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Tennessee couple doubts ACA replacement will serve patients' interests

June 15, 2017

By BETSY TAYLOR

Marjorie and Tim Riley of Bartlett, Tenn., describe themselves as private people, but they are telling their own story to illustrate the need for affordable, quality health insurance. It's something that has been a worry of theirs for decades, as they often didn't know from year to year if they could pay for needed health insurance.

w170115_MarketplaceInsurance_CoverageIsCriticalBoxMarjorie, better known as Bonnie, was diagnosed with multiple sclerosis in 1994 at age 33, when she was a stay-at-home mother. She woke up one morning unable to see out of her right eye. A battery of tests led doctors to the life-changing diagnosis. Multiple sclerosis is a disease of the central nervous system that disrupts the flow of information within the brain and between the brain and body and can be debilitating. It manifests in a variety of ways. In Marjorie's case, multiple sclerosis has limited her vision in both eyes. She has mobility problems and suffers searing, chronic pain. "MS is a strange, fickle thing," she says.

Tim says at times Marjorie describes the burning sensation in her hands and feet as akin to being dipped in a deep fryer. She sees a pain specialist monthly and takes pain medicine to try to manage her symptoms.

Tim is self-employed as a food broker, working for several food company clients. At one time the Rileys got insurance through TennCare, a state insurance program that used to cover more Tennesseans but today only covers those who qualify for Medicaid. The Rileys, who make too much money to qualify for Medicaid, lost their TennCare coverage years ago.

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Tim and Marjorie Riley

The couple bought insurance in the commercial market, but their premiums took a growing and oversized bite out of the family's income. Tim recalls that at one point, a policy just to cover Marjorie was pricing out at about $1,800 a month.

Marjorie says for the family's sake, she insisted on dropping her coverage. Her husband was working long hours, and often stressed and sleepless. Tim argued against the decision to drop Marjorie's coverage. "I just had to put my foot down with him," she says. "We just said we'll take our chances."

Tim was otherwise in good health and he got an individual policy at a reasonable cost.

Marjorie was uninsured for about five years, Tim says.

Today, they have coverage through a marketplace policy made possible by the Affordable Care Act. Tim says they pay $425 a month, after an income-based federal subsidy of about $1,100 a month. He says their deductible is about $3,500 per person per year. Marjorie's doctors' appointments have a $40 copay. With insurance, her medications, including nine prescription and three over-the-counter drugs, each cost anywhere from $3 to $20 a month.

Tim is skeptical that efforts to repeal and replace the ACA, in part by giving states more flexibility in designing health insurance requirements, will provide access to better insurance coverage. For one, he said, "the idea that states can do this is just unworkable." He says he doubts that allowing insurers to sell coverage across state lines, a key component of many GOP health reform initiatives, would promote price competition and address barriers to access faced by people with preexisting conditions, as claimed by some proponents. "There's no insurance (provider) from California to New York that wants my wife as a client."

 

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