Without a Subsidy, Couple Faces Higher Insurance Premiums

Bruce Mainzer and his wife Beth Shader in Lake Forest, Ill., in 2004. With a household income too high for a federal subsidy, the couple is bracing for higher health insurance premiums in 2017. (Courtesy of Bruce Mainzer via AP)

With a household income too high for a federal subsidy, Bruce Mainzer and Beth Shadur are bracing for higher health insurance premiums in 2017.

As in other states, many insurers in Illinois have requested double-digit rate increases. Americans ineligible for the government subsidies that help cover their premiums will be hit hardest.

The suburban Chicago couple buys coverage through HealthCare.gov, the federal insurance exchange set up under President Barack Obama’s health overhaul. Mainzer is a consultant in the travel industry, while his wife, Shadur, is an artist and part-time gallery director at a college.

As with many who are self-employed, their combined income can vary a lot, ranging from $65,000 to $100,000 a year. And under the health care law, there is no subsidy for individuals making more than $47,520 a year or families of four earning at least $97,200.

Mainzer and Shadur are among the millions of Americans who buy their own insurance without a tax credit to help defray the cost.

Health insurance already takes a hefty bite out of the couple’s budget. They pay $1,200 a month for a bronze plan with high deductibles, which means they pay $13,000 annually out of pocket before their coverage even kicks in.

“It has been a challenge, and it causes us to dip into our retirement savings and increase our debts,” Mainzer said.

On top of the cost, they’ve experienced the hassles of major disruptions in the Illinois insurance market. For one, their insurance company recently folded. It was one of the struggling co-ops set up under the federal health care law.

They are switching to Aetna in October but will start shopping again for another insurer a month later because Aetna recently said it is bailing out of the Illinois exchange-based marketplace.

“I’m looking forward to being on Medicare starting in June,” Mainzer, 64, said of the government-run health insurance program for those 65 and older. “I’ll be out of this whole crazy mess. But my wife will still be on it for a while.”

For her part, Shadur, 62, hopes the health law’s early problems ease.

“As the years go on, as long as Republicans don’t take it away, it will settle into a smoother process,” she said.

They are in good health, but Mainzer has a blood disorder, a pre-existing condition that led insurers to reject him before the Affordable Care Act took effect. He was able to get coverage only through Illinois’ high-risk pool, at about the same price he pays today.

Mainzer rejects the “repeal and replace” Republican solution, in part because getting rid of the law would mean that insurance companies could go back to denying coverage for people with pre-existing conditions.

“Ultimately, it’s clear that health care is not something that can be efficiently provided by the private sector,” he said. “The rest of the Western world has figured out that health care is a right and is intrinsically a government, public-sector activity.”

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