When the Affordable Care Act was first being debated, it was easy to keep an open mind. In 2009 and 2010, I was working a journalist. I was neither a Democrat or a Republican, or even a Libertarian. In fact, at one point throughout my career, I’d been registered as each at various points. It was a good place to be as a journalist.
As someone who had battled a long and scary illness without insurance, topping the $100,000 mark in medical bills, I knew why so many people were anxiously hoping it would go through. But I also thought there were various parts that sounded not quite so great, and downright unconstitutional.
While I liked that you couldn’t be denied coverage for past medical issues, I will always immediately doubt anything Congress passes that it exempts itself from (Congress has since fixed that issue). It also never made sense to me that you could financially penalize someone for not purchasing something. That’s not exactly the American way and health insurance is not the same as vehicle insurance.
I did my best to cover a law so complex, few understood it entirely. That generally means there are a lot of little things inserted by lawyers who want to ensure their lobbyists are covered. And that is always scary.
Years later, I have friends and family who are seeing some of the benefits of Obamacare, and some who are living through the very things Republicans warned us about.
Although I now work for a member of Congress, I am not on Obamacare. I use my husband’s insurance and the issues with Tri-Care (and how it’s not “free” like everyone thinks it is and how I’m STILL waiting to see a doctor), would take up another column entirely. But after hearing from a close family member about her Obamacare experience, I am now just grateful for what we have.
My family member is a stay-at-home mom. Because of this, I’ve seen them go through very difficult times financially. They made a lot of sacrifices and she became a financial ninja; learning how to budget, save and be very frugal with one salary. I’ve seen her husband go through layoffs and job losses, and yet they made it work so she wouldn’t have to put her children in daycare.
After one of those layoffs, he became a contract worker. That means no benefits. No 401k, no disability paid for by the company, and no health insurance. It also means no guaranteed income. Sometimes he gets paid every five weeks. Sometimes they go two months without a paycheck. Yet they make it work.
When they signed up for Obamacare, they faced the reality that so many other Americans faced: higher premiums, deductibles and out-of-pocket costs, along with trying to navigate which doctors they could see and switching doctors when necessary. Because of his income, they do not qualify for reduced costs despite the fact that he’ll go months without a paycheck. I’m not sure if Obamacare takes into account cost of living, but where we live (DC and surrounding area), my rent and her mortgage are equivalent to two mortgages for a 6-bedroom, 3-bath house in the Utah/Idaho area where we grew up. In fact, I have some colleagues on the Hill making $30,000 or less and sharing a $3,000-a-month apartment. It’s not exactly ideal.
In the beginning, my family member was paying $700 a month for her insurance for a healthy family of five. For several months now, she’s been calculating the increase. Last week she sent me a frantic text that floored me:
“For the first time, we’re having to look at the cost of the penalty.”
She had received her new health insurance quote: $2,400 A MONTH, and that’s before dental.
As it turns out, Republicans were right about at least one thing: the cost doesn’t go away, it just gets shifted onto someone else’s back. But whether to blame the bill and the Democrats who pushed it through, or Republicans for making changes to it since then, is still up for debate depending on what your political affiliation is.
After hearing her story, I reached out to other friends to see what their experience has been. I know at least one person who loves Obamacare because she can now afford her medication. She has some serious health issues and this has been live saving for her. But other friends have said they can’t get appointments anymore, or they can’t afford their insurance now.
These are two of their stories.
Evelyn, Spokane, Washington, Mom and Breast Cancer Survivor
Evelyn was diagnosed with breast cancer in 2013. At the time, she had a health care plan with Blue Cross of Idaho. Her premium was only $250 a month for herself and her daughters, and she said she’s grateful for the plan offered by her former employer. However, after being diagnosed, her premiums doubled and she was paying more than another employee who was a longtime smoker.
In 2014, Evelyn could no longer work and left the company she’d been with for eight years.
“Finally, I just couldn’t keep up with paying roughly $500 a month with no paycheck coming in,” she said. “Because of my medical history and my husband’s disability through the military, I qualified for free health care. My kind of insurance is the kind that everyone is angry about supporting.”
But for Evelyn, it wasn’t a choice. Now on long-term disability, she didn’t choose to have debilitating medical issues.
“I get it,” she said. “I have worked hard all my life, and I do not believe in handouts. This was just something I couldn’t get around.”
Evelyn and her family relocated to Washington state and she no longer receives the same health coverage.
“I have a very small group of physicians available to me and have had to petition for much-needed physical therapy,” she said. “This is really frustrating for me because in the area I live, there are many drug seekers who don’t get denied service. I have had to switch oncologists and had mediocre doctors for surgeries, causing the need for more surgeries to fix the damage.
“I am very thankful for the coverage and treatment that I have received,” she said. “However, to receive good healthcare, I have to be on top of my care, making sure they send authorization to the correct place, etc. I have to manage everything myself.”
Mandi, Boise, Idaho, Mom and Health Clinic Employee
Mandi, much like my family member, discovered the Obamacare premiums and deductibles for her family were too high, and instead she chose to pay the tax penalty.
“Even the hit we take on our taxes is more affordable than ACA,” she said. “Over $600 for a monthly premium for a family of four, with a $12,000 deductible is, in my mind, ludicrous. We would never meet that deductible as we are a generally healthy family, and the monthly premium is money wasted on coverage that would never be used.”
Instead of a typical health insurance plan, she uses a hodgepodge of services to keep her family covered.
“Neither mine or my husband’s employers offer coverage as they fall into the category of having less than 50 employees so they are not required to offer it,” she said. “On the flip side, I work for a privately-owned medical clinic and my family is seen free of charge for any type of visit as a benefit for working there.”
Those office visits cover basic medical care and she has to pay out-of-pocket for all their prescriptions. However, having been in the industry for nearly 20 years, she shops around and knows how to get prescriptions as cheap as possible.
Because her children play sports, they are required to have some sort of coverage. She purchased accident coverage for both her children for $300 a year. When she had her gallbladder removed, she worked with the hospital to set up payment plans.
“I received a bill for $4,300. If I had insurance, it would have been applied to deductible and I’d still have to pay for it out-of-pocket,” she said. “I called the hospital, set up a payment arrangement and am paying it off in monthly installments. This is more affordable for me as I don’t have to pay the additional $600 a month on premiums.”
As an employee at a medical clinic, she said her experience with ACA hasn’t been great.
“Most people are unaware of how insurance works; what’s covered, not covered, co-insurance, deductible, co-pays, etc. They have no clue,” she said. “The general consensus with people who have coverage through ACA in our area think that because they have coverage, they aren’t required to pay anything at time of visit or (they don’t) understand that they still have to pay out-of-pocket until their deductible is met. They get angry when our billing office sends them a bill or they respond with ‘but I have insurance’ when asked to pay their co-pay. Ridiculously high deductibles have us turning patients to collections on a monthly basis because they can’t pay their bill. ACA in my opinion, and I’ve said this since it was enacted, is a recipe for medical bankruptcy. ACA is not affordable, period.”