TOP Members Fight to Defend ACA

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Houstonians depend on federal subsidies to afford ObamaCare plans

Claudette Newsome believes her health is the most important thing she can give her two daughters.

Within the last five years, her husband died of cancer and her son died in an accident. The coverage she bought for herself and her children through the federal health insurance marketplace will ensure Newsome, a self-employed project manager and consultant, can get the care she needs to be there for her girls, she said.

On Wednesday, Newsome, 42, and her daughters, Alexandria, 14, and Zoe, 10, traveled from Houston to Washington, D.C., to rally in front of the Supreme Court as the justices heard oral arguments in King v. Burwell, the lawsuit challenging the subsidies issued to millions of people, including her, who bought coverage in the federal marketplace.

“I went to Washington to represent the 1.5 million people in Texas that have subsides,” Newsome said by phone as she prepared to head home. “There’s no way I could afford coverage without a subsidy. The girls would have to go back on the (Children’s Health Insurance Program) and I would be uninsured.”

Newsome’s family qualified for a $385 monthly subsidy to reduce the cost of her coverage, which allows her and her daughters to any doctor they choose. Their monthly premium is $184 per month.

“I am happy we have insurance and that I can afford it,” Newsome said. “It works for me and my family. I have to take care of myself. I have to stay strong for my girls.”

At issue in the lawsuit is whether the Internal Revenue Service can extend tax credits, better known as subsidies, to federal marketplace consumers, 87 percent of whom rely on them to make their monthly premiums more affordable.

The health law’s opponents say people, including Texans, who buy coverage through the federal marketplace are not entitled to subsidies because the law states subsidies are available to those enrolling through marketplaces “established by the State.”

Proponents argue the wording is flawed, saying the law was supposed to extend subsidies to all consumers.

Shala Russell, a full-time student at University of Houston-Downtown, says she could not afford even the minimal coverage she bought on the federal health insurance marketplace without the $180 monthly federal subsidy she received to reduce the cost of her plan.

At $28.55 a month, the plan Russell bought is affordable and gives her the coverage she needs in case she gets in a wreck or becomes ill, she said.

“I’m always afraid of getting into a car accident,” said Russell, 26, who drives to campus and around for her part-time hospice job. “I could end up at the hospital. It would cost thousands of dollars for the most minimal treatment if I didn’t have insurance. It’s very important to have insurance. The subsidy is the only way I can afford it.”

Russell said a persistent thyroid condition concerns her and she wants to stay on top of it. Her older brother was diagnosed with diabetes and Russell said she saw first-hand how relieved he was when he became insured and was able to care for himself.

Even if the cost of her plan rose to $50 a month, Russell said, her coverage would become too expensive.

“That would absolutely be a struggle for me,” she said. “I just would not have insurance. Living without it is kind of risky.”

Houstonian Aurora Harris said the potential loss of her $15 monthly subsidy would push her premiums to almost $209, which is more than she would like to spend but not insurmountable to maintain coverage.

“Anything helps,” said Harris, a senior outreach navigator for Houston’s Lesbian Health Initiative. “For me, it would be OK. But it would absolutely not be OK for 87 percent of the people who qualified for subsides. These are people who have families.”

She often talks about how an estimated 150,000 lesbian, bisexual, gay and transgender people in the Houston area are uninsured and urges them to enroll in coverage.

Harris, 26, first bought coverage in 2014 and qualified for a $56 monthly subsidy. However, a premium increase pushed her to buy less expensive 2015 coverage. She also earned more money, which lowered her subsidy, Harris said.

Harris knows she could have bought less expensive coverage but selected a more expensive plan because of the coverage and doctors it included. She developed her passion for educating people about the need for health coverage after watching her uninsured mother suffer from lupus, an autoimmune disease, she said.

“(The Affordable Care Act) has made a huge difference, especially for people with pre-existing conditions,” she said. “I always think about that.”

Analysis by various health care consultants and think tanks show an estimated 8 million people would become uninsured without insurance subsidies, which the government directly pays to insurers. Those left in the individual health insurance market would face staggering premium increases to cover the costs of the sickest people, who would most likely continue to buy insurance to maintain the medical coverage they need.

“Those premiums will be unaffordable for most people who bought insurance through their state marketplace,” said Vivian Ho, health economics chair for Rice University’s Baker Institute, in a written statement.

“The repercussions of 8 million people suddenly losing health insurance would reverberate throughout the health care system.”

Dametria Myles said she is convinced she would not be able to afford the coverage she bought after losing her job last fall without a subsidy. Myles, 48, of Stafford qualified for a $273 monthly subsidy to lower the cost of her premium. She pays $59 per month for a plan that includes vision and dental coverage as well as medical coverage.

“I am trying to live as normal as possible,” said Myles, a social worker. “It’s important to me to have access to the services I’m accustomed to. You just don’t know what could happen.”

She said she would like to keep the plan after she gets a new job, if it remains affordable.

Story originally appeared in the Houston Chronicle.