Health Laws Prompts Confusion in Rural Counties

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By Rachel Begle

POSTVILLE, Iowa (AP) - For Candy Seibert, a self-employed property manager from northeast Iowa, getting by without health insurance is just a way of life.

Her experience isn't unusual in Allamakee County, where the 44-year-old Seibert lives. According to 2010 Census data, the bucolic county has the highest percentage of people without insurance in Iowa. A total of 18.2 percent of the population here lacks insurance, compared with a statewide average of 10.7 percent, based on the Small Area Health Insurance Estimates survey.

The onset of President Barack Obama's health care overhaul could bring down the number of uninsured in this region, with an expansion of state-run low income health coverage and new insurance marketplaces where people can buy plans. But there is both confusion and skepticism about the program in this area. Seibert, who has never had health insurance as an adult, said she didn't know much about the new law and wasn't sure if it would have an impact on her life.

"I feel a little strange that this is the first time we're forced to do something by our government," said Seibert, who said she'd be taking a wait and see approach. Currently, she pays doctor bills off in installments, though she admits she's been lucky to have had relatively good health.

Like Seibert, people without insurance in Allamakee, a county of about 14,000 people, said they manage in a variety of ways - visiting a free clinic in a neighboring county, seeking charity care at the hospital, putting medical bills on a payment plan, or just not going to see a doctor. Most who said they didn't have insurance, or had limited insurance access, said they knew little about the health care overhaul - officially the Affordable Care Act, but often referred to as "Obamacare" -and were not sure it would solve their problems.

The federal law will expand state-run low-income health care in Iowa and will set up new health care marketplaces where people can shop for private coverage and apply for government aid to pay premiums. People can start signing up for plans Oct. 1, with the coverage to start Jan. 1.

Under the new law, insurance plans must all provide certain benefits, like emergency care, maternity coverage and prescription coverage. In Iowa, six companies have been approved by the state to participate in Iowa's exchange, including two - Coventry Health Care of Iowa, Inc. and CoOportunity Health - that would offer coverage to individual buyers throughout the state. No information has been released yet on what the premiums will be for those buying on the public exchanges in Iowa, but there will be a variety of options. Those who don't have health insurance will be subject to fees when they pay their federal taxes, though the very poor could be exempted.

So far, there has been little information released about the new law in Iowa. The state is partnering with the federal government to set up the exchange. Iowa Insurance Commissioner Nick Gerhart said he expected a marketing effort from the federal authorities, though the state has done some outreach, like setting up a booth at the state fair.

"It's a heavy lift and a big job," Gerhart said of the education effort. "There is a lot of trepidation in the minds of consumers."

Rochelle Becker is one of those consumers.

"I'm afraid it's going to jack up everybody's prices," said Becker, 55, a divorced mom who has insurance but finds the $400 monthly cost so expensive that she avoids the doctor for fear of additional bills. She said her three young adult children don't have health insurance.

Becker said she treated her plan as insurance against a catastrophe.

"I feel like I can't afford it. I got it in case something major happens," said Becker who works a number of part-time jobs, including housekeeping at nursing home, working at a convenience store and house cleaning.

Allamakee County Supervisor Larry Schellhammer said he wasn't surprised by the health insurance statistics in the area, noting the county has a small population and many residents live paycheck to paycheck.

"There's a lot of agriculture jobs in the county, but it's usually young men, young women. Their concern is usually not health care," Schellhammer said.

About 11.1 percent of Allamakee residents lived below the poverty line between 2007 and 2011, according to the Census. That's slightly less than the statewide average of 11.9 percent. But access to health care for lower income people can be harder in rural areas, said Keith Mueller, a professor who heads the Department of Health Management and Policy at the University of Iowa.

"Rural small employers are more likely not to provide insurance than urban small employers," Mueller said.

Many of the area's problems are attributed to Postville, a dusty little town that gained international fame in 2008 when a kosher slaughterhouse was raided by federal immigration authorities. The raid, the largest of its kind in the United States at the time, led to the arrest of 389 workers, many of whom were deported.

The plant now operates under a different owner. But residents said the town has lost population and stability since the raid. Many people said they worked jobs that didn't provide insurance - like farming, running a shop or part-time jobs - and couldn't afford a plan.

"We're looking for some, but it's very expensive," said Laura Moncada, 43, who runs La Canasta Supermarket in Postville with her husband. She said two of her three children are on Medicaid and she and her husband pay for medical services if they need them.

"Sometimes I'm sick. Sometimes you need tests, but it's very expensive," said Moncada.

Aaron Hickman, 39, said he was without insurance because he lost his job at the meat processing plant after he got sick and couldn't work. Now he needs a surgery for an infection but doesn't know how he'll pay for it.

"Because I don't have money to go to the doctor, I didn't know," Hickman said, saying he saw a doctor after he lost weight and felt lethargic. "I don't got nothing. I don't got a damn job. I got trouble all the time."

Asked if he thought the Affordable Care Act might help his situation, Hickman said he didn't know.

"I'm not into voting," he said. "I'm not into that government crap."
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