WALLA WALLA — He’s spent much of his life without health insurance, paying expensive medical bills out-of-pocket and delaying care while sick.
But now, 35-year-old Walla Walla nursing student Jacob Metcalf says he may be able to get insurance for the first time in four years, thanks to the Affordable Care Act’s insurance exchanges.
Starting Oct. 1, people who don’t have insurance will be able to enroll in plans through insurance exchanges operated by the state. Washington’s exchange, known as the Washington HealthPlanFinder, offers individuals the ability to compare prices between equivalent plans offered by different insurance companies and sign up for a policy that fits their coverage needs. Health coverage for plans bought on the exchange will begin Jan. 1, when the ACA mandate for individual insurance coverage kicks in.
For Metcalf, the options the exchange offers means insurance will finally be affordable. He was last insured in 2009, while working full-time as a contractor in computer graphics. After being laid off and losing his health insurance, he decided to start a second career as a nurse and enrolled in a program at Walla Walla Community College.
But the long hours required in school mean he can’t get a job that would provide insurance coverage, and without the options offered by the ACA, Metcalfe said buying an individual plan is too costly.
“I’m a nursing student and if I get sick, I can’t do clinicals, which affects my ability to finish school,” he said.
Though generally healthy, Metcalf had a close call in August when he came down with shingles. Because his credit card was maxed out from buying books for school, he delayed going to the doctor until the problem was too serious to ignore.
His parents were able to pay the $250 out-of-pocket cost for the clinic visit. But without their help, he said, he would have waited longer and possibly ended up in the emergency room, incurring medical bills he wouldn’t have been able to pay.
“Had I not gone to the doctor, the recovery (from) shingles can be months,” he said. “I’m actually really fortunate that I received care at that time. It could have been much worse.”
He’s also had difficulties staying on prescription medications he takes to lower blood pressure. Without a regular doctor, Metcalf relies on free clinics and asks doctors to write him prescriptions with many refills so he doesn’t have a gap in his medication. But he’s had days where he couldn’t get a refill in time, and experienced elevated blood pressure and difficulty concentrating and sleeping.
Not having insurance, he said, can be dangerous for people who need regular medication.
Working in health care, Metcalf knows his own experience is common. People without insurance often delay addressing medical problems because they can’t afford to see a doctor.
“They wait until their problems are too big to ignore and they go to the ER,” he said.
Beginning in January 2014, most people will be required to have health insurance, whether it’s provided through a job, bought individually or provided by Medicare or Medicaid.
But not everyone will face penalties for not having insurance.
According to guidelines released by the Department of Health and Human Services, individuals and families earning below the minimum threshold to file income tax are exempt from the mandate, as is anyone who would have to spend more than 8 percent of their income on health insurance after tax credits and employer contributions are factored in.
Undocumented immigrants, members of Indian tribes, people who are currently incarcerated and those with religious beliefs opposed to accepting insurance benefits are also not required to have coverage.
For everyone else, the penalty in 2014 will be $95 per adult and $47.50 per child, or 1 percent of family income up to a maximum of $285 per family, whichever is greater. By 2016, the penalty will be 2.5 percent of income or $695 per person, whichever is greater.
Metcalf hopes the insurance requirement will encourage people who are able to get coverage to seek medical care early.
“Hopefully in a couple years after the ACA, people will be able to go see a doctor and deal with medical problems when they’re small,” he said.
Rachel Alexander can be reached at email@example.com or 509-526-8363.