A little over a year ago, I quit my full-time job as a nurse practitioner at a community health center. I had just finished the two-year commitment that I owed the government after receiving a federal scholarship that paid for my master’s degree. Instead of pursuing another full-time position, I decided instead to opt for 1099 contract work as a travel nurse practitioner. This would allow me to earn a higher-than-average hourly wage while also giving me the freedom to travel. Unfortunately, as a 1099 employee, I am considered self-employed and thus not given benefits like health insurance.
The irony is not lost on me: I am a health care provider in my 30s without health insurance, and that is something that I struggle to accept on a daily basis.
After graduating with three nursing degrees (my master’s was paid for but I also earned a bachelor’s and a doctorate degree), I was saddled with debt, and the contract work would help alleviate that burden. This route would give me more time to start my own business and, more importantly, help me pay down my student loans at a faster rate. The interest on my loans was killing me, and they caused me a lot of anxiety and stress. If you’re one of the 44 million people who have student loans, I’m sure you can feel my pain.
This is a classic dilemma of our time: pay down student loans or have health insurance. I’m aware that the risk that I am taking to pay down my loans may ultimately put me further in debt, but it’s a risk that I’ve decided to take. I also realize that to make that type of decision is a privilege in itself, and I am grateful that my profession has allowed me to do so. However, as I reflect on having to choose between health insurance and paying down debt, I realize just how badly change is needed in our country’s health care (and student loan) system.
“The irony is not lost on me: I am a health care provider in my 30s without health insurance, and that is something that I struggle to accept on a daily basis.”
Many people do not understand my decision and say they could never do what I’m doing. The constant travel, lack of stability and benefits, and the many unknowns do not appeal to the vast majority of people. However, I have grown tremendously as a nurse practitioner who has the flexibility to take care of many different patient populations, and I am grateful for the opportunity to do so.
Once I actually made the decision to become an independent contractor, I realized that I’d have to find some sort of insurance plan, and so I began to look into various insurance options. I decided against a commercial insurance plan because they were outrageously expensive and many consisted of high deductibles with lower-than-average coverage. Just looking at how much I’d owe on a monthly basis made my stomach churn.
Eventually I opted for a health cost sharing ministry (HCSM) in order to have emergency coverage in case of a catastrophe. An HCSM is a nontraditional alternative to commercial insurance where its members share the costs of each other’s medical bills. Essentially, you pay a monthly fee, which is then shared to help pay for other members’ medical bills. An HCSM is typically affiliated with a religion, and may not be an option for everyone due to guidelines for membership. This is not an insurance plan, but a more affordable option for many who cannot afford commercial health insurance.
If I have to get medical care, I have to pay out of pocket for my medical expenses and submit the bills to be reimbursed. However, reimbursement is not guaranteed. I am fortunate for my medical training, as I understand things like ICD-10 codes ― required for documentation purposes for reimbursement. For the average person without medical knowledge, this would likely pose a significant challenge. My plan also doesn’t include dental insurance, but I have relied on dental schools in the past for routine cleanings and exams at affordable prices.
“I don't have dental insurance, but I have relied on dental schools in the past for routine cleanings and exams at affordable prices.”
Being a health care provider, I am very frustrated not to be able to receive affordable preventive care myself. As many people treat their health in a reactionary manner, I know just how invaluable preventive medicine is. A patient of mine was recently complaining that his insurance would not pay for chiropractic care. I gently reminded him that he was lucky to have insurance and that not all of us, myself included, have this benefit. He was stunned when he realized I was uninsured, making a comment along the lines of, “It’s like working at a restaurant but not being able to eat the food!”
So what’s it like not having insurance when you’re in an emergency situation? Let’s just say it sucks. Last year I landed in the emergency room for severe abdominal pain. After spending about four hours there, I left with a $6,000 medical bill. I’m still waiting for reimbursement from my HCSM plan, and I have to make monthly payments on the debt in the meantime.
There is nothing unique about my uninsured status. In fact, statistics show that there are almost 28 million uninsured Americans out there just like me. I have a significant advantage working in the medical field, as I can essentially take care of myself for many things. However, as a nurse practitioner in primary care, I also come across many patients who, just like me, are struggling with insurance coverage.
When taking care of my uninsured and underinsured patients, it is often challenging to provide comprehensive medical care given that cost is always, and understandably, a factor. People who are uninsured usually are because they make too much money to qualify for state Medicaid yet they do not make enough to afford commercial insurance. Once I discover a patient is uninsured, I try to get them set up with insurance as best as I can. I typically refer them to someone within the organization whose job is to help people get insurance, usually with Medicaid.
“As a nurse practitioner in primary care, I also come across many patients who, just like me, are struggling with insurance coverage.”
I am, and always will be, my patients’ advocate. I often fight harder for my patients to get insurance than they do for themselves, as they are so beaten down by the system. If this fails, I have to provide medical care within their budget, which can be a huge challenge, especially if the patient has multiple chronic diseases. This usually includes giving them medication coupons, advising them on which providers will take a sliding scale, and finding creative solutions to challenging medical problems. I often cannot order them their recommended screenings, nor can I order bloodwork or imaging unless they are able to pay out of pocket. My heart definitely goes out to these patients, as I can relate to their plight.
If a chronically sick patient comes to me who doesn’t have insurance and who does not qualify for insurance, an internal panic button goes off as I know they will not be able to receive the care they need. There have been many days that I’ve left the clinic feeling dejected that I cannot do more for my patients due to their lack of insurance coverage. I’ve spent countless nights worrying about them and hoping that their situation improves. It’s no secret that people die, and will continue to die, due to lack of appropriate insurance coverage.
As both an uninsured patient and a health care provider, I am in a unique position to view our health care crisis from both sides of the spectrum. Being uninsured is a humbling experience and can provoke a lot of anxiety and fear. There’s always an underlying fear of a huge medical emergency happening, one that I won’t be able to afford. I’ve learned that a lack of insurance not only affects a person’s quality of life, but also affects many of the decisions they make.
“As both an uninsured patient and a health care provider, I am in a unique position to view our health care crisis from both sides of the spectrum.”
For example, the fear of not having insurance keeps many people in jobs they do not like, and they continue to do work they find unfulfilling. Yet they will not change jobs since doing so would mean they’d lose their insurance. Unfortunately, the stress of staying in a job that you do not like can also negatively affect your health.
I believe that like health care, health insurance is a human right. Yet if we don’t have the means to obtain great health care, how can we possibly achieve that fundamental human right? I’m not sure what the answer is to the current health insurance crisis that plagues the U.S. I do agree “Medicare for All” is a start, though it shouldn’t end there. What I know for sure is that the uninsured and underinsured have many challenges that the fully insured do not.
It’s been almost a year and a half that I’ve gone without health insurance. I definitely miss going to the dentist and having the luxury of seeing a medical provider without having to pay out of pocket. I’m very grateful that I’m healthy, because if I weren’t, there is no way I would go uninsured. I often consider returning to a regular employment position just to have insurance coverage. Though this would mean putting my dreams and goals on hold indefinitely, which is something that I also cannot fathom. Although I’m paying down my loans quicker than expected, I’m dreading the day when I’ll have to seek health care again.
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