As Congress continues to debate repeal and replacement of the Affordable Care Act, some local residents closely are tracking the latest maneuvers and expressing anxiety both over what they have now and what’s to come.

They are those without health insurance from their employers, who have Medicaid or private insurance plans obtained through Access Health CT — Connecticut’s online marketplace created in response to the ACA. Others obtained private insurance on their own or pay for medical costs out of pocket.

“We’re really worried,” said Jessica Offir of Coventry, who’s seen the benefits of coverage through the Medicaid expansion under the ACA for herself and members of her family, including a disabled brother who is able to work because of the health care he now receives. “This has been an absolute life saver for us.”

As Offir and others able to get health insurance coverage through the ACA fear losing what they have, another group has not only been left out of those benefits, but feels as though their health insurance options have gone from bad to worse.

“This seems to be a radically unfair system,” said Jim Holley of Mystic, who owns two stores in Olde Mistick Village with his wife, Heike. Unable to qualify for federal subsidies and tax credits available through the ACA to those with lower incomes, the Holleys are paying $15,240 in annual premiums this year for coverage that doesn’t kick in until they’ve satisfied a $14,000 deductible.

“There’s not a lot of choice out there,” Heike Holley said. “I feel like we’re getting the shaft.”

Rep. Joe Courtney, D-2nd District, has been hearing a lot from constituents on all sides of the issue since January, when the House of Representatives made an unsuccessful attempt at repeal and replacement of the ACA. 

Known as Obamacare, the ACA was signed into law in 2010, with major provisions implemented by 2014.

Opposed to the Republicans’ American Health Care Act that passed the House on Thursday and now heads to the Senate, Courtney said neither those who like Obamacare nor those who’ve seen no benefits will be the winners if the new GOP bill becomes law.

“This bill is not a response to those frustrations,” he said. “What we need is a way to stabilize the individual and group insurance markets, and what’s being debated here is not a solution to that.”

Under the GOP plan, the expansion of Medicaid coverage to those earning up to 138 percent above the federal poverty scale — $49,000 for a family of four in Connecticut — would be phased out. In the current plan, the federal government pays 90 percent of the costs, with states picking up the rest. About 219,000 Connecticut residents now on Medicaid are at risk of losing it if the new plan becomes law, according to Lt. Gov. Nancy Wyman.

The Republican plan also would eliminate the ACA’s mandate for people to have health insurance or pay a penalty, weaken restrictions on insurers’ ability to charge higher premiums based on age and waive requirements that all insurance plans cover “essential health benefits” including mental health services, maternity care and emergency room visits.

It also would end the ACA’s requirement that insurers provide coverage to people with pre-existing health conditions without charging exorbitant premiums. Instead, an $8 billion high-risk pool would be set up for states to subsidize coverage for people priced out of private insurance coverage.

Courtney said there’s no dispute that the ACA “needs work,” especially to provide subsidies to offset premium costs to more people and to create insurance pools where small business owners could get coverage. He also advocates reinstituting federal support for the reinsurance program — basically insurance for insurance — that was eliminated in a 2015 budget compromise. The program’s end this year, Courtney said, is the main cause of recent price spikes in the private insurance market.

One alternative proposal he’s interested in is a plan to lower the eligibility age for Medicare to age 50 from 65. That would be a way of providing coverage to millions at a time when costs of private insurance can jump and their need for health care often increases.

As the debate continues in Washington, local residents like Gary and Loretta Giarmonti of Stonington and Christine Fischer of New London want Courtney and his Congressional colleagues to know about the experiences of ordinary Americans like them as they make their decisions.

“I think the politicians have a disconnect with the people who are actually on the other end using these services,” Loretta Giramonti said.

Fischer, in a recent letter to President Trump, Courtney and Sens. Richard Blumenthal and Chris Murphy, advocated for a solution that would benefit everyone.

“I urge you on behalf of all Americans ... to improve the Affordable Care Act, not to dismantle it, and to make sure that high quality health insurance remains available to all, regardless of pre-existing health issues and ability to pay,” she wrote.

The Giarmontis and Fischer are among local residents interviewed by The Day over the last three weeks about the ACA and their experiences with private insurance. They are among those who responded to a query on www.theday.com or were found through other contacts. Here are some of their stories:

As Deb Gilpin of Waterford prepared for retirement in January, she began researching her options for health insurance. Her job at Easter Seals had provided her with good coverage for her entire working life, she said, and she couldn’t imagine she and her husband, Wayne, being without it.

“My husband has a couple of medical conditions and we need medications, so we cannot be without health insurance,” said Gilpin, 60.

To her surprise, she said, the insurance available to her through Access Health CT, the state’s online marketplace, wasn’t affordable for them. They didn’t qualify for federal subsidies, and the prices they’d have to pay for what they considered substandard coverage wouldn’t be worth the price, she said.

“It was actually cheaper for us to go with COBRA,” she said, referring to the program that allows people to continue to stay on their employer’s plan after leaving work. “I looked at the cheapest plan on the ACA, and COBRA was still cheaper, and we get dental coverage.”

Gilpin said they’re now paying a $1,200 premium per month, and have a high deductible. While expensive, she said, “we’re sucking it up for now,” until her husband turns 65 next year and is eligible for Medicare.

“I think the ACA is wonderful for people who have low-income jobs without insurance, but for the rest of us, there isn’t enough choice,” she said. “For middle-income people, it’s just not affordable, and they’re forced to purchase types of insurance they don’t need or don’t want.”

Virginia Boucher of Groton doesn’t know how she would have fared without the Affordable Care Act. Two years ago, the former Westerly Hospital secretary became disabled after a severe back injury. After qualifying for Social Security disability payments, she purchased an Anthem Blue Cross and Blue Shield Plan through Access Health CT, getting a federal subsidy to help with the cost.

“They pay all but $52 per month of the plan,” she said. “It’s been absolutely wonderful.”

Her annual deductible is $1,200, and she also is responsible for a co-pay of $25 for physician visits and $5 per prescription. If she didn’t have the insurance, she said, the $26,000 back operation she needed would have been out of reach.

“I’ve really got a great plan,” the 63-year-old said.

But she knows there are others not benefiting from Obamacare, and would like to see it improved.

“For the poor, it’s great, but for people in the middle, it’s not,” she said.

Both 63 years old, the Giarmontis of Stonington are looking forward to turning 65 so they can qualify for Medicare.

“My wife and I are extremely frustrated,” Gary Giarmonti said. “My health insurance costs more than my mortgage, more than my property taxes. It’s our biggest bill.”

The couple work for a small company that doesn’t provide insurance to its employees, so they purchase insurance on the private market. They checked out the offerings on Access Health CT, they said, but didn’t find any that were affordable, and didn’t qualify for a subsidy. This year, they said, their rates jumped 38 percent over last year’s, with less coverage. Now, they’re foregoing some routine screening and wellness care that no longer are covered rather than pay for those things themselves. Their monthly premium is $1,818, with a $9,000 deductible. Basically, he said, it’s catastrophic coverage.

“I am past due for my annual physical and my PSA (prostate cancer screening) test,” he said. “I am delaying some of my normal health care. Our message is that they need to make insurance more affordable.”

Groton resident Angela Gaeta, a 40-year-old computer technician at Lawrence + Memorial Hospital, appreciates the health insurance coverage she had through the ACA in 2014. She recently had left a job that provided insurance coverage, so went to Access Health CT to find a plan she could afford until she found a new position.

“I had a good plan that I was only paying $76 per month for,” she said. “The subsidy covered the rest. It was great. I didn’t have to change doctors.”

Now, she has coverage through her job at L+M, contributing about $64 per month toward her premium and deductible costs of $2,000 per year.

“I end up using a lot of health care because I’ve got some health issues,” she said. “I am grateful for the Access Health CT plan I had.”

The insurance plans have covered the costly prescriptions she needs, as well as biopsies, X-rays, ultrasounds and other procedures. Regardless of her own positive experiences, she believes the current system needs improvement.

“I know it isn’t working for everyone,” she said. “But I think it just needs some tweaking, not an overhaul.”

After he did the math, James Correira of Mystic figured that paying out of pocket for his and his family’s medical expenses was “the most efficient use of my money.”

“I know I’m gambling with my greatest asset, my real estate,” said Correira, 61, a self-employed consultant. But the risk that he could be forced to liquidate his assets and declare bankruptcy to pay high medical bills, he said, seems worth it for the savings he’s seeing.

All the insurance plans he considered for himself and his family, he said, were too expensive and covered too little, and he didn’t qualify for subsidies available through the ACA. Last year, he figures he paid about $5,000 out of pocket in medical expenses for himself, his wife and their child, plus a $1,900 tax penalty under the ACA’s mandate to have health insurance. This year, President Trump has told the IRS not to enforce the penalty, so Correira expects he won’t have to pay.

But that’s not to say he’s content with his current situation. He’d rather have affordable insurance and not be taking such a gamble.

“I’m really looking forward to a solution,” he said. “Congress should listen to the people and not be influenced by the pharmaceutical companies and the insurance companies. That’s what’s driving this.”

He said he’s “all for trying something different” this time. But the kind of replacement for the ACA he has in mind isn’t the one that’s on the table.

“I would like a single payer system,” he said, referring to a Medicare-like arrangement where individuals pay a tax for their health care, rather than paying private insurers. “I know that can work.”

A breast cancer survivor and mother of a 34-year-old son with ongoing medical needs from an accident as a teenager, Chris Fischer of New London understands what living with a pre-existing condition means. She can’t imagine not having insurance.

“I wouldn’t qualify for any insurance if not for the ACA,” said Fischer, 64, who put off retirement until the ACA took effect, even as her own health and a family crisis made her want to stop working sooner.

At first, she and her husband paid $1,000 per month in premiums and a $12,000 deductible under the plan they obtained through Access Health CT. A couple of years ago, her husband qualified for Medicare, so her premium dropped to $700 per month, with a $6,300 deductible.

“I had knee replacement surgery last fall that would have cost me $55,000 if I didn’t have insurance,” she said. “If you have a pre-existing condition and you don’t have insurance and you get sick, it’s like saying, ‘tough luck.’ It’s terrifying.”

Her son, who had to have his leg amputated below the knee, will need expensive treatments and prosthetics the rest of his life, she said. Without protection for people like him with pre-existing conditions, she said, how will he be able to afford the care he needs?

“If people can’t be secure that they can take care of themselves and their families, they can’t live up to their potential, and they can’t feel good about being citizens, or have any loyalty to the country that abandoned them,” she said. “I don’t think Obamacare is perfect, but I’d like to see it preserved and strengthened. What we need is a single payer system.”

Lorraine Cordeau grew up in Canada, coming to this country nine years ago and marrying Michael Donovan. Part-time residents of Westerly who live in Florida the rest of the year, the couple bring a unique perspective to the conversations about how to fix this country’s health insurance and health care system.

“The problem stems from uncontrolled costs for treatments and prescription drugs,” Cordeau said. “In Canada the costs are all controlled by the government. My first husband died of cancer, and he had the same if not better treatments there than he would have had here. They need to control the costs.”

In 2014, the couple obtained insurance in Florida through the ACA that cost them $1,000 per month in premiums, but they qualified for a $160 per month subsidy to help pay for it. But the premium costs leapt as much as 30 percent each year, with higher co-pays and deductibles, so they’re now paying about $1,700 per month for insurance coverage.

“All of my life savings has gone into my health care,” Cordeau said. “Thank God I’m turning 65 next month.”

Jessica Offir of Coventry, a 52-year-old former teacher and psychologist, had to stop working a few years ago when an autoimmune disease left her disabled. But thanks to the Medicaid coverage she obtained through Access Health CT, she still can get the expensive medications and treatments she needs. If the Medicaid expansion ends, she said, “I would lose that. This really is something that could result in my death.”

Her 32-year-old brother, she said, also qualified for Medicaid because of the expansion, and now has the services of a visiting nurse to make sure he’s taking the medications he needs to control his mental illness.

“It has literally saved his life,” she said. “Because of having the nurse, he’s able to work full time and pay his taxes. If he loses his coverage, he’ll lose his apartment and be back on the streets.”

The coverage they receive, she noted, isn’t free. She pays $30 per month for her Medicaid coverage, and her brother pays more. The plan being advanced in Congress, she said, would leave them both uninsured because of their pre-existing conditions, and premium costs they couldn’t afford on their incomes.

“It’s really immoral to do this on the backs of the most vulnerable people,” she said.

Heike and Jim Holley of Mystic want policymakers to find a solution that works for small business owners like them.

“Change cannot come soon enough,” Heike Holley, 58, said. “Pretty soon, we will be the new uninsured.”

She’s a breast cancer survivor, and Jim Holley, 60, has had a couple of recent knee surgeries, so they know that paying for expensive medical care out of pocket isn’t an option. But their current costs — $1,270 in monthly premiums with a $14,000 deductible — are making them feel some resentment toward those who pay less and have better coverage, she said.

“This is critically unfair to small businesses,” Jim Holley said.

Heike Holley said they found few choices on the private insurance market, and all of them included kinds of coverage they didn’t want.

“It has to change,” she said. “It should be more like shopping for car or homeowner’s insurance, where you pick your options of what you’re covered for. And it shouldn’t be a government mandate.”

j.benson@theday.com