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Price Hikes,Hard Choices for Insurance 12/10 12:34

   (AP) -- Margaret Leatherwood has eight choices for health insurance next 
year but no good options.

   The cheapest individual coverage available in her market would eat up nearly 
a quarter of the income her husband brings home from the oilfields.

   The Bryson, Texas, couple makes too much to qualify for Affordable Care Act 
tax credits that help people buy coverage. But they don't make enough to 
comfortably afford insurance on their own, even though Paul Leatherwood works 
seven days a week.

   "I hate to put it like this, but it sucks," said Margaret Leatherwood, who 
stays at home and takes care of her grandchildren.

   This largely middle-class crowd of shoppers is struggling to stay insured. 
They've weathered years of price hikes and shrinking insurance choices with no 
help. Faced with more price increases for next year, they're mulling options 
outside insurance or skipping coverage entirely --- a decision that could lead 
to a fine for remaining uninsured and huge bills if an emergency hits.

   The sign-up period for 2018 coverage closes on Friday in most states, 
meaning shoppers have only a few more days to find something that squeezes into 
their budgets.

   "I kind of cringe when I am meeting with those clients because I don't have 
a solution for them," said Kelly Rector, a Missouri-based insurance agent.

   The ACA helped chop the U.S. uninsured population 41 percent to 28.8 million 
people earlier this year from 48.6 million in 2010, when it became law, 
according to the latest government figures.

   The law expanded Medicaid coverage for the poor and created health insurance 
marketplaces where people can use income-based tax credits to buy a single or 
family individual insurance plan if they don't get coverage through work. Those 
subsidies cover part or all of the bill, capping insurance costs at a 
percentage of income for those who are eligible. That shields recipients from 
price hikes of 20 percent or more that have hit many markets.

   But that help stops abruptly for people making four times the federal 
poverty level or more --- around $48,000 for an individual and more than 
$98,000 for a family of four.

   Of the roughly 15 million people who bought ACA-compliant individual 
insurance for this year, nearly 7 million had no tax credit help, according to 
the Kaiser Family Foundation.

   Meanwhile, the uninsured rate among adults who make too much to qualify for 
help buying coverage jumped to 5 percent this year from 2 percent in 2016, 
according to The Commonwealth Fund.

   Brokers and health care researchers expect that to climb again, especially 
for people with income levels close to the cutoff for federal help.

   "It's not going to be like an on-off switch where prices get too high and 
nobody buys coverage," said Sherry Glied of New York University. "It's more 
like a drip, drip, drip."

   The vulnerable population includes the self-employed, small business owners 
and those close to qualifying for the Medicare program that covers people age 
65 and over.

   These customers can face monthly bills that climb past $2,000 for a family 
plan and then a big deductible before most coverage starts. Plus fewer markets 
this year have insurance that comes with a health savings account, which lets 
people save for medical expenses before taxes. Those accounts are popular with 
individual insurance shoppers who don't get tax credit help, said St. Louis 
broker Emily Bremer.

   Leslie Glogau said some of her customers in the Orlando, Florida area are 
considering short-term, limited-benefits plans that are cheaper than 
ACA-compliant coverage but can leave them vulnerable to big medical bills. Such 
plans also won't stave off the uninsured penalty, which can amount to a few 
thousand dollars depending on income.

   "People just don't know which way to turn," Glogau said.

   Insurance shoppers won't be fined if they can't find an affordable option in 
their market. But going uninsured would still leave them exposed to huge 
medical bills.

   Margaret and Paul Leatherwood wound up with a limited-benefits plan this 
year, but they want better protection in case of a big bill. She's 58 and he 
just turned 60. They're weighing joining a medical cost-sharing ministry for 
next year.

   These ministries are not insurance, but they allow people to band together 
to share expenses, often by making monthly payments. They can be cheaper than 
regular coverage, and belonging to one allows customers to escape the ACA 
penalty for remaining uninsured.

   Such arrangements usually come with restrictions or qualifications. For 
instance, participants may not be allowed to use tobacco, and there might be 
limits on help for medical conditions that existed before the customer signed 

   "That's really the only option we have that's going to cover anything," 
Margaret Leatherwood said.

   Lance and Stephanie Schmidt bought family coverage in the individual 
insurance market for years because they don't get employer-sponsored coverage 
through Lance's dental practice. But the Oklahoma City couple opted for a 
cost-sharing ministry this year after they realized the monthly insurance bill 
for their family of five would have more than doubled to over $1,200 and stuck 
them with a deductible that topped $7,000.

   They now pay $450 a month for a plan through Liberty HealthShare, and they 
are leaning toward returning next year.

   "There's still some risk there, but so far it has proven to be just fine," 
said Stephanie Schmidt.

   Cost-sharing ministries and short-term plans aren't the only alternatives to 
individual insurance. Tom Morrill, a broker from Kansas City, Missouri, has 
helped many of his customers set up group coverage through their businesses.

   He said that gives them better options than what they would find on the 
individual market, where coverage prices from the dominant insurer, Cigna, are 
climbing an average of 42 percent. Four insurers have left that market. The 10 
remaining plans all have narrow networks of providers and don't pay for care 
outside those networks.

   "It's nuts," Morrill said. "Rates have jumped dramatically. It's not good 


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