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VOL. 41 | NO. 11 | Friday, March 17, 2017

Health care Conundrum

Scrambling for insurance amid political turmoil

By Mike Blackerby

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Randy Kurth and Barbara Nicodemus hardly fit the profile of those likely headed for a health care crisis.

But the great health care quandary that America is embroiled in knows no demographic boundaries as people from all walks of life scramble to cope with the skyrocketing cost of medical care and navigate the murky waters of complicated and shrinking insurance options.

And now, there’s the great unknown.

Americans now covered under the Affordable Care Act are waiting to see what emerges as President Donald Trump and Republican lawmakers cobble together a health care plan to scuttle Obamacare.

Some 6.4 million Americans signed up for ACA, or Obamacare, policies through the federal exchanged for coverage starting Jan. 1, 2017.

Since the advent of the ACA in 2010, about 20 million previously uninsured Americans have signed up for Obamacare.

Kurth and Nicodemus, a married Knoxville couple, certainly empathize with the millions of Americans who are tip-toeing through the unpredictable health care minefield.

The couple, too, thought they had a health care game plan.

When serious illness hits

“My father, grandfather and uncle all died at a relatively young age of prostate cancer,” says the 61-year-old Kurth.

Barbara Nicodemus and Randy Kurth of Fountain City are among the many left scrambling for insurance after Humana decided to leave many Tennessee markets.

-- Adam Taylor Gash | The Ledger

“This is something I’ve been monitoring since I was 40 years old. Because longevity is not a strong point with men in my family, I retired early.”

The couple’s worst fears came to fruition. Kurth was diagnosed with prostate cancer in 2014. He had surgery in 2015 and just recently finished his seventh round of radiation treatments.

Kurth, who has a private insurance policy through Humana, says he’s hoping to be pronounced “cancer free” at his next check-up.

With her husband’s genetic predisposition for cancer at an early age, Nicodemus says the couple formulated a plan of action years ago.

She says there were fortunate to both have good jobs. Kurth was an environmental project manager while Nicodemus was a pediatric audiologist.

“We saved and did all of the right things,” Nicodemus points out.

“We’re lucky – we were able to fund our own retirement,” her husband chimes in.

Randy Kurth, right, has prostate cancer. His doctors give him a 97 percent chance of beating the disease.

-- Adam Taylor Gash | The Ledger

Still, the couple has paid a steep price to cover their medical costs associated with Kurth’s surgery and treatments the last few years.

Since 2012, monthly premiums for his Humana policy have increased from $420 to $610 a month. The policy includes a $10,400 deductible with no prescription coverage.

Counting their monthly premiums, they had $20,000 in out-of-pocket medical expenses in both 2014 and 2015. Last year they divvied up about $13,000.

Nicodemus says they expect this year’s medical bill to be close to $30,000.

An insurance crisis looms

While Kurth is optimistic about his health in the future, his insurance outlook is not as rosy.

“My insurance company, Humana, told me they are not going to offer insurance to anybody in the Knoxville area after Dec. 31 (2017),” Kurth explains.

“With everything going on with the proposed Republican plan (The American Health Care Act), will I even be able to get insurance?”

Humana, in addition to no longer offering private coverage to people in Knoxville after this year, is the latest insurer to pull out of the ACA exchange in Tennessee.

Humana’s pullout will leave an empty stable of ACA insurance providers in Knoxville beginning in 2018, and essentially leave 40,000 people currently covered by Obamacare without a provider.

Countdown to Medicare

Kurth and Nicodemus are already counting down the years and days until Kurth is eligible for Medicare, the federal health insurance program for people who are 65 or older.

Until then, Kurth says the couple will figure out a way to meet their health-insurance conundrum.

“I have a retirement nest egg,” Kurth explains. “I’ve put away dollars, and we’re going to take care of our health care needs over the next three years.”

His voice takes an ominous tone as he looks at what might be ahead.

“We’re going to wing it. I can tap into my nest egg, or die.”

Nicodemus chimes in, “or go bankrupt.”

She shudders at the thought of finding a new health care provider, and at what cost?

“We’ll probably pay three to four times as much for our premiums, and we’ll have a much higher deductible , probably $16,000 to $20,000. We can’t do $20,000 to $30,000 a year for medical expenses until we’re 85 or 90.”

Nicodemus says she has resigned herself to the likelihood of paying exorbitant insurance premiums the next few years as the couple scrambles to find insurance.

“Insurance companies can charge people age 50 to 64 five times as much for premiums as a healthy 25-year-old,” she says.

Nicodemus is referring to differences in the age-based premiums offered under Obamacare and the proposed GOP health care bill.

Under Obamacare, premiums for a 64-year-old are capped at three times the premium for a 21-year-old purchasing the same plan.

Provisions under Trumpcare would allow providers to charge a 64-year-old up to five times as much for the same policy as a 21-year-old.

The ‘lucky ones’

Despite their dilemma, Kurth and Nicodemus consider themselves the lucky ones.

They say that many people in this country don’t have the means and foresight to prepare a health care game plan.

“I’m just as concerned about the middle class and lower class in this country as myself,” Nicodemus explains.

“This (the health care crisis) is just making a larger divide between the haves and have-nots in this country.

“We have to do something to reign in medical and prescription costs in this country.”

Mike Blackerby is a freelance writer living in East Tennessee