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Health Care Frustrations Turn Into Satisfaction For Ga. Man


Now, we'll introduce you to someone who did successfully sign up for insurance on Michael Lappin of Atlanta, Ga., had a reason to shop for insurance early. His husband has health care needs that made buying their insurance on the individual market difficult and expensive.

Jim Burress, from WABE in Atlanta, profiles the small-business owner.

JIM BURRESS, BYLINE: Michael Lappin's Midtown Atlanta office is quiet, his mortgage brokerage small. It's just he and his husband. And on this day, he's using the website to shop for a health plan.

MICHAEL LAPPIN: Going here, I know the address where the doctor's office is.

BURRESS: Lappin's husband, John, has a pre-existing condition, and that means John's monthly premium was significantly more. So even when he felt bad, Lappin says, he would avoid his doctor's office whenever possible.

LAPPIN: Because if your doctor writes something down and puts it down in your chart, and then they ask for medical records, if you ever want to shop for insurance again, you couldn't get insurance.

BURRESS: When he did go to the doctor, Lappin made sure to start the conversation with this disclaimer.

LAPPIN: Write down what you need to write down, to keep an accurate medical chart; but if we're just having a discussion about things, don't write it down. Because we've had the experience where something in the medical records has triggered questions when applying for insurance. Just a comment.

BURRESS: Lisa Clemens-Cope, of the Urban Institute in Washington, D.C., says Lappin's anxiety was warranted.

LISA CLEMENS-COPE: What really sets Georgia apart is that it's one of just a handful of states where insurers could look back into a person's entire medical history to screen for pre-existing conditions. And then an insurer could not cover payments for certain types of care, and they could also end a medical policy.

BURRESS: She says insurance plans on the exchange may well be better than much of what's now available through the individual market.

CLEMENS-COPE: Individuals can't be denied coverage. Insurance has to cover a comprehensive set of health benefits, including hospital care, maternity care and prescription drugs. And it also means that individuals will pay premiums based on their age and some other factors, but they won't pay higher premiums based on their medical needs.

BURRESS: Initially, Lappin was frustrated, because he couldn't get very far due to website issues. Yet any annoyance disappeared several weeks later, when he was actually able to compare the new options with his current plan.

LAPPIN: Right now, I have an individual plan that has higher deductible than this, and has higher co-insurance amounts. And it's about $45 more per month.

BURRESS: Within a day, Lappin had researched, selected and purchased a plan at a significant savings.

LAPPIN: I anticipate between the two of us, we're going to save over $5,000 a year, and have better coverage and have lower out-of-pocket and co-pays.

BURRESS: About three weeks later, at a press event with Health and Human Services Secretary Kathleen Sebelius, Lappin pulls me aside. He tells me about the last time he signed up for health insurance. It was on paper. The process took a month.

LAPPIN: People have to relate it to what it was the old way, and what it is now. Technology has made this so much easier than it was before. Yes, it's not perfect. It's not three clicks, and it takes a little bit of time, but it is much better than it was.

BURRESS: So as positive as Lappin feels about the health law, it's not an experience everyone trying to sign up in Georgia will share. The Atlanta area has lots of insurers competing in its markets, but some counties in Georgia have just one company selling on the exchange. And that's driving the price of premiums higher.

For NPR News, I'm Jim Burress in Atlanta.

WERTHEIMER: This story is part of a reporting partnership with NPR, WABE and Kaiser Health News. Transcript provided by NPR, Copyright NPR.