Putting a Face on Obamacare

face-of-obamacareI’ve debated for quite some time about whether or not to tell this story publicly as it is a very personal one. With the mid-term elections less than 24-hours away, the decision is now clear. If only one person reads this story and it changes his/her perception of the Affordable Care Act, aka Obamacare, and its importance, then sharing the story will be worthwhile.

My objective is not to try to sway your vote. I hope to present a different perspective as you consider campaign promises and candidates’ plans for the future of Obamacare and the eight million people currently enrolled in the program.

Who Wants Obamacare Anyway?

Daily I hear anti-Obama/Obamacare folks, candidates and citizens alike, talking about “those” people…the takers of society. “They” only voted for Obama to get free insurance and free everything-else-under-the-sun. “They” are lazy, don’t work, and, frankly, should’ve done better for themselves so “they” wouldn’t need us to pay for their insurance! “They” want to destroy and bankrupt our country and “they” will succeed unless we, the taxpayers, do something to stop this insanity!

But who are these people, anyway? The “theys”. Have you ever wondered? Surely “they” are not like us. “They” aren’t our neighbors, friends, or relatives; certainly no one we know and love. Or are they?

Let me introduce you to just one of the 8 million faces of Obamacare…

It’s me. That’s right; I’m one of “them”.

I am one of the 8 million people who’ve been able to get healthcare thanks to the Affordable Care Act. Healthcare that otherwise wouldn’t have been available to me.

How I Became a “They”

I’ve had health insurance the majority of my life. It was something I took for granted. Growing up, I was covered on my parents’ group policies through their employers. As an adult, it was a given that my employers would offer group health insurance to employees.

Having a pre-existing condition wasn’t a concern either. There was never a question as to whether a pre-existing condition might exclude me from healthcare eligibility. There was often a waiting period, but coverage would come. During a waiting period the remaining benefits were already in effect. So what if you had to wait a couple of months to resume treatment of a pre-existing issue? No big deal.

I turned 56-years-old in September. I hold a Bachelor’s degree in Journalism and a Master’s in Human Services. I’ve had quite a varied professional career. I’ve worked in several facets of the entertainment industry, taught elementary school, and was a program specialist and trainer in emergency preparedness and response for a non-profit post-Hurricane Ike. After my contract with the non-profit ended, I started a social media consulting agency. It was the first time I’d been self-employed and therefore the first time a job didn’t provide healthcare benefits.

There are many scary things about being self-employed, chief among them is not having access to healthcare. Let me rephrase that: it’s possible to get individual health coverage; that is, if you can afford the premiums and can overlook the crappy benefits provided through individual policies. Then there’s the issue of those of us with pre-existing conditions. Most insurance companies won’t offer an individual policy for someone with pre-existing conditions (even if the condition is no longer ongoing). If it’s in your medical records, they can, and do, deny coverage. If you find coverage, the premiums and out-of-pockets are astronomical and to say the benefits are lacking would be a gross understatement.

For that reason, many self-employed professionals opt to take their chances, so to speak. I can tell you from experience that you pray every day that you don’t slip in the shower or get sick with anything more serious than a cold that can be treated with over-the-counter meds or natural remedies. But the fear is always there in the back of your mind: if something serious happens to me it could bankrupt me and my entire family.

I know, at this point, some of you are thinking that I’m just another liberal cry baby. Healthcare is available to everyone! All you have to do is go to an emergency room and they, by law, must treat you regardless of your insurance status. And you’re right. Emergency rooms do have to treat patients without insurance coverage, but that doesn’t mean there are no bills that come later. And those bills can (and do) drive people into bankruptcy. And what about chronic conditions that require continued care? Guess what. You’re SOL. Most private practices won’t even set an appointment with someone who has no insurance. Sure, you can go to clinics, but the waiting list is long and, while there are some great doctors at clinics, you don’t have access to the best of care. Then there’s still the matter of those pesky expenses.

When the ACA came along I was excited. Finally! I might just be able to get coverage. The enrollment process and website had issues aplenty, but once I was able to navigate through I found a plethora of policies at every price range with varying premiums, co-pays and out-of-pocket caps. Most importantly, most policies included really great coverage, all from the most well-known insurance providers, such as Blue Cross/Blue Shield, Cigna, Humana, Aetna, and more. Please take note of that last sentence…these policies are written by INSURANCE PROVDERS, NOT the government.

The policy I chose had LOWER premiums, LOWER deductibles, and LOWER out-of-pocket caps than any group policies I’d had via employers in the past 15 years. These lower costs DO NOT include government subsidies. To top that off, the benefits far exceeded what I’d had through the aforementioned group policies. FAR EXCEEDED them.

What a relief! I’d been blessed that I hadn’t gotten sick or had any injuries while uninsured and now I no longer had to worry. With the payment of that first premium, I knew that IF something happened, I could seek quality medical attention without fear of drowning in medical bills for the rest of my life – or worse.

I received my coverage through Blue Cross/Blue Shield in April. I soon went in for a well-woman exam and mammogram (100% paid by insurance). I hadn’t had a mammogram for three years. For a woman my age, these are incredibly important. Thankfully, all of my results came back fine. Another sigh of relief. Thank You, Lord!

Wait. I’m Not Healthy After All?

Then it happened. In late May I began to have severe stomach pains. Out of the blue, my stomach started hurting and didn’t stop for four solid weeks. I’m talking doubled over in pain 24/7. I went to my GP who ran some blood tests. When those didn’t give us answers, she sent me to a gastroenterologist who immediately ordered more blood testing, an abdominal ultrasound, and a colonoscopy. Costs for the blood testing totaled well over $3,000. My co-pays just over $100. The ultrasound was 100% covered. I haven’t had the colonoscopy yet because the blood tests revealed that I had a previously undiagnosed chronic illness which could be cured if it were treated immediately.

Ironically, the newly diagnosed issue was not what caused the stomach pains. Had I not had insurance, though, I’d have suffered through the stomach pains until they went away or forced me to the emergency room. This illness wouldn’t have been diagnosed and likely wouldn’t have been detected until major damage had been done and it most likely wouldn’t have been curable.

When my doctor wrote the prescriptions for the medications that will CURE my chronic illness, he told me that we would most likely “have a fight on our hands with the insurance company” because the meds are very expensive, but he assured me it would eventually get approved. To my delight, the pharmacy called a few days later to tell me that the meds had been approved by Blue Cross/Blue Shield. I mentioned that the doctor had anticipated a fight for approval. The pharmacist said that typically there is some back and forth, but my prescriptions had been approved. What a blessing! Thank You, Jesus! And, yes, thank you, President Obama for the ACA.

Here comes the real shocker. There are two meds needed to treat my condition. The treatment protocol lasts three months. One of the meds is almost $1,000 per month. The other is over $28,000 per month (that’s NOT a typo). That’s $29,000 each month for three months. It is obscene that a month’s supply of medication would ever cost as much as a small car (that’s a story for a different day)! I wonder how many of us could afford that treatment without insurance? I don’t know about you, but I don’t typically have a spare $29,000 lying around each month.

To date Blue Cross/Blue Shield (NOT the taxpayers) have paid over $70,000 to my providers on my behalf (and yes, I have contributed via premiums, co-pays, and out-of-pocket expenses). What I’m dealing with isn’t cancer or some other life-threatening illness. It is a chronic illness that can be cured if treated, but otherwise could (and most likely would) become life-threatening down the road. In fact, I most likely wouldn’t have known about it until it became a life-threatening situation when I ended up in a “charity” hospital. And, IF it were still treatable, my family and I would be bankrupted just trying to save whatever life I had left.

What Do My Doctors Think of Obamacare?

Thanks to this coverage I have access to the best doctors. I’ve asked each of them their feelings about Obamacare. I’ve asked about the rumors that health care providers are pulling out of Obamacare coverage because the reimbursements are slow. I’ve asked if they view it as a fiasco. All three of my doctors (two of them specialists) scoffed at those suggestions and said that, while they were unsure at first, they’ve found the ACA policies work very well for both patients and providers. Not only that, they’re encouraging their colleagues to come on board as well. Wow. That’s not what we hear from some current candidates, is it?

On the issue of reimbursement, I’ve noticed that claims with doctors, labs, and pharmacies (even for $29 grand) have been paid within two weeks, often sooner. I recall from past group policies that it often took a month or more for claims to be settled – especially expensive ones.

My point is this: If the candidate you’re voting for has no other plan to help Americans get healthcare and, rather than working to make the ACA better, their only plan is to repeal it, please stop for a minute and think.

Think about me. I am a “they”. Think about the other 8 million “theys” who may lose critical or even life-saving care if the ACA is repealed. Consider what you would want for your family, your friends, your neighbors. Consider what you’d want for yourself if you were without a group policy and unable to get an individual plan. Would it be acceptable if you or your loved ones a) had nowhere to turn for medical help but the emergency room, b) had no access to the best possible doctors, or c) were bankrupted or put into overwhelming debt just to stay alive? Most of all consider that “they” are our fellow Americans. Living, breathing human beings, not just numbers on a chart. Some of them may just people you know and care about.

It’s NO Secret I’m Not a Fan of the GOTea Party

Obamacare is but one part of the reason for my disdain toward them, but let me stay on track… Republican and Tea Party politicians love to talk about the horrors or Obamacare. Most candidates are running on the promise of repealing it (STILL!). They’ve spent most of the last six years doing nothing more than talking about why they loathe it and how they’ll get rid of it, yet never providing an alternative solution to our health care crisis.

They say it will bankrupt the country! They talk about “those” people needing the government to pay for their healthcare and how “we”, the taxpayers, can’t afford to pay for “those” people (in spite of the fact that if “those” people had some sort of coverage, our costs will be lower in the long run)! As my story illustrates, not all of “them” are looking for free handouts from the government. We are taxpayers, just like you, who simply want access to healthcare – both preventive and ongoing. Candidates talk about rising insurance premiums because of Obamacare (in spite of the fact that premiums have been skyrocketing for decades, while coverage and benefits have dwindled)! They tell us that doctors and healthcare providers are going bankrupt and leaving Obamacare in droves because they aren’t getting reimbursed by the government (in spite of the fact that the government subsidies don’t go to the providers, they’re paid to the insurance companies, and the claims are being paid)!

They talk only about repealing Obamacare while providing no alternative or ever mentioning what would become of the 8 million Americans now covered under the program. Republican governors have chosen not to expand Medicaid coverage in their states, thus ensuring that those living in poverty will NOT have access to healthcare aside from emergency situations. Because, you know, “those” people don’t deserve access to preventive care or to be healthy! Not on “our” dollar, by golly! Never mind that “we” are already paying for their emergency care and federal dollars would’ve alleviated some of that burden on our state resources. And let’s definitely not consider that preventive care lowers healthcare costs for everyone!

So please, friends, I ask that you give some thought to the fact that the solution may be in improving the ACA rather than abolishing it. I ask you to consider the “theys” and what might happen to “them”. I ask you to consider just who the “theys” truly are. Is it possible that you could one day find yourself in the unenviable position of a “they”?

At the very least, ask your candidates what their plan is beyond doing away with Obamacare. What do they foresee for the 8 million of us who will lose vital coverage if they manage to repeal the ACA?

After careful consideration, research, and asking questions…vote as your heart tells you to.

2 thoughts on “Putting a Face on Obamacare

  1. That was an elequently written article. I completely understand where you are coming from and I agree something needs to be done with our healthcare system BUT there is the other side to you having such great benefits that does suggest “we the people are paying for it”. Obamacare has raised my and my husbands insurance sky high. (And it was too high before Obamacare). Our deductible has tripled and RX’s that used to be paid for with just a copay are now being applied to our deductible. My mother inlaw who is 83 now has to pay her internist $1500 a year “to keep her doctor”. I don’t have a solution for our healthcare and I agree with you that we need changes. I am very concerned with what is written in The Obamacare law. It is written to raise taxes. It gives the IRS complete access to our personal information. There are many underlying issues that Americans are unaware of. Anyway, with all that said. I wish you the very best in your recovery and I’m grateful you were able to see a doctor in time to get the treatment you need. Be well. Lori

    1. Lori, thank you for your comment and compliment! Yes, insurance companies raised rates on existing policies (again!) because they’re now forced to cover those with pre-existing conditions and can no longer cap lifetime and annual dollar limits. The thing is, the more people who purchase their insurance through the marketplace the lower the rates for all will go. Also, the more ins companies & providers see that people are buying in, the more likely they’ll be to participate. Just like all insurance, the more low-risk people that buy in, the better for everyone. In the long run, when previously-uninsured-people begin getting preventive care rather than urgent or critical care only, “we the people” will spend less money via Medicaid, etc because their health care costs will be reduced which, again, helps us all with long-term costs. Also as more physicians and insurance companies buy in, the lower the costs will go.

      I hate that your mother-in-law has to pay that much to retain her doctor! That’s just wrong! Is it because the doctor wasn’t accepting plans from Obamacare? Just before I lost my insurance a few years ago I had a great doc (this was just before the implementation of ACA) who told me she wasn’t going to accept ACA policies & was “going private”. If I wanted to keep her I could pay a yearly retainer fee for her services. Is that what happened with your mother-in-law or did the policy she had go up that much? Either way, I can understand not wanting to change doctors, especially at her age.

      Is your and your husband’s insurance a group or individual policy? I know group policies have continued to skyrocket and, like I said in the article, the coverage has dwindled. Pathetically so! It’s obscene that the ins companies have gotten away with this kind of thing for so long. I pray that you all get some relief from these exorbitant rates very soon.

      I have to ask…have you guys checked the ACA policies? While some people haven’t been able to keep their docs, some have. It just depends on if the doc buys in; my doctors say that more and more are as they begin to realize that reimbursements are coming, and coming quickly. More ins companies are also coming on board, too. Enrollment begins again Nov. 15. I’d encourage you to at least check it out, if you haven’t already. Some people don’t save money, but get better coverage. Some save money AND get better coverage. I haven’t heard anyone who has the policies say that the coverage is lacking.

      I agree with you that it is far from perfect! I just pray that the GOP can find it in themselves to TRY to make it better before arbitrarily tearing it apart. I think we could end up with something great that works for everyone AND saves taxpayers money. Here’s hoping someone does something to make it better!!

      Thank you for the well wishes! I, too, am very grateful for the care I’ve been blessed with. The doctors I have are awesome!! Ironically, my primary care provider was chosen for me by the ins co because of her proximity to my house (I could change at any time) and she is one of the best doctors I’ve ever had. The specialists she’s referred me to have also been incredible. In other words, these aren’t second rate doctors by any stretch of the imagination! I mention that because I think many people are afraid they won’t get good care through ACA policies…I was concerned about that in the beginning, myself. I was very pleasantly surprised!!

      Thanks so much for taking the time to comment! You’re the FIRST commenter on my new blog!! 😀
      Carole

Leave a Reply

Your email address will not be published. Required fields are marked *