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Out of health-care furor, satisfaction in New England

The federal overhaul has had a bumpy start, but with insurance payments they can handle, many have stopped gambling on their future

“It could have been bankruptcy, if something major had happened. . . . You can see your whole life and your whole family fall totally apart,” said Arnold Gamage, a lobsterman in Maine. His old monthly premium was $800. It’s now $480.

Fred Field for The Globe

“It could have been bankruptcy, if something major had happened. . . . You can see your whole life and your whole family fall totally apart,” said Arnold Gamage, a lobsterman in Maine. His old monthly premium was $800. It’s now $480.

Much has gone wrong since state and federal health insurance websites created under the Affordable Care Act launched on Oct. 1. Technological glitches have frustrated customers, flustered politicians, and fueled debate about President Obama’s landmark legislation.

Lost amid all the fury, however, have been the success stories.

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Many who struggled without insurance are getting it. Others with poor coverage have found better plans. Some whose policies cost a lot, yet covered little, have obtained more comprehensive coverage that — with government subsidies — often costs less.

About 3 million people have signed up for a private health plan through the online insurance exchanges, a senior US health official said Friday. More people are newly enrolled in Medicaid in states expanding that program, which provides coverage to people with low incomes.

The federal law requires most Americans to have health insurance and provides tax credits to make it more affordable for people who earn up to 400 percent of the federal poverty level, or $79,160 for a family of three. It sets minimum standards for health plans, requiring insurers to cover more preventive services and prohibiting them from charging women higher fees. People with preexisting conditions no longer can be denied coverage.

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In New England, more than 91,000 people have signed up for private plans through the federal health law.

Here are five of their stories.

Never insured

John Cashore, of Robbinston, Maine, has never been to a doctor.

“Ever,” he said. Then the 62-year-old corrected himself: “I went once. I got hit in the chest with a rafter when I was working one time and had to go to the Eastport clinic, where we’re on a sliding scale” for fees.

Except for a brief period when he had coverage through a job in a metal shop, Cashore and his wife, Diane, have never had insurance. Their two children, now adults, received some state aid when they were young, for dental and preventive care. But when their daughter broke her arm cheerleading in seventh grade, the couple paid the $8,000 hospital bill in monthly payments.

“A few years later, it was paid for,” he said. “That’s how we have handled it.”

The couple, previously among the 47 million uninsured in the United States, simply could not afford to pay an insurance premium, he said. He is a carpenter. She works part-time as a gardener and a scythe-maker.

The couple started looking at their options under the Affordable Care Act about two months ago. They got help at the Eastport Health Care clinic from a “navigator,” trained through a federal grant to help with enrollment. They chose a plan that will cost about $80 a month, with a subsidy.

“I don’t mind paying that,” he said, “even if I don’t get sick for 20 years.”

The couple’s 28-year-old son, Daniel, who lives with them on a farm along the St. Croix River, is uninsured. He makes too little to qualify for the new federal subsidies and too much for Medicaid. Maine is one of about two dozen states that have declined federal funding to expand Medicaid this year, to close that coverage gap.

Even with their new health plan, the Cashores are not rushing to schedule medical appointments. But, John Cashore said, they have a greater peace of mind.

“People don’t last forever,” he said. “I’ve been worrying about it.”

But not anymore. “We just signed up because it’s affordable and things eventually do break,” he said. “And it’s the law.”

Young and vocal

Alisson Wood was panicked last fall. Her health insurance was set to expire in March and she feared new coverage would cost more. She could not be uninsured.

Wood sees a psychiatrist regularly and takes medication to cope with the post-traumatic stress she has experienced since witnessing a neighbor’s stabbing.

“I was nervous that I wouldn’t get the coverage that I needed,” she said.

Wood, 30, is a part-time student at Sacred Heart University and works two part-time jobs writing grants and running programs for community organizations in Bridgeport, Conn. She makes less than $15,000 a year.

The plan she previously purchased on her own cost about $500 a month. Often, Wood said, she had to borrow money from her parents to pay the premium.

Wood signed on to Connecticut’s exchange, Access Health CT, when the program launched Oct. 1, but she found the application confusing. With help from a counselor at the Bridgeport Child Advocacy Coalition, she learned that she qualified for Medicaid. With federal money, Connecticut expanded Medicaid to cover people who make up to 138 percent of the federal poverty level, or $16,104 for an individual. As a result, Wood’s health insurance will cost her nothing and she will be able to keep her doctor, she said.

“Instead of being in the red every month, I’ll be in the black,” she said.

Advocates of the federal law and health insurers are counting on young adults like Wood with relatively minimal health needs to sign up for coverage. Their premium payments are expected to help cover the cost of caring for sicker people, including those previously denied coverage.

One in four people who signed up for a private health plan through state and federal exchanges in the first three months of enrollment was between the ages of 18 and 34, a recent federal report said. But many more young people must enroll to avoid big premium increases for everyone next year.

Hours after she applied for coverage, Wood posted contact information for the Bridgeport coalition that helped her on her Facebook page and urged friends to reach out and learn about their insurance options. She hoped her personal story would motivate them more than any news story they read or heard.

A heart problem

Every year, it seemed, the cost of Arnold Gamage’s health plan grew while the coverage shrank. In 2012, the 61-year-old paid nearly $800 a month for a plan that included $10,000 deductibles for him and his wife.

“You better be a wealthy person” to pay that, said the lobsterman from South Bristol, Maine.

The plan was a safety net in case something horrible happened — another heart attack — but it was not much help otherwise. Through most of the year, until he met the deductible, Gamage paid the whole cost of two medications he takes to protect his heart.

High deductible plans were common in Maine, particularly among lobstermen and seasonal workers whose income fluctuates.

More than 1 in 3 health plans sold in the state’s individual market had a deductible of $7,500 or higher, according to a 2011 analysis.

Many of those plans will be prohibited under the Affordable Care Act, which requires insurance to cover at least 60 percent of expected health care costs for a typical patient.

Gamage dropped his coverage early last year. With lobster prices low, he and his wife were forced to gamble on his heart.

“It could have been a nightmare,” he said. “It could have been bankruptcy, if something major had happened . . . You can see your whole life and your whole family fall totally apart.”

Today, Gamage and his wife are insured again, making them “two very happy people,” he said.

Gamage bought a plan through HealthCare.gov, the federal site, that will cost $480 per month, with a subsidy.

He said he’s satisfied with the coverage, which includes a combined deductible of about $5,000. His biggest concern is that he could be required to return the subsidy if he has a good year on the water. His income, dependent on weather and lobster prices, can fluctuate as much as $20,000 a year.

Lobstering is “a game to play,” he said, but it’s one he prefers to playing with his health.

Covered without a subsidy

When communications consultant Jane Kramer of Lexington shopped for a health plan last year through the state insurance website run by the Massachusetts Health Connector, she found the process to be simple. She expected to have trouble, though, when she reenrolled last fall.

The Connector’s website has been problematic since it was relaunched in October to comply with the federal law. Basic functions have not worked, and the state has been processing applications on paper and offline instead, leading to long waits for customer service.

But Kramer, who is in her 50s and not eligible for a subsidy, was one of the lucky ones. Her application went through with little trouble. She selected a Tufts Health Plan product that was comparable to her prior plan. Even better, she saved money.

The $718 monthly premium is $104 less than she paid last year, she said.

“It’s $1,200 a year” in savings, she said. “That’s a lot of money.”

Despite its problems, the Connector has met her needs, Kramer said.

“If you look at the plans, there really is something for everyone there, no matter who you are and no matter where you are in society,” she said.

Self-employed and saving

Susan Lampe-Wilson had low expectations for the Affordable Care Act.

“Everybody was saying, ‘Oh, this isn’t going to work,’ ” she said.

The first time the 56-year-old from Rockingham, Vt., punched her financial information into a premium calculator, she thought she must have made a mistake. Her estimated monthly premium was $119.

A freelance graphic designer, Lampe-Wilson had been paying $625. She made an appointment with a counselor at Southeastern Vermont Community Action who could talk her through the application for Vermont Health Connect, the state’s insurance exchange.

That is where she learned that she qualified for Medicaid and probably would pay no premium at all. Sitting in the counselor’s office, Lampe-Wilson began to cry.

She and her husband, who is on Medicare and runs a small mystery-book store, make about $26,000 a year in combined income.

“We are living hand to mouth, pretty much,” she said. “It would be nice to settle some accounts.”

Hurricane Irene washed out their driveway. Nearly three years later, the couple are still paying off the more than $5,000 it took to rebuild it and install a culvert. The insurance savings, she said, will go a long way.

Chelsea Conaboy can be reached at chelsea.conaboy@globe.com. Follow her on Twitter @cconaboy.
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