Health Insurance: Getting Personal!

November 15, 2014

Open enrollment is here under the Affordable Care Act. That means we’re in “get ready for crap” mode, where anything and everything that is wrong with healthcare gets blamed on the ACA aka Obamacare. Think Benghazi, only local!

I take the health care thing personally. Pre-ACA, I was uninsurable in the private market, dependent for coverage on AHCCCS (Arizona Health Care Cost Containment System), which had a plan for self-employed individuals. (AHCCCS is Medicaid in Arizona because, well, we’re Arizona. My state was the last state to adopt Medicaid, and we go our own way!) Our insurance program depended on the good graces of the Arizona legislature, a dependency no one should have, ever. (We covered our daughter separately, just in case we lost our coverage.)

Now, I’m pretty healthy. (I just finished a hard 60 minute, 4.5 mile run/walk at elevation on my treadmill, and I’m 57 now.) Medicine controls my mild hypertension/cholesterol. I do have Barrett’s esophagus, a condition that slightly increases my risk for esophageal cancer. I eat well, I’ve never smoked, and I don’t ride motorcycles, sky dive, or enter hot dog eating contests. I could surely drink a few less martinis, but that’s my only vice!

Seems like health care coverage should have been a non-issue for me and my family? Not so much.

I tried the private markets in 2008. First, I looked at a health savings account with a high deductible policy. “No” said the leading provider of these accounts.

Next, I applied under the State Bar of Arizona’s group plan. “No” again. Surprised and annoyed, I called. The nice lady on the phone said the hypertension and cholesterol were non-starters. If they weren’t, though, any policy I got would exclude, always and forever, coverage for gastrointestinal problems. So, I might be insurable without the hypertension and cholesterol, but only if I agreed to self-insure for esophageal cancer and other digestive system diseases. Absurd! I tried one other carrier. Same answer.

Days after Senator Ted Kennedy died in 2009, as it looked like the Affordable Care Act was dying with him, I found myself a job with the firm that employs me now. Did having access to a group health insurance plan decide the matter? No, not at all. Was it a significant factor? You bet, and I would have been a fool not to let it matter.

I offer the foregoing confessional not because my story is unusual, but because it’s a very common story. Our health care financing system, pre-ACA, deprived me of the freedom to protect myself and my family. (Silver lining:  I got hooked up with a great law firm, but not everyone’s story ends so well.)

So where are we now? As many as 10,000,000 people may now have coverage who did not have it before the ACA, and people like me have options we did not have before. On a more practical plane, the computers seem to be working well, and good on that!

Premiums have been the subject of many stories. Some say premium increases are modest, but today’s front page New York Times story, Cost of Coverage under Affordable Care Act to Increase in 2015, reports on price increases of as much as 20%, which are not modest by any measure. The story also says individuals can get insurance with lower premiums if they shop around.

Of course, per the article, “Republicans quickly pounced … .” Here’s Senator Orrin Hatch, (R-Ut.), pontificating that:

Last year, many who liked their plan were surprised to learn they couldn’t keep it. This year, many who like their plan will likely have to pay more to keep it.

The premium increase discussion—and the rest of the whining about the process—reflects the anti-ACA crowd’s intellectual dishonesty. Employers have dealt with premium increases and benefit cuts, year after year. Employers and, now, many more individuals, shop for better prices, and yes, shopping for insurance is and always has been hard. Carping about increases and complications only matters in context and, here, it’s as if we all lived in Valhalla until the ACA was foisted upon us.

(A friend has great government coverage. His kids got covered through age 26 because of the ACA. He insisted I was insurable in 2008, and just didn’t want to pay the premiums. And, about insurers, pre-ACA? Constantly complaining!)

There are also people in Congress, puffed up and pluming since November 4, talking about repeal or major fixes. And what do they offer? First, eliminate the tax on medical devices, a change that only affects our national budget and, barely, the bottom line for very successful manufacturers. Second, high risk pools. And, finally, limits on suits against doctors and hospitals. (If their plans include anything else, other than platitudes about markets and not getting between you and your doctor—as if your insurer hasn’t been between you and your doctor for decades—I missed it.)

About those high risk pools. If you’re healthy, you don’t want sick people in your pool. And if your pool only includes sick people, no one wants to insure the lives. Bottom line:  Insurance is about sharing risk, and high risk pools are not!

And about medical malpractice suits? Well, if you’re on the receiving end, you don’t like them, but if you or yours suffer as a result of professional negligence, are you ready to have no remedy? A hard-luck life? Regardless, I am aware of no peer-reviewed study which supports the notion that limits will matter, and in states where limits on recoveries exist, neither malpractice nor health insurance premiums have decreased.

One more thing for now. If you want to complain, show up. The Republicans took a pass on the ACA, despite many long months during which President Obama and Senator Max Baucus (D-Mont.)—and the chair of the Senate Finance Committee—courted them desperately. Their choice, and although it has worked pretty well for them from the standpoint of elections, we’d have had a better outcome if they would have joined the party. Regardless, millions of people have coverage, that matters for real, and truth catches up with demagoguery every time.

Republicans fought Medicare just as bitterly in the 1960s. Now, Tea Partiers demand that the government keep its mitts off their Medicare. We’re in for a tough ride about this insurance thing, but in the end we’ll have the same people demanding that no one interfere with their right to have coverage.


7 Responses to Health Insurance: Getting Personal!

  • Yours is a great story to tell. Before the ACA many people were serfs to the companies they worked for. If they or someone in their family was uninsurable, they had to keep working for a company that had these benefits. Cutting back, getting a better job with a small company that didn’t have a plan or being self employed was simply not an option. The American Dream according to these buttheads is only for healthy people, I guess.
    Since the ACA is now working, they have stopped talking about the details and focus on the drumbeat….Obama lied! And because he “lied” it has to go away.
    It’s beyond disgraceful.
    Thanks for sharing your story….I know many like it.

    • Thanks. My story is mine, and it’s like many others, but for the fact that I had options, i.e., the state program for as long as it lasted, a law firm, etc. Many/most others are more limited in their choices.

  • I thank you also for sharing your story, Mark. For fifteen years I paid unbelievably high premiums for coverage and was afraid to use it. I often said I paid healthcare premiums instead of a mortgage.Working as a self-employed, single artist I searched many years for plans where I might receive coverage and was denied over and over OR offered coverage with so many clauses it would have been completely irresponsible to consider them. I too am essentially a very healthy 60 year old. Last year I delighted in paying a $600 premium instead of $1440 and received a policy with excellent coverage – without any of the ludicrous clauses. And, I feel very blessed to have been supported enough as an artist to somehow make all those high premium payments for so many years (its not always been an easy road). And, with regards to all the issues surrounding the many flaws in the new program – it’s a little like cleaning out that closet which continued to be deluged for many, many years – it’s going to get a little messier before the real benefits are clearly apparent. And, someone has to foot the bill so the novel idea of shared, equal responsibility seems a worthy one to me.
    Of equal importance, I find it remarkable that while we continue to argue and fight about the healthcare system we rarely (if ever) stop to evaluate WHY so many people, especially in America, continue to become seriously ill more and more frequently and often at an early age. I long to see attention given to WHY we continue to become a sicker nation (in many more ways than one). It seems to me that one key area we completely neglect is in the arena of how our food industry continues to offer us food with lesser and lesser healthful and nutritional qualities. More and more toxins have become absolute commonplace in a major portion of every shopping cart – and the lower income families, needing to choose with their budget serving as their core criteria, eat items with nearly zero nutritional value on a daily basis. Fillers and ingredients one cannot even pronounce let alone recognize are commonplace. And toxic pesticides continue to be allowed simply increasing their potency year after year as the treated plants become immune and few seem to take notice. I could go on and on about this issue as it’s a really big one for me, but a large part of “fixing” our healthcare system focuses on the wrong end of the problem in my mind. We need to be willing to hold the profits of the food industry accountable, we need to care about the loss of our pollinators (well if we want to eat at all that is since at least 35% of our fruits, nuts and vegetables are pollinated by our dramatically diminishing honeybees alone), and we need to demand quality food (even if less of it) for every family. Seriously considering this side of the healthcare challenge – addressing WHY we are so sick – seems to me to hold every bit, if not more importance, as finding the proper tools to fix the costs of the bandaids.

  • No disagreements with anything you’ve written. We’re reaping the rewards–good and, sadly, many bad–of advanced capitalism. No correction I’m aware of, and the ever present focus on more dollars dominates.

  • Three words come to mind and they are “you are welcome”. My full response will be posted tomorrow and i really hope for feed back. Until then it amazes me that all of my liberal friends ( I wanted to say libtard since Ted Cruz was called gas bag) all say you must like Obama care while they call their doctors that come to their homes and paid in cash.

  • Looking forward to the full explanation, as “you are welcome” is not computing. Gasbag is a term that, at least for me, is the shortened version of Sabbath gasbag, Calvin Trillin’s non-ideological reference to the Sunday morning talk show guests. It’s not equatable to libtard in any way. Finally, I’m not personally familiar with house calls and paying in cash. (My doctor was my next-door neighbor/close family friend for many years. One house call in all of those years, when I was 15 and had pneumonia, and he had me off to the hospital for five days in 15 minutes. Payment was routine, and always by check.) Maybe it’s a Texas thing?

  • Thanks for a great post Mark. I was also in your same boat, facing finding coverage with a pre-existing condition on a pretty limited retirement budget – six more years until Medicare kicks in. Although I bring in too much income to benefit from buying on the healthcare exchange, it is still a great tool to look at the various current policy offerings – something I just did this week. I’m disappointed to be seeing an overall increase of about 10% in my personal case, still . . . without the law, many of us would be priced out of the market entirely. Not quite sure what Eddie is talking about above when he talks about folks having doctors that come to their homes/pay in cash? Maybe in Mexico? Anyhoo . . . let’s hope and pray that this new congress (and a likely republican president in 2016) don’t throw the baby out with the bath water, if you know what I mean.

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