
Valentina Holroyd: "We're savvy, but we had no idea that the premiums were going to be what they are."

By most people's standards, Valentina Holroyd is in excellent health. She works out six to seven days a week and competes in triathlons with a group of equally high-energy friends. She participates in 10 to 12 races a year and has made it to the podium on several occasions. She struggles with the usual joint problems associated with an active lifestyle, but otherwise she is healthy.

Holroyd supported the Affordable Care Act when it was passed in 2009. The moderate Democrat hoped it would help people with pre-existing conditions -- such as her husband -- get access to insurance, and would allow people who could not afford insurance before to find plans within their reach.

She found an affordable insurance plan through Kaiser Permanente in 2012 that met her budget and provided appropriate coverage for her family's needs.

Everything changed in October, when Holroyd was notified by her insurer that her plan could not be renewed in 2014. The comparable plans offered to Holroyd featured a 29% increase in premiums and higher co-pays, as well as significantly higher prescription costs.

Holroyd expected to pay more under the new law, but the new estimates exceeded her expectations.

"We're savvy," she told CNN, "but we had no idea that the premiums were going to be what they are."

After the president's announcement, Holroyd was hopeful she'd be able to keep her policy after all. But the information that she was able to get over the next few days was cryptic at best.

Kaiser Permanente said only that it would review the announcement and that "If federal and state governments intend to change the health care coverage rules and the composition of federal and state marketplaces in 2014, we hope those changes will be done thoughtfully and with all stakeholders involved, to obtain the best outcome."

Holroyd anxiously waited for more definitive news, but the answer wasn't what she wanted to hear.

At the end of November, Covered California's board of directors -- the group that runs California's health insurance exchange -- unanimously rejected the administration's proposal.

"So, in a nutshell," Holroyd said in an e-mail, "we are now, once again, being forced into a lower coverage plan, for more money."

She still believes in the underlying principles behind the health care reform law, but is unhappy with the way it has left people like her out in the cold.

"We need more people in this country to be covered," Holroyd told CNN on Monday, but added that her situation has been miserable. "I'm losing faith in our administration."

She vehemently rejects the idea that her policy is inadequate because it doesn't meet the Affordable Care Act's minimum criteria. She insists that it provides better coverage for many of the things she counts on, such as chiropractic and eye care. "My current plan is not junk," she said.

Holroyd and her husband will both be searching for new insurance plans, but are frustrated by the rates they're seeing so far.

Dr. Martin Klein

54, Fairfield, Connecticut

Martin Klein: \
Martin Klein: "My plan's supposed to be grandfathered in."

Connecticut psychologist Martin Klein has plenty of experience dealing with insurance companies. After all, he's been practicing in the state for 11 years and runs two offices, one in Branford and one in Fairfield. But his experience with insurers over the past couple months has surprised even him.

Since 2008, Klein has held an insurance policy from Anthem Blue Cross Blue Shield of Connecticut, the state's largest insurer. The policy offers what he considers comprehensive coverage at a reasonable price. It does not however, meet the minimum coverage criteria set by the Affordable Care Act.

On September 26, Anthem Blue Cross Blue Shield sent Klein a letter notifying him that his plan would no longer be offered for renewal when it expires in January.

"We're making this change in an effort to offer coverage with more comprehensive benefits," the letter said. "By moving to a health care reform (also called the Affordable Care Act) compliant plan you will enjoy all the benefits made possible through the new health care reform laws."

In an interview with NBC earlier this month, Obama called plans that did not meet the minimum coverage standards "subpar," but Klein disagrees.

"I have a low deductible and once the deductible is met my plan pays 100% of my medical, mental health and pharmacy costs," Klein told CNN.

In any event, "my plan's supposed to be grandfathered in," Klein added.

Policies purchased before March 23, 2010, as Klein's was, are "grandfathered" in by Obamacare, meaning the law theoretically allows people such as Klein to keep them. But the law also stipulates that grandfathered plans must be canceled if the insurance company changes them in any significant way.

And nothing prevents insurance companies from canceling non-compliant policies entirely.

A spokeswoman for Anthem Blue Cross Blue Shield of Connecticut would not comment on the company's plans in the days that followed the president's remarks, saying only that the company was still in the process of "analyzing the market" and reviewing options.

However, Connecticut Gov. Dannel Malloy later announced that the state reject the renewals.

"The truth is that the solution offered last week won't work for Connecticut," Malloy said.

Losing his insurance plan is a big financial blow for Klein. He makes just enough to not qualify for a subsidy on the health exchange, but lives in a New York City suburb where the cost of living is high. Based on his research on and off the exchange, Klein says he would have to pay 50% more to get a plan that he deems comparable to the one he is losing.

Klein says he cannot afford a comparable plan, so he has decided to purchase an HMO with a $12,700 deductible for himself and his family.

What concerns him most about the plan is that it limits him to a narrow network of providers, all of which are in Connecticut. This prevents him from keeping some of his doctors in New York City.

Basically, said Klein, he's going to accept his new policy and, "hope nothing major happens."

The self-proclaimed "lifelong Democrat" is frustrated with his insurance company, the president and the law itself.

Peggy Rose

62, Johnson City, Tennessee

Peggy Rose: \
Peggy Rose: "I like my plan now, it is not subpar."

Peggy Rose is retired from a career in pharmaceuticals.

She signed up for her current insurance plan when she stopped working full time in 2011. Her husband had enrolled in Medicare at that point, and she wanted an affordable plan that would provide basic coverage until she could enroll as well.

"Basically, I'm pretty healthy," Rose told CNN. "I was just looking for a policy that would help me if I get sick."

She settled on a plan from Blue Cross Blue Shield of Tennessee with reasonable premiums and a health savings account. The plan fit her needs, but it was not ACA-compliant.

Rose was disappointed when she received a cancellation letter in July, but she was even more concerned when she learned how much the loss would cost her. The comparable plans she found on the private market would have increased her premiums by 25% and triple her deductible.

The plans she's seen on the health care exchange also have higher premium costs.

She does not qualify for a subsidy from the federal government.

When CNN first spoke to Rose in October, she expressed her frustration about the cancellation, and put much of the blame on the insurance companies for not offering more affordable alternative plans.

Rose was pleased when Obama announced he would allow insurance companies to extend canceled policies for another year. Like many, she felt the president's oft-repeated promise, "If you like your health care plan, you can keep your health care plan," was misleading.

Last week, Tennessee Gov. Bill Haslam endorsed the president's renewal plan, which Blue Cross Blue Shield of Tennessee also supports. The news was a big relief.

Despite her stressful experience, Rose continues to support the health care law.

"I still believe in the [ACA]," she told CNN, "as I have seen what can happen when you do not have the options to buy insurance due to health and costs."

CNN's Tami Luhby contributed to this report.

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