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The next step after losing health insurance

Whether they saw it coming from a mile away or it felt like a sucker punch, there's no turning back for people whose health insurance policies have been canceled.

To put it simply, those plans didn't meet minimum requirements imposed by the Affordable Care Act, forcing carriers to shelve the policies and consumers to seek new ones either through exchanges or privately.

For most forced into the valley of decision, it means waiting until software glitches and other obstacles are resolved in the Cover Oregon exchange portal, where they can sign up with one of eight companies providing plans for Jackson County.

Ashland resident Bruce Borgerson has pushed for health care reform for years, hoping to stem tsunami-like insurance rate increases.

The former local Democratic Central Committee member has reached Medicare age, but his wife and two children are very much caught in the sea-change waves.

"The LifeWise Essentials policy for my wife and two children will be canceled," said Borgerson, who runs a marketing firm for tech companies. "We've had LifeWise for 15 years, with a high deductible policy. Since we're healthy, it has worked out quite well."

LifeWise, based in Portland, told the family two years ago the present policy with its higher deductibles and reduced coverage would not be grandfathered into the new system.

"We knew it was coming," Borgerson said. "From then, it was just a matter of time and how much it would be."

Until now, the monthly premium for Borgerson's wife and children, age 21 and 18, was $296.

"The cheapest bronze (offered along with silver, gold and platinum) policies available through Cover Oregon look to be at least $450 a month," he said. "Because of our middle-class income, we are — just barely — not eligible for any subsidies. The added mandatory coverages will not save us any money (because) we don't need them."

Soaring deductibles are the crucible for many consumers who say they are now forced to buy more insurance than they can afford. But there are other elements of the new offerings that hit consumers hard.

Dee Kruger, an administrative assistant in the hospitality industry, has had private insurance with Portland's ODS, now known as Moda Health, since October 2007.

"I pay $266 a month for a policy that has a $7,500 deductible, but it offers three medical visits per year and three alternative visits per year that I can use without first meeting my huge deductible; and it covers all my preventive care appointments," she said.

Better yet, her co-pay was just $10 for prescriptions.

After checking out private insurance options, the closest plan to the one she has costs $382 a month, carries a $5,250 deductible, includes no medical visits unless the deductible is met and does not offer alternatives such as chiropractic help, she said.

The plus, Kruger added: "It does offer a $2 prescription co-pay."

The designers of the Affordable Care Act may have people such as Kruger in mind, thinking she would appreciate a kick-back on her taxes.

But that's not the case.

"The same new policy I could buy privately will cost me about $150 on Cover Oregon, with a $233 tax credit," Kruger said. "I don't want to have to use a tax credit that is making my children pay more taxes to help me pay for my premium, when I am paying my current policy just fine. I cannot make a $382-a-month payment, however."

An additional worry, she said, is that if she were to lose her job and couldn't make the payments during the course of the year, she would have to return the tax credit dollars.

"If you read it carefully, you see it's actually only a loan and if something happened and you couldn't pay the premium after four or five months, you would have to pay at the end of the year," Kruger said.

Alison Stevenson said she's always had insurance, buying what was offered in college, even obtaining it between jobs.

"I always bought a policy, so if I had a real problem I had it," Stevenson said. "I look at my history and I've been a very good, healthy patient."

But after moving from California to Oregon, she was denied insurance because she tore her meniscus and had knee surgery.

"Nothing major," Stevenson said. "Just an arthroscopy."

That pushed her into the Oregon Medical Insurance Pool. "I was able to use our savings for the past two years to purchase from the OMIP program through the state," she said.

OMIP coverage costs about $200 more a month than a similar private policy.

"I was lucky I could afford it," Stevenson said.

She's a fan of Obamacare, even though it has antiquated her OMIP program.

"I have been on the Cover Oregon site," she said. "I should get most of my insurance cost covered. So, my husband's and my coverage should go from $1,148 a month to $100 a month. If that is the case, I can get better insurance and not have to use my savings."

Reach reporter Greg Stiles at 541-776-4463 or business@mailtribune.com. Follow him on Twitter @GregMTBusiness, and read his blog at www.mailtribune.com/Economic Edge.

From left, Dorita, Hannah and Bruce Borgerson look over a letter announcing their private insurance will be canceled because it doesn't meet the standards of the Affordable Care Act.