Either find a way to stay healthy or face bankruptcy.
The 64-year-old retired Anniston resident dropped her health insurance coverage three years ago due to its cost and lack of sufficient benefits. Living on a fixed income, Jones has had to constantly worry that just one significant ailment could wipe out her savings.
Then coverage began Jan. 1 for the health insurance plan she enrolled for through the Affordable Care Act's insurance exchange almost four months prior.
"I cried because I was not covered for so long ... now I do not have to worry about me or my husband going bankrupt," Jones said.
Jones is one of thousands of Alabamians who have received coverage through the federal insurance exchange. But while some residents are happy about the recent changes under the ACA health care reform law, others are more wary. Some local businesses say changes in the law could mean higher costs for them and their employees. Meanwhile, health care industry experts disagree on whether the changes will actually lower costs and improve healthcare for Americans as promised.
Enrollment began Oct. 1 for the insurance exchanges, which offer tax credits to help Americans who previously could not afford health insurance. However, technical glitches with the website set up to enroll people slowed down the process. Most of the technical problems were fixed in November, but enrollment numbers are still low.
According to recent statistics from the U.S. Department of Health and Human Services, just 28,663 Alabamians had selected a plan from the insurance exchange by the end of December - echoing low enrollment numbers across much of the rest of the country. Also, of all the Americans who had selected a plan, just 9 percent were between the ages of 18 and 25, while 15 percent were between 26 and 34 years old. In contrast, 30 percent of Americans who selected plans were between 55 and 64 years old.
"Clearly the numbers are low ... we're not seeing the young enroll," said Dr. Michael Morrisey, director of the UAB Lister Hill Center for Health Policy.
Morrisey said that he doubts a significant number of younger Americans will enter the exchanges due to the insurance premium costs, which could hurt revenue for the program in the future.
"What it means is there won't be sufficient revenue coming in for people who do enroll and that means premiums could be higher next year," Morrisey said. "And the taxpayer will be on the hook for all that."
Jim Farrell, owner of Blastcrete Equipment Company in Anniston, said his business of 18 employees is already facing cost increases due to the ACA. Farrell said his company's employee insurance provider, Blue Cross Blue Shield, will increase premium costs by 2 percent this year as part of a tax included in the ACA. The individual and small group health insurance tax will be used to fund Medicaid expansion in the coming years.
"We pay all of the health insurance for our employees, all 100 percent of it, and it's extremely expensive," Farrell said. "But this is a very important benefit ... it helps us keep our employees long-term."
Farrell said he is still in the dark about much of the ACA and hasn't considered switching his employees over to an insurance exchange plan due to a lack of details about it. His hope is that he does not have to pass on any health care costs to his workers.
"Our biggest concern is how all this will impact our employees," Farrell said.
Georges Benjamin, executive director for the American Public Health Association, said while the ACA will mean higher costs for businesses at the start, the law will result in lower expenses in the long run.
"Once everybody is in the system, we will have certainly a much healthier workforce, which will mitigate costs," Benjamin said. "Upfront costs will be greatly offset by healthier employees and lower cost growth overall."
Unlike Morrisey, Benjamin expects more younger Americans to enroll in the coming months.
"Young folks do everything at the last minute," Benjamin said. "I expect more and more will enroll."
In the meantime, Jones plans to meet her doctor for the first time in February for a check up.
"I just pray to God that I was able to sustain my health until now," Jones said.
Staff writer Patrick McCreless: 256-235-3561. On Twitter @PMcCreless_Star.