Health insurance is a tough sell when tax credits are low

Those eligible for the lowest subsidies to buy health insurance were  the least likely to sign up for 2015 plans, studies show, another indication of the challenge of boosting enrollment for President Obama's signature health care law in 2016.

The percentage of those choosing health plans dropped from about 75% for those earning $23,540 or less  to about 14% for those earning about $47,000, new research from the Urban Institute and the Robert Wood Johnson Foundation (RWJF) shows. Premium tax credits available on the federal and state insurance exchanges decrease as consumers earn closer to 400% of the federal poverty limit, which is about $47,000 for an individual.

This research and other studies of the 2016 plans on HealthCare.gov are likely to further hamper efforts to enroll some of the remaining people that Department of Health and Human Services Secretary Sylvia Burwell calls "hard to reach."

Obama makes personal push for open enrollment

Affordability is one of the biggest challenges facing those trying to boost enrollment.

When the insurance comparison site Healthpocket asked uninsured consumers how much they could spend on insurance a month, nearly 60% said $100 was their limit. That's about the same percentage that said they had only $100 left after paying all their bills, RWJF found.

There was an 11% increase in the average deductible amount for individuals and a 10% leap for family deductibles, according to Healthpocket. A single 30-year-old man who makes about $35,000 a year would have to pay nearly three times that to get a silver plan on HealthCare.gov. If he wanted to pay less each month, he could drop down to a bronze plan and save about $25 a month, but his deductible would be an average of about $5,800 a year.

RWJF found 96% of the newly insured with 2015 plans purchased on the new health insurance exchanges reported being happy with their plans. That's been evidenced by the predominance of people re-enrolling rather than signing up for the first time with application counselors at Parkland Hospital in Dallas, says Bob Reed, the vice president of patient access.

For many uninsured consumers,  having no insurance has "become a way of life," says Katherine Hempstead, RWJF's director of insurance coverage.

The rest are "the really tough population, which has been uninsured for a long time and is not really interested in paying several hundred a month" for insurance, she says.

Many of the uninsured are making do with low-cost drugs and health appointments  available at retailers, including Walmart and Costco, Hempstead and others say.

Margaret Brawner of Charlotte says she is opting out of buying insurance again this year because of what she called unaffordable premiums and ridiculous deductibles. Instead, she'll continue getting discounted prescriptions from CVS and discounted services from her doctors.

Brawner, who has a pet sitting business, was thinking about moving to South Carolina last year because there was more insurance competition and lower premium prices. But now she can't even find better prices there so thinks she will need to move far further.

"Those ramen noodles taste pretty good when all you have is 19 cents in college," Reed says.

In a conference call thanking enrollment aides last week, Obama mentioned former cancer patient Natoma Canfield, who wrote him a letter in 2009 saying she once had to give up her insurance because her rates kept going up every year and she "couldn't afford to lose her house." People such as Canfield, who has been cancer-free for five years, no longer have to "hang their future on chance," Obama said.

It's convincing the healthy and the near-broke that it's a good deal for them.

"If you're making $15 an hour, $90 a month is a lot of money," Reed says. "It won’t take much of a mishap to make that unaffordable."

In a call with reporters Monday, White House officials joined the mayor of Tampa and a Dallas judge to talk about a new "Healthy Communities" challenge that pits 20 areas with high numbers of uninsured people against each other to see who can sign up the most new people for insurance.

The winning community gets "bragging rights, a healthier community and a visit from President Obama," the White House said.

Tampa Mayor Bob Buckhorn says his obstetrician/gynecologist wife regularly sees the dangerous effects of people using the emergency room as their primary physician and going without prenatal care.

Newly insured Tampa residents, on the other hand, "now have a sense of security" because insurance helps them in a "very, very tangible way."

Still, he recognizes that even a small monthly premium might be out of reach for many people.

"Certainly people have to make very, very difficult choices,"  said Buckhorn.