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<p>Ron Nelsen of Las Vegas, a supporter President Barack Obama, said his garage-door installation business Overhead Garage Door, has benefited from the Affordable Care Act.</p>

Ron Nelsen of Las Vegas, a supporter President Barack Obama, said his garage-door installation business Overhead Garage Door, has benefited from the Affordable Care Act.

<p>The Coffee Cup restaurant owner Al Stevens makes a Bloody Mary in his Boulder City eatery Monday. Stevens said he knows family and friends who have seen their insurance premiums double or triple, and others who have been kicked off their existing policies and forced into HMOs.</p>

The Coffee Cup restaurant owner Al Stevens makes a Bloody Mary in his Boulder City eatery Monday. Stevens said he knows family and friends who have seen their insurance premiums double or triple, and others who have been kicked off their existing policies and forced into HMOs.

Stethoscope wrapped around hundred dollar bills
Stethoscope wrapped around hundred dollar bills

Those who fear the horrifying imposition of socialized medicine referred to as “Obamacare,” hiding in Nevada under the governmental rubric of “HealthLink,” are right about some fundamental issues.

Signing up for a health care plan is complicated and confusing, even if the state version is no where close to the catastrophe that it’s big-brother national cousin has been.

If they, the critics, got individual health insurance after 2010, they could very well have their policy cancelled by their insurance company. In total, those cancellations affect just a few percent of the total population, but when President Barack Obama said three years ago that nobody would lose their insurance, he was wrong.

Individuals may lose their insurance. And there will certainly be some, those with very high personal incomes, who will pay more for insurance. Often, the premiums they pay will purchase much better insurance than they once received, but that doesn’t erase the “sticker shock.”

That’s because one of the primary impacts of the Affordable Care Act is to limit deductibles, prohibit lifetime caps, include group coverage for women’s health care and other factors.

Most of the evidence for dramatically higher premiums is anecdotal, the stories of friends and family that are difficult or impossible to fact-check.

Jim Hager is director of the Silver State Exchange, the state’s marketplace for ACT-qualified health insurance plans. Hager said it’s difficult to compare policies and premiums before and after the Affordable Care Act.

The difficulty cited by Hager in comparing policies is real, in large part because the ACT now requires health insurance policies to cover catastrophic medical events, does not allow lifetime caps which previously had provided a quick trip to bankruptcy for victims of serious disease and accidents, and has other provisions that, in fact, most Americans want.

A quick look at some of the examples held up by the media as Obamacare horror stories indicate that they aren’t, perhaps, so horrible after all.

CNBC, the conservative, business-friendly network that has been a consistent critic of the White House generally and the ACT specifically, last month highlighted the story of Deborah Cavallaro, a 60-year-old California real estate agent who, the network said, was an example of the millions who would be forced into new, more expensive health-care plans.

The L. A. Times’ Michael Hiltzik took a look at Cavallaro’s specific example. He found that her bare-bones existing insurance, for which she pays $293, limits her to two doctor visits a year at $40, includes a $5,000 deductible and includes out-of-pocket costs of $8,400. Under Obamacare, Anthem Blue Cross cannot offer her plan as medical insurance. Its provisions do not conform to the law.

Hiltzik found that Cavallaro qualifies for a “silver” level plan for $333 a month, but with a deductible of $2,000, 60 percent lower than her old plan. Doctor visits would cost $5 more than they do now, but all her visits would be covered, not just two a year.

But if Cavallaro wanted a bare-bones plan as she has now, she could get a subsidized “bronze” level plan for $194 a month with the same as her existing deductible, a lower out-of-pocket limit and $60 primary care visits (no limit). She would still be ahead. (Conservatives insist that because it is unclear whether Cavallaro would continue to see the same doctor she has been limited to see twice a year, say the Obamacare plans are still worse for the Californian.)

One strong determiner of whether the Affordable Care Act is a good thing or a bad thing is the politics of those who are hearing the question.

Al Stevens and his wife, Carri, own The Coffee Cup of Boulder City, a small-town bistro. Al said he knows family and friends who have seen their insurance premiums double or triple, and others who have been kicked off their existing policies and forced into HMOs.

The cutoff for subsidized premiums under the Obamacare regime is an annual income of about $40,000 for a single person. Those above that income mark could be paying more for their coverage. And even those making less may pay more, a fact of which Al and Carri are well aware.

Al scoffs at President Obama: “He doesn’t even know what’s in it,” he said. “He’s a puppet… How much can one person screw up so many things? And people, especially the press I’m sorry to say, protect him.”

Carri Stevens, who handles the Coffee Cups’ finances, said the shop has about 18 employees, most of whom are part-time workers; most of them would qualify to be covered under their parent’s insurance until the age of 26, another provision of Obamacare. Those employees outside that age range would pay premiums that Carri Stevens said that would still be too much for some of her employees. (The Kaiser Family Foundation has an excellent tool for estimating premiums and subsidies for individuals and families at

Carri Stevens said insurance for her and her husband would be safe from cancellation because their policies pre-date 2010, but she still deeply distrusts the Act and Barack Obama. “This president is so divisive,” she said last week. “It’s his way or it’s no way and there’s no compromise. That’s not just health care, that’s everything.”

She said the Act would be OK if it just provided a place for people to shop for insurance (which it does) without setting minimum standards (which is integral to the reform, since without those standards insurance companies would continue to deny coverage to people with, for example, pre-existing conditions, or would continue, as they demonstrably done, kick people off of coverage once they get sick).

Why would men or older Americans, for example, have to pay more in premiums to extend maternity coverage to young women, Carri asked. Her daughter, she said, “paid for her baby and she didn’t get any government assistance.”

“Now she has to pay for somebody else’s when she had to pay for her own?… People have to be responsible for what they do. That’s how I was raised.”

Al Stevens echoed the “self-reliant” messaging; he said he has had insurance since he was 17, without any government subsidy, and doesn’t see a reason why others cannot follow the same path.

But interpretations of the Act differ greatly based on one’s opinions about the president. Ron Nelsen Las Vegas, has supported President Obama, and he said his garage-door installation business has benefited from the Act.

“The ACA has already bent the cost curve for health-care costs at Pioneer Overhead Door,” Nelsen said. “After 20 plus percent increases in premium costs for years last year we bought a new policy at no increase. This year the carrier is looking for a 18 percent increase for that policy but at my direction my broker has found a policy on the Nevada HealthLink exchange that will cost less with lower deductibles.

“After decades of less for more, in 2014 we will get more for less,” he said. “That’s after already getting rid of lifetime limits, exclusion for pre-existing conditions and charging more for women than men.”

Nelsen offered health insurance to his employees, but Nevada overall is second only to Texas in the percentage of people who do not have health insurance, the U.S. Census reported this year. And for children, Nevada was dead last, with almost 17 percent of children without any coverage, almost twice the national rate.

“Nevada also has the largest portion in the nation of households earning under $25,000 per year without health insurance,” USA Today reported last month. “The state also has the highest proportion of residents employed in service jobs, which are less likely than many jobs to provide health benefits.”

For those seeking insurance, those earning up to 400 percent of the national poverty rate will be eligible for subsidized coverage.

Regardless of the potential benefits - the goal, after all, is to extend health insurance and then health care to some 30 million Americans who once would have used very expensive emergency care as a last ditch and often hopeless final option - conservatives who see the health-care law as the central achievement of the Obama administration will not be mollified.

Many are offended that the government would replace the invisible hand of the free market in setting profit margins and benefits offered by private insurance companies. Other critics see winners and losers, and not necessarily those they would choose.

“Aside from all the website glitches, the law is doing pretty much what it was designed to do — drastically increase premiums on the young and poor in order to subsidize health care costs for the old and affluent,” said Geoffrey Lawrence, deputy policy director at the Nevada Policy Research Institute. “The ACA, like many federal programs, is, in a way, an acknowledgement by politicians in Washington that old folks tend to vote with much greater regularity than young people. So these vote-seeking pols score points by transferring resources from the young to the old. I’m sure CityLife readers will be thrilled to find out they’re now paying more so their rich uncle or grandparent can pay less.”

But as much as individuals and organizations fear change in healthcare delivery, there is some powerful evidence that change is exactly what America needs. Despite the claims from conservative political commentators, America’s health care system is far, far from the best in the world.

In fact, Americans are paying far more for health care - at almost 18 percent of gross domestic product, or more than $8,000 annually per person, it’s more than 50 percent higher than the next-most-expensive country in the world (one of those socialist European countries). And while American (and Nevadan) health care is expensive, it’s also not that good; the U.S. consistently ranks at the bottom of almost every health care comparison among developed nations, and many developing countries as well. CL