How health care law affects lives of 7 Americans

Associated Press

CHICAGO (AP) – A father lost his job at a medical device company that is facing a new tax. A young woman got back on her parents’ insurance and was able to get surgery for an injury that could have hobbled her. A part-time sales woman stopped putting off a colonoscopy and cancer screenings and saved nearly $3,000 because health plans now must pay for preventive care without co-pays. A business owner received a tax rebate for providing health coverage to her employees.

As the U.S. Supreme Court prepares to hear arguments on President Barack Obama’s health care overhaul, The Associated Press spoke with a variety of people to hear their experiences so far with the landmark legislation, whose major provisions don’t take effect until 2014. Reporters asked: How has the health care law affected your life?

Here are snapshots of seven Americans:

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Name: Michael Esch

Home: Warwick, N.Y.

Age: 48

Occupation: Former middle manager for medical device company, now working as a hospital purchasing agent.

Insurance coverage: Paying out of his own pocket for COBRA insurance through his former company.

Esch, a father of three, lost his job in November in a layoff his employer said resulted from President Barack Obama’s health care law. Medical device maker Stryker Corp. announced in November it intended to lay off 1,000 workers worldwide to save money ahead of a 2.3 percent tax on medical devices that starts in 2013.

The tax on medical devices is meant to help pay for expanding health coverage to uninsured Americans. The Obama administration argues device companies will gain in the long run as more patients become eligible to receive their products because they have insurance.

Esch was a middle manager who had worked for Stryker for six years. He helped develop a product known as the Triathlon Knee. Since the layoff, he’s taken a salary cut to work as a hospital purchasing agent. He’s still looking for a job with another medical device company.

He blames the medical device tax for the loss of his job, but he’s grateful for the provision in the health care law that will allow his oldest child, now a college sophomore, to stay on his health insurance to age 26.

“We tend to forget that for every great idea there is a ripple effect through other sectors of a business,” Esch said.

Economists say most companies should be able to pass on the bulk of the tax to customers, but the industry says it will squeeze profits and chill investment, hiring and innovation.

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Name: Glenn Nishimura

Home: Little Rock, Ark.

Age: 62

Occupation: Consultant to nonprofit groups.

Insurance coverage: Uninsured since COBRA coverage from a previous job expired in May of 2009.

Nishimura has been uninsured for nearly three years. He lost his health coverage after he left a full-time position with benefits in 2007, thinking he could land another good job. The recession destroyed that plan.

He’s been denied coverage because of high blood pressure and high blood-sugar levels. A provision in the national health care law gave his state $46 million to insure people like him who’ve been denied coverage because of pre-existing conditions.

But Nishimura said he can’t afford the coverage. It would cost him about $6,300 a year in premiums with a $1,000 deductible, meaning he would pay the first $1,000 out of his own pocket before coverage kicks in.

He worries about suffering injuries in a car accident or falling ill before he’s eligible for Medicare at age 65.

“I don’t like feeling vulnerable like this,” Nishimura said. “I’m completely vulnerable to some catastrophic problem.”

Nationally, about 50,000 people with pre-existing conditions have signed up for the coverage available through the health care law, fewer than expected. The government has offered new options to encourage more to enroll. In another two years, he may be eligible for subsidies under the law for insurance.

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Name: Samantha Ames

Home: Washington, D.C.

Age: 25

Occupation: Law student

Insurance coverage: Got back on parents’ insurance, thanks to the health care law.

As a teenager, Ames was prone to ankle injuries playing catcher on baseball and softball teams. Last April, she tripped over her mini bulldog and badly injured her left ankle. Ultimately she needed surgery that cost her insurer $30,000.

But she considers herself lucky.

Only a few months before her accident, Ames had been able to get back on her parents’ insurance, thanks to a provision of the health care law that lets young adults keep that coverage until they turn 26. Nationally an estimated 2.5 million young people have gotten insurance as a result.

Ames says it’s unclear if the student health insurance she had been relying on previously would have covered her surgery. In any case, the copayments would have been steep. She would have had to postpone the operation, risking another _ potentially crippling _ injury.

“The fact that I was able to get on their plan is the reason I can walk today,” said Ames. “Very rarely have I had something political affect me this personally.”

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Name: Sharon Whalen

Home: Springfield, Ill.

Age: 59

Occupation: Publisher of a weekly alternative newspaper

Insurance coverage: Small group plan.

As a co-owner of the Illinois Times, a weekly newspaper, Whalen wants to keep her small staff healthy. So she and her business partner provide them with health insurance and pay half the cost of premiums for their 10 employees.

Keeping that employee benefit is getting more and more expensive. The company saw a spike in premium costs after one employee’s child had chronic health problems.

With costs climbing, the company switched to a managed care plan with higher copays for some services in 2009. Whalen’s company also contributes less than it once did to cover the premiums of employees’ family members.

The health care law brought some relief: a tax credit for small businesses that provide health coverage. The Illinois Times qualified and received a $2,700 tax credit last year.

“We see ourselves putting that money right back into the company,” Whalen said.

Whalen heard about the tax credit from a health care advocacy group, not from her accountant.

“I had to practically beg them to look at this,” Whalen said. “They weren’t familiar with it.”

The Obama administration has proposed expanding the number of businesses eligible for the credit, and simplifying the paperwork.

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Name: Melissa Pearson

Home: Prineville, Ore.

Age: 53

Occupation: Retail sales, part time.

Insurance coverage: High-deductible plan purchased on individual market.

A few years ago, Pearson’s doctor ordered her to have a routine colonoscopy. It’s one of several colon cancer screening methods highly recommended for adults ages 50 to 75.

Pearson kept putting it off, in part because of the cost. Her high-deductible health insurance plan requires her to pay the first $5,600 out of her pocket each year. She knew the colonoscopy would be expensive and figured she’d be paying.

Then she learned that a provision in the health care law requires health plans to cover all costs for preventive care including colon cancer screening _ with no out-of-pocket costs to the patient.

“That’s what made me make the appointment,” she said. She also scheduled a mammogram and cervical cancer screening, which also are covered preventive services under the law. In all, she saved nearly $3,000 in out-of-pocket costs last year because of the Affordable Care Act.

“I said to my sister, `Thank you Obamacare,” Pearson said.

The Obama administration says the Affordable Care Act provided about 54 million Americans with at least one new free preventive service last year through their private health insurance plans.

But Pearson is worried that covering preventive services will mean her insurance premiums and her taxes will go up. “It’s being paid for by somebody,” she reasoned. She recently talked with a student from Norway who told her about the tax levels in that country. “I’m fearful our world will turn into that.”

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Name: David Zoltan

Home: Chicago

Age: 34

Occupation: Field marketing coordinator for a public relations firm.

Insurance coverage: Federally funded health plan for people with pre-existing conditions.

Zoltan lost a job and his health insurance during the recession. His diabetes sent him to the emergency room three times when he ran out of insulin during the two years he was uninsured.

In 2010, he was one of the first to sign up in Illinois for a new health insurance program for people with pre-existing conditions. The Affordable Care Act set aside $196 million for the state of Illinois to start the program.

Zoltan now pays about $1,848 a year for that coverage. The plan has a $2,000 deductible, meaning Zoltan also pays that amount out of pocket before the coverage starts.

Zoltan has found work, but his new job doesn’t include health benefits, so he’ll stay on the federally funded health plan.

“As a diabetic, I never again want to be without health insurance,” Zoltan said. “Anything is better than not having coverage at all.”

He is watching the Supreme Court as it considers the law. The requirement that Americans buy health insurance is under constitutional scrutiny. Zoltan believes the individual mandate is needed to spread the risk among the well and the sick, and keep insurance affordable.

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Name: Carol McKenna

Home: Pembroke Pines, Fla.

Age: 70

Occupation: Retired.

Insurance coverage: Medicare Advantage plan.

McKenna and her husband Morty have noticed that Medicare’s “doughnut hole” is shrinking. The coverage gap in Medicare’s prescription drug program _ dubbed the “doughnut hole” _ caught Morty in December last year. But once there, he received a 50 percent discount on brand-name drugs and other discounts on generic drugs thanks to Obama’s health care law.

Last year, he received a $250 rebate check provided by the new law for people in the doughnut hole. Under the health care law, the gap will be gradually phased out by 2020.

Warnings about possible cuts to Medicare Advantage plans caused by the health care law haven’t come true, Carol McKenna said. Their health plan still includes extra benefits such as fitness center membership.

She said she’s grown weary of the political debate over the health care law.

“I’ve been following it somewhat. Then it got so convoluted and out of control during the elections that I stopped paying attention,” McKenna said. “I don’t want to hear it anymore. All they’re doing is sniping at each other.”

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Alonso-Zaldivar reported from Washington.

(Copyright 2012 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.)

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