The deadline for Americans to sign up for health coverage under the Affordable Care Act has come and gone for 2016 — with millions of people still uninsured. Some have remained uninsured by circumstance; others have no insurance because of confusion about the mandated policy, which is now in its third year.
Still more Americans, many who are middle class and working, are opting out of coverage altogether for strictly economic reasons. Faced with paying a tax penalty to the government this tax season or paying thousands more in insurance coverage, many of the struggling find the choice simple.
“It’s a no-brainer for me,” Martin Lansing (not his real name) told LifeZette.
“I’m trying to pay rent and eat,” said Lansing, 53, with barely a hint of a grin. A freelance writer and part-time actor in Los Angeles, he spent the year largely unemployed. He lost his union-based health coverage in November when he couldn’t pay his dues.
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Based on his income from last year, Lansing faces the minimum tax penalty for an adult going uninsured this year. The fine is $695 for an adult, or 2.5 percent of household income — whichever is higher. That’s up from $325 per adult or 2 percent of household gross in 2015.
Compared to the more than $800 per month he said he’d have to pay for the least expensive plan he could find, Lansing is opting to go without health insurance.
“I know it’s a gamble, but I haven’t needed to see a doctor in five years anyway. That was for a colonoscopy, preventative care and all that,” Lansing explained. “I’ve been paying in and haven’t really used my insurance at all. I could use some dental work, but the plans I looked at didn’t cover that anyway.”
While the Obama administration touts an estimate of almost 4 million new subscribers in 2016, the overall total increased only a fraction of that — from 11.7 million subscribers in 2015 to 12.7 million this year. That’s according to the latest statistics from the Department of Health and Human Services.
This indicates that despite higher penalties, roughly 3 million people walked away from the program. Other statistics show many more who signed up will ultimately default on their monthly payments.
Saving several thousand dollars on insurance premiums may be worth the risk to those who are confident they’ll remain healthy. But doctors know everyone is susceptible to an accident or a serious diagnosis, in which case the consequences could be financially devastating.
“Let’s say you fall in the bathtub and smack your head, maybe dislocate a shoulder, and need to go to the emergency room,” explained Dr. Walter Reece, an internist in private practice in Atlanta.
“The cost of just the basics, X-rays, other tests, a physician’s examination, is going to be thousands of dollars right off the bat. A one-night stay for observation with all the incidentals can cost $8,000 to $10,000 or more. If you need an MRI, that’s thousands more. It can get really costly real quick. It’s just not worth it.”
But “affordable” is not how Patty Spinks would describe the mandate known as Obamacare. Spinks, a 64-year-old breast cancer survivor from Greenbrae, California, was on a COBRA 18-month gap policy since leaving an employer in 2014.
She looked at plans available through the exchange, Covered California. Comparing the cost of deductibles, co-pays and medications, she was sorely disappointed.
“I’m looking and trying to compare all these different types of plans they offer and nothing compared to what I already had,” Spinks told LifeZette, explaining she would have to change oncologists just as a recurrence of her breast cancer was diagnosed. “None of the health insurance plans I looked at covered what I needed well enough.”