Thousands of Arizonans already dropped off ACA coverage. More likely won't pay their 1st premium

It might seem like a year ago, but it was just a few months ago that Democrats forced a government shutdown over health care funding. Republican leaders in Washington, D.C., had refused to extend subsidies for the Affordable Care Act marketplace, known as ACA.

In the end, they agreed to reopen the government with the promise Republicans would negotiate about the subsidies. But so far, lawmakers have not come to an agreement.

Now, more than 70,000 Arizonans appear to be dropping their coverage.

It all comes as enrollment in the ACA has been on the rise. Other states have been setting up their own subsidy programs to soften the blow. But Claudia Maldonado says she has seen a lot of Arizonans having to make difficult decisions.

Maldonado is director of outreach and enrollment with the Arizona Alliance for Community Health Centers. The Show spoke with her about what she’s seeing.

Full conversation

CLAUDIA MALDONADO: We saw quite a few plan shifts from silver level plans to bronze. And then we also had a lot of people that looked at the bronze plans, they looked at the catastrophic plans because those are also available, and they decided to take the risk and go without.

GILGER: Right, just pay out of pocket if you happen to get sick.

MALDONADO: Exactly. And because we work with so many federally qualified health centers, they also have a sliding fee scale program. Some of those folks decided to move to that, which is not insurance, right. It's a fee for service. But they felt that they would be better off with that versus trying to select a catastrophic plan.

GILGER: That says a lot given the cost of that out-of-pocket fee. I mean, how much were rates going up for folks?

MALDONADO: Oh, my gosh. Well, it was really interesting because every year the issuers have to file their rates. So you see issuers and you see if their rates are going up by 5%, 10%. And we saw rates from three issuers go up more than 40%.

And so naturally, when you have that big of a jump, folks are also going to be switching their plans, right. ... Because those that had significant jumps, you know, that wasn't feasible for them at that point.

GILGER: Yeah. OK, so 40%, it's a big jump. I mean, like this adds up to a whole lot of money every month that just some people could not afford.

MALDONADO: Yes, yes.

GILGER: Talk about those catastrophic plans. It sounds like some people chose those as opposed to having no health insurance. How does that work?

MALDONADO: They really are for that immediate emergency situation that you have. It's really not meant to be used for that person that needs ongoing care, you know, if they have a chronic health condition. So catastrophic plans have very, very high deductibles and out-of-pocket max, and they only include three primary care visits per year.

And if you have any kind of health emergency, it's going to cost you so much out of your own pocket.

GILGER: So, there's another layer to this, too, right, which is, you know, we'll wait and see at the end of the year how many folks signed up for a plan and then ended up not being able to afford it. You anticipate those numbers being relatively high as well.

MALDONADO: Like you had mentioned, we had less people sign up for coverage this year, and then now we're going to wait and see if they actually made that first month's payment, right. We call it that binder payment. And to actually effectuate their coverage to make it active.

GILGER: So these numbers could be higher.

MALDONADO: Yes. And so it'll be really interesting to see in the summer when they release that report. Of those that signed up, how many actually paid that binder payment?

GILGER: Seventy-thousand might be an undercount.

MALDONADO: Yeah.

GILGER: Let me ask you, like, what you're hearing from folks. I know you started your career, you said, like, talking to people directly about why it's important to basically enroll and have health insurance. And now you're talking to people who are probably looking at not having it for the first time in a long time. What's that like, what do people say this is like for them?

MALDONADO: It can be stressful. It's a stressful situation to be in when you are having to make decisions about your health care and your other living expenses. You might have rent or mortgage, child care. All of those things can eat up your budget significantly.

Health care is one of those things that sometimes people are willing to gamble with. Sometimes there just isn't money, a whole lot of money left over for health care. And so folks are actively making decisions on, can I buy more food or can I do this, right. And those are really difficult decisions to make.

GILGER: There's also, like a big picture, system wide kind of impact when you have a lot more people uninsured, right. What are you watching on that front?

MALDONADO: Well, what we see is, naturally, when you have more people go uninsured, you have a lot more people going to the emergency room at the hospital. And so folks start to use the emergency room as almost like primary care. And that's not really the intent of an emergency room, right. Not only that, but it's the most expensive doctor's office you could ever go to.

Those bills can be high, they can be astronomical. And so that kind of starts this spiraling of trying to figure out, how am I gonna pay for this bill? And not only that, but it puts a lot of stress on our health care system as a whole. Hospitals are having more uncompensated care. And so it's like a ripple effect.

And especially when, you know, you think about the rural parts of our states where health care is even harder to find and they may only have one hospital and they drive hours to get there. Yeah.

GILGER: So let me ask you lastly, Claudia, watching the politics around this, the back and forth in Congress, the kind of, you know, press conference after press conference, the deal making and the promise of a deal that still has not come to fruition, do you feel like this is one of those issues that's just gonna become a can we kick down the road, a kind of political football?

MALDONADO: I think in some instances we have not paid attention enough to our communities. It's really hard to talk to folks, you know, on the daily saying, Claudia, I can't afford this medication anymore. I have to go without. But I need this medication to manage my diabetes and I'm going to start rationing my medication. And now my diabetes is no longer controlled.

And then you see, oh, oh my gosh, this clinic or this health provider may not even be available in this rural part of the state. And a lot of people think, well, I don't live in that part of the state, right. But I see all these connections.

I see almost like a web. It's a web to me. And so when certain pieces start to fall, then you start to see the domino effect of them. All of these things have to work together cohesively in order for people to thrive and be healthy. Between the programs and the clinical providers and the folks that are on the ground helping people navigate, all of these pieces have to work together.

And so when we start moving those pieces around or maybe taking away some of those pieces, that's when you really see things start to shake.