Uncertainty reigns before health sign-up period

DES MOINES, Iowa -- Jason Sanford has heard so many rumors about the changing health-care landscape, every few weeks he dials a local information desk, seeking a rough estimate of what his diabetes medication soon will cost him.

The answer is the same: It's too early to say, even with the next open enrollment period under the Affordable Care Act beginning in two weeks.

"It's just hearsay," said the 55-year-old sales representative from Davenport. "There's no channel for information that I'm getting anywhere."

After several attempts in Congress to repeal and replace the 2010 health-care law, Americans across the country are grappling with unanswered questions about how "Obamacare" will function during the six-week sign-up period beginning Nov. 1.

The confusion is pronounced in Iowa, which is seeking last-minute federal approval to revamp its individual insurance market.

Uncertainty has mounted in recent days amid a push by President Donald Trump to allow the purchase of skimpier insurance plans than the ACA requires and a move by the president to cut off federal payments that help keep consumer costs down. On Tuesday, some senators announced a tentative agreement to continue those payments.

What it all means for Iowa isn't clear. Its proposal, known as the stopgap measure, would be unlike any other state's health-insurance market. It would replace the variety of plans from which people can choose with one plan for everyone, and the cost would be based not just on income, but on age.

Critics say it could prove more expensive for people with high-cost medical needs. State officials argue the higher out-of-pocket expenses would be offset by lower premiums.

Gail Orcutt of Pleasant Hill, Iowa, receives chemotherapy for lung cancer. She attended meetings over the summer on the stopgap measure, though she said she left confused.

Because she doesn't know what her costs will be next year, she is considering putting off some periodic scans that help detect whether her disease is spreading.

"I just might need to skip those until I'm on Medicare," Orcutt said, who will be eligible in May for the national health program for older Americans.

Some health-care experts say if Iowa's plan is approved in the next two weeks, there won't be enough time to inform people adequately about the changes.

"It's just hard to imagine there's not going to be mass confusion," said Timothy Jost, a retired professor at Washington and Lee University's law school.

Reyma McCoy McDeid hears concerns like Orcutt's almost every morning when she listens to voicemails from strangers who have called into the Central Iowa Center for Independent Living, a disabled-services center where she is executive director.

She tries to provide as much information as she can -- which often is little more than the callers already know.

"I listen," she said. "I think that's something that people are needing right now. I think a lot of people are overwhelmed. Health care is an extremely important part of being alive, and people are feeling really vulnerable."

Jennifer Busch, who typically answers Sanford's calls about diabetes, is one of a small number of federally funded "navigators" in Iowa whose job is to help people enroll in the insurance marketplace. For now, she offers only general answers because she hasn't received word from the state on how everything would work under the stopgap.

"It's difficult to reassure people because I don't know what the picture looks like either," said Busch, who works for Genesis Health System.

Earlier this month, The Washington Post reported Trump personally asked federal officials to reject the Iowa plan. State officials dismissed the report, and the Iowa Insurance Commission said it expects an answer soon.

Chance McElhaney, a commission spokesman, said the state is already talking about the stopgap measure with insurance agents and navigators and will be ready to roll out the plan quickly, informing the public via radio and newspaper ads and social media. And Gov. Kim Reynolds assured reporters this week: "We've got a process in place."

Meanwhile, Sanford is waiting. He said he pays about $350 a month for insurance under the ACA and has seen unverified estimates his bill could soon double.

"My health is the most personal thing in my life, and with the help of the ACA, I was able to manage it," he said. "Now I have a big question mark."