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Example: [Collected on the Internet, December 2013] My family's journey with securing our new insurance under the Affordable Care Act (ACA) started on October 1, 2013. I have decided to write this letter to let the American people know what it has been like for us. We are a family of four, with two little boys' ages seven years old and three years old. My husband and I have had full time jobs for 6 years and 13 years respectively. We have been with the same two companies for those years. We are a middle class family; we own our three bedroom two bath house, we own two cars, and previously provided our own insurance for the four of us. We have coverage through Individual Blue from Blue Cross Blue Shield of Alabama until 12/31/13. Our premiums have been $380.00 a month, which also included dental coverage for all four of us. On October, 1, 2013 we received our letters like other Alabamians about our new premiums and plans for 2014 from Blue Cross Blue Shield (BCBS) of Alabama. When I opened our letter to say I had sticker shock was an understatement. Our premiums for the Blue Saver Silver would now be $753.26. This included the ACA tax but did not include the additional $75.00 we would need to pay in order to keep dental for me and my husband. So we would need to pay total $828.26 to keep health and dental insurance for the four of us. This payment is roughly $64.00 less than what we pay for our mortgage each month. I was outraged that anyone thought we could afford this. Sure we have some savings, but with that price tag we would whittle it down to almost nothing very quickly. I consider savings as a rainy day fund, a start to saving for the kid’s college, our retirement, etc. I never dreamed in a million years we would need to use it to pay our insurance premiums each month — how in the world could this help the economy too? [Rest of article here.] Origins: The item referenced above, an open detailing one Alabama woman's extreme difficulty and frustration in obtaining ACA-compliant health insurance coverage for her family (including her 7-year-old son with ADHD) was posted under the name of Karri Kinder on 23 December 2013 as the sole entry in a blog and was republished (without additional comment) by the Independent Journal Review on 31 December 2013. Certainly her experience is not unique in kind, as many residents of Alabama covered by Blue Cross and Blue Shield (BCBS) of Alabama (an insurer who has an 88% share of the state's health insurance market) found out at the end of 2013 that they would be paying much higher premiums for ACA-compliant coverage through BCBS: Doug Hoffman, who works statewide to help people sign up for benefits through the Affordable Care Act, just received a Blue Cross and Blue Shield of Alabama notice in the mail to find health insurance rates for his family have doubled.And he's mad — at Blue Cross.I just got my benefits renewal from Blue Cross for next year and they doubled my rate! he wrote AL.com in an email. I was paying $675 for a family premium (2 adults, one 22 yo dependent) with a $1,500 deducible. The new rate for a comparable plan is $1,360 with a $3,000 deductible. Basically they have doubled my costs.It appears as though Blue Cross is taking advantage of the ACA by hiking rates big time, said Hoffman, who is based in Birmingham with Enroll Alabama.Others, who have received the notices from the state's dominant health insurer are mad as well — at Obamacare.Obama thinks that he is making insurance affordable, wrote one reader to the Mobile Press Register Sound Off feature. I just got a letter from my Blue Cross Blue Shield that if I want to keep their insurance it's going to cost me $300 more a month. I already pay $300 a month now and they're wanting right at $600 a month for this Affordable Care Act.Blue Cross posted an explanation for the rate hikes to its Facebook page, maintaining that several reasons are behind the increased premiums: more taxes and fees, a requirement to rate family members individually, and the elimination of health underwriting and waiting periods for preexisting conditions: The new law requires all health insurance companies in the individual and small group markets to use a consistent rating method called member level rating. For the individual market, this means each person on an insurance policy will now be rated based on age, whether he or she uses tobacco, and the county in which the policy holder lives.In the past Blue Cross was able to offer one family premium, no matter the size. For family plans, most family members will now be rated individually. Once each person has been rated, the amounts are added together to get a family's premium cost. For children age 20 and younger, the oldest three children will be individually rated and included in the family premium amount. As a result, larger families may experience higher premiums.As Mike Oliver noted in an article for AL.com, the elimination of health underwriting may have a substantial effect on health insurance premiums in that state: Alabama has allowed medical underwriting — you're going to be quoted a high premium if you have something wrong with you, said Michael Morrisey, director of the University of Alabama at Birmingham Lister Hill Center for Health Policy. The Affordable Care Act abolishes medical underwriting.This means that those with expensive health problems will likely now jump in and buy coverage because it will be less expensive for them — or if they already have coverage — their rates will go down. But that also means rates will go up for everyone else as the insurer spreads that new cost around.The thing that happens when you eliminate underwriting is that you lump dissimilar people together, Morrisey said. When you combine groups, one group is better off and the other group is worse off — in terms of premium prices.As a policy, the elimination of medical underwriting and preexisting condition clauses helps broaden access to health care coverage and that was the aim of its inclusion in the Affordable Care Act. Reformers say it eliminates insurers from cherry-picking and reduces uncompensated care.Karri Kinder subsequently posted followups to her original blog entry about her insurance issue, the update of 4 January 2014 stating that: I do have some good news. Because I decided to write my letter and speak out, people stepped up and helped us. We were contacted on January 1, 2014 by the U.S. Department of Health and Human Services. I was told by the woman I spoke with that she had read my letter and wanted to get her team involved and see what they could do to help us. I recounted to her what was happening and that I had been advised to go ahead and sign me and my husband up for a plan on healthcare.gov. We went with a lower cost plan because it was going to just be the two of us. We had no idea what it was going to cost for the children once we got some answers. So we went with BCBS Blue Value Saver plan. The cost of the plan is $459.19. We qualified for $255.00 in subsidies so the final cost of the plan to us is $204.19 each month. I told the lady that I would cancel that plan if I needed to. What we wanted was to have all of us on one plan like we always have been. She said, If the kids qualify for All Kids then I am pretty sure they have to go that route or you will have to buy them a plan at the normal rate. So again we were told more than likely we will have to go through All Kids. She took the rest of our information down and said she was getting her team to work on it and would either call us back or All Kids would contact us.
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