Shots - Health News
2:27 am
Tue May 27, 2014

Frustrated By The Affordable Care Act, One Family Opts Out

Originally published on Tue May 27, 2014 2:21 pm

The Robinson family of Dallas started out pretty excited about their new insurance plan under the Affordable Care Act.

Nick Robinson had turned to Obamacare after he lost his job last summer. He had been working as a youth pastor, and the job included benefits that covered him, his two young daughters, and his wife, Rachel, a wedding photographer.

Nick says he wasn't too nervous at first, because everyone was healthy. Then, he recalls, they found out Rachel was pregnant.

"It's one of those times where you hear the news and there's this immediate sense of joy and excitement like, 'Yay, a new kid. That's awesome!' " he says. But they were also concerned. "What are we going to do? How are we going to pay for this? This is intense."

Nick found a new job fairly soon, working as an account manager in retail sourcing. But the small firm did not offer health benefits.

The couple started looking around. They applied for Medicaid but didn't qualify in Texas. They thought about paying out of pocket, but the quotes they got scared them — up to $15,000 for a basic hospital birth.

Summer crept into fall, and Nick started hearing the buzz about the Affordable Care Act.

"I was like, oh, here's the answer! This is simple!" Nick says. "It's a cheaper insurance plan; there's no pre-existing condition stuff."

Rachel was skeptical, but Nick went online and started shopping. He had trouble getting through the glitchy website at first, but eventually he picked a plan just for his wife. It was a gold plan HMO through Blue Cross Blue Shield for about $375 a month.

In January, as soon as the plan began, Nick printed out a list of obstetricians from the plan's website. "I handed it over to Rachel, fully confident, fully feeling like I had accomplished something for her; I had come through for my wife," he says. "This whole Obamacare thing was going to work!"

Rachel recalls two days in January when she sat down and called every doctor on the list of 28. According to her, most of the practices told her, in one way or another, that they didn't take the plan.

"Some would just come right out and say, 'We don't take Obamacare,' " she says. "Or the best one was, 'The doctor takes it here at the actual practice, but whatever hospital you use ... does not take that insurance.' "

She says there were other issues, too. Some of the doctors said they wouldn't see her because she was too far along in her pregnancy — about 30 weeks. A few practices did take the HMO insurance, but they operated as a rotating clinic and couldn't guarantee she would see the same doctor every time. Rachel wanted to establish a relationship with her obstetrician.

"It was mind-numbing," she says, "because I was just sitting there thinking: I'm paying close to $400 a month just for me to have insurance that doesn't even work. So what am I paying for?"

Nick got even more frustrated when he called Blue Cross and was told those doctors should take the plan.

"How could this not be working?" he says. "The United States government has set this up. It's this whole big deal; there are commercials everywhere saying we need to use this. And they're just saying, 'No, no, no,' and that just made me so mad."

Louis Adams, a spokesman for Blue Cross Blue Shield of Texas, says he went down that same list a month after Rachel had checked. He says most of the 28 obstetricians do take the HMO insurance.

"We're committed to helping our new members understand how to get the most from their coverage, and also [are] working with doctors and hospitals to inform them of the range of coverage options we have available," Adams says.

Even if it was a matter of miscommunication, the Robinsons felt lost. It was January, and their baby was due in April. They started considering a midwife, an option friends had suggested but that they had previously rejected.

"Our answers to that were, 'Absolutely not,' " says Nick. " 'That's insane. We're not going to go to some crazy witch doctor lady and make us get in a giant tub. Those are the crazy people. We're the normal people. We want to have our birth in a hospital.' "

It was risky, too. Rachel had already had two cesarean sections; a home birth would mean trying to deliver vaginally. But gradually the Robinsons changed their minds. Rachel met with a midwife and loved her. Out of pocket, a home birth would cost only $4,000.

And so they dropped their new plan; they just stopped paying the premium.

They signed on to be in the midwife's care. Nick signed up for a nonprofit, Christian-oriented cost-sharing plan. The Robinsons will pay cash upfront and request reimbursement later.

"We're so happy with where we are now," says Nick, "but this is not OK. And I'm extremely confident that that's not what the architects of this plan had in mind."

On April 28, Rachel gave birth — at home, in the giant tub, with no pain medication.

The baby is a healthy boy named Cash. Nick says that's for Johnny Cash, whom they both love — and not for the midwife's fee.


This story is part of a reporting partnership between NPR, Houston Public Media and Kaiser Health News.

Copyright 2014 KUHF-FM. To see more, visit http://www.houstonpublicmedia.org.

Transcript

STEVE INSKEEP, HOST:

Now that the exchanges are running, people are learning just what they signed up for. They're using their new coverage - or at least trying. Some find it frustrating, like the couple who spoke with Carrie Feibel of Houston Public Media.

CARRIE FEIBEL, BYLINE: Last summer Nick Robinson lost his job working as a youth pastor in Dallas. He also lost the health benefits - coverage for himself, two young daughters and his wife Rachel, a wedding photographer. He wasn't too nervous at first because everyone was healthy. But then Rachel found out she was pregnant.

NICK ROBINSON: It's one of those times where you hear the news and there's this immediate sense of joy and excitement - like, yay, a new kid. That's awesome. What are we going to do? How are we going to pay for this? This is intense.

FEIBEL: The Robinsons didn't qualify for Medicaid. And they couldn't afford a $15,000 hospital birth. Summer crept into fall. And right around then, Nick started hearing the buzz about the Affordable Care Act.

N. ROBINSON: I was like, oh, here's the answer. This is simple. This is the cheaper insurance plan. There's no pre-existing condition stuff.

FEIBEL: Nick picked a plan just for his wife. It was a Gold HMO plan through Blue Cross Blue Shield for $375 a month. Nick printed out a list of obstetricians from the plan's website.

N. ROBINSON: So I handed it over to Rachel, fully confident, fully feeling like I had come through for my wife. This whole Obamacare thing was going to work. Here you go. Have fun.

FEIBEL: Over two days in January, Rachel says she called every doctor on the list of 28. According to her, most of the practices told her they didn't take the plan in one way or another.

RACHEL ROBINSON: Some would just come out - right out and say, we don't take Obamacare. Or the best one was, the doctor takes it here at the practice. But whatever hospital you use that we go to and do all of our deliveries through does not take that insurance.

FEIBEL: She says there were other issues, too. Some of the doctors said they wouldn't see her because she was too far along in her pregnancy. And some practices did take the HMO, but they operated as a rotating clinic. And Rachel wanted to see the same doctor every time.

R. ROBINSON: It was mind-numbing 'cause I just was sitting there thinking, I'm paying close to $400 a month just for me to have insurance that doesn't even work. So what am I paying for?

FEIBEL: Nick got even more frustrated when he called Blue Cross and was simply told those doctors should be taking the plan.

N. ROBINSON: How could this not be working? The United States government has set this up. It's this whole big deal. There's commercials everywhere saying we need to use this. And they're just saying, no, no, no. And that just made me so mad.

FEIBEL: A spokesman for Blue Cross Blue Shield in Texas, Louis Adams, says he went down that same list of 28 and confirmed that most of the doctors do take the HMO.

LOUIS ADAMS: We're committed to helping our new members understand how to get the most from their coverage, while also working with doctors and hospitals to inform them of the range of coverage options we have available.

FEIBEL: Whatever the miscommunication was, the Robinsons felt lost. It was January, and Rachel was due in April. And so they started considering a midwife, an option they had previously rejected.

N. ROBINSON: Both of us quickly, our answers to that were, absolutely not. That's insane. We're not going to go to some crazy witch-doctor lady who's going to make us get in a giant tub. Those are the crazy people. We're the normal people. We want to have our birth in a hospital.

FEIBEL: And it was risky, too. Rachel had already had two C-sections, but a homebirth would mean trying to deliver vaginally. But soon the Robinsons saw a midlife as the solution. Rachel met one and loved her. And out-of-pocket, a homebirth would cost only $4,000. And so they dropped their new plan. They just stopped paying the premium. They signed on to the midwife.

N. ROBINSON: We're so happy with where we are now. But this is not OK. And I'm extremely confident that that was not what the architects of this plan had in mind.

FEIBEL: Nick found an alternative for the whole family, a nonprofit Christian-oriented medical cost-sharing plan. The Robinsons pay cash upfront and request reimbursement later. On April 28, almost two weeks after this interview, Rachel gave birth at home in that giant tub with no pain medication.

N. ROBINSON: There he is.

FEIBEL: A healthy baby boy named Cash. Nick says that's for Johnny Cash, mind you, and not the midwife's fee. For NPR News, I'm Carrie Feibel in Houston.

INSKEEP: OK, Eric Whitney and Carrie Feibel's stories are part of a reporting partnership with NPR, local member stations and Kaiser Health News. We're glad you're with us on your public radio station, which brings you MORNING EDITION and is with you throughout the day. You can continue to follow NPR News this afternoon on All Things Considered and of course we're on social media. You can find us on Facebook. We're on Instagram. We're on Twitter @MorningEdition, @NPRInskeep and @NPRGreene. Transcript provided by NPR, Copyright NPR.