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If you need heart surgery, cancer treatment, or a transplant, or if you have to take one of dozens of drugs that cost Americans $1000 to $10,000 a month or more, any insurance with 100% coverage is "affordable." But is Obamacare affordable?

At the end of the first year of full implementation of the Affordable Care Act, also known as Obamacare, health insurance coverage made possible is getting mixed reviews.

Obamacare Pluses and Minuses

On the positive side, anyone who is not already on Medicare can sign up for coverage through either their state insurance exchange or the federal insurance exchange. There are no exclusions for preexisting conditions. There are no limits to how much insurance will pay. Many plans offer 100% coverage after policyholders pay a $500 to $5000 (in some cases, $10,000) deductible. There are even plans from healthcare.gov that offer a $0 deductible. Even better, a majority of Americans are eligible to get all or part of their insurance premiums paid for with tax credits, and many also get help with their deductibles in amounts of up $6000 per year, although this is paid directly to the insurance company.

The US government reports that of the 7.1 million people who have signed up for insurance through the new healthcare exchanges, 85% have received a premium subsidy, paying on average 73% of their cost of coverage.

On the negative side, many Americans complain that coverage under the Affordable Care Act simply is not affordable. Individuals who in 2015 will earn more than $46,680 per year, couples who will earn more than $62,920 per year, and families of four who will have an income over $95,400 per year don't get any subsidies to offset their premiums. The cost of coverage for a family of four can be quite substantial. A family of four in Dublin, Georgia, two parents in their 40's with two teenagers, with an income of $100,000 per year, could be offered coverage for $2,560 per month and still have a $4000 annual deductible. They might be able to get coverage for as little as $866 a month, but with a $10,000 deductible.

Why not just go without health insurance? The fact is, the tax penalty for not having health insurance is not very high. a maximum of $325 for an individual or $975 for a family, much less than the cost of insurance. But a trip to the doctor for a broken arm can cost $5,000 to $20,000, a five-minute heart catheterization procedure can cost $125,000, and an autoimmune disease or cancer can cost $120,000 to $200,000 per year in drug costs alone. Not having health insurance can invite financial disaster.

Whose Premiums Are Going Up the Most?

Most premium increases have been very local. That family in Dublin, Georgia, mentioned above, has to deal with a 33% increase in premiums in 2015. A family in Varnell, Georgia, a few hours away, probably has a 12% premium reduction. In some small states, like Vermont, a single company dominates the market and premiums are going up. But in some larger states, like California, multiple companies have moved into the market and premiums are going down.

Premiums are going up the most in some markets in Georgia, Tennessee, Indiana, Michigan, New York, and Oregon. Premiums are going down in some markets in Colorado, California, and Maine. But it is usually possible to find a less expensive plan that still meets your or your family's needs.

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