The Not-So-Affordable Care Act and Me

This month we were late on making our monthly insurance payment. We’d just returned from vacation in Maine, I needed to buy all sorts of back-to-school supplies, and we needed birthday presents for two of our three kids whose birthdays are in the same week of August. Money was going to be tight until the end of the month. I realized that I was down to the last bottle of my test strips, and when I called the pharmacy to place a reorder of my 90-day supply, I was told that the cost would be $885.53. Normally the cost is $80. My heart stopped, and then I remembered that I hadn’t paid the insurance bill. I wouldn’t be able to order test strips until I paid the staggering insurance bill, which I couldn’t do until the end of the month, and it was the middle of the month. I cursed. I sighed deeply and then I drove to Walmart and bought enough (inexpensive) generic test strips to last until the end of the month. Thank God for Walmart. It wasn’t too far in the past that places like Walmart didn’t offer inexpensive, generic test strips.

I remember when the Obamacare talk first began in 2009. It was the year my third son was born and I was excited because they were talking about eliminating pre-existing conditions as something that meant you could be denied coverage. (I’d lived in fear of the pre-existing condition label ever since I graduated college and was kicked off my parent’s insurance. Unlike most of my friends at that time who were pursuing their “passions,” my job search was limited to jobs with benefits.) By 2009 I was a stay-at-home mom (I hate that term, but for lack of a better term, that’s what I’ll use here), and while we had insurance through my husband’s job, it wasn’t great. My “high-risk” pregnancy and Cesarean section was costly, and with three kids under 10 years old, it seemed as if we were at the doctor’s office on a weekly basis. Not having insurance was not an option.

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My husband changed jobs a few years ago and now he works for himself, which means we have to pay for insurance through Obamacare. I cringe every month when it’s time to pay our insurance bill. Our BlueChoice bill is bigger than our mortgage. (It’s not even a great plan, and our deductible is really high.) Experts project that premiums will rise by approximately 9% next year, which makes me hyperventilate. But I don’t have a choice. I need insurance.

Last week it was announced that Aetna, the nation’s third largest health insurance company, was going to pull out of Obamacare exchanges in 11 states. This followed the April 2016 announcement that UnitedHealth Group, the biggest insurer in the United States, was pulling out from most exchanges on the health-care marketplace. USA Today reported that “The insurer blamed heavy losses for the move. The company suggested that too many sick people are buying plans, not enough healthy people are paying premiums to cover the expenses, and the government isn’t making policy changes to fix it.” When I read that I was outraged, because they’re talking about me. According to insurance companies I am a “sick” person, a person who desperately needs insurance to buy the drugs that keep me alive, a person who is expensive to cover.

Insurance companies want more “healthy” people to sign up for coverage, but they are the people who need it the least. Many of them decide it’s more affordable to pay the fee than pay for insurance. (The annual fee for not having insurance in 2016 is $695 per adult and $347.50 per child.) As someone whose quality of life depends on good insurance, it’s disheartening to hear that companies are pulling out of Obamacare because they’re not making enough money. Having insurance is not about choice for most of us, and I’m not sure it should be a for-profit business. I don’t like to be negative, but if we’re labeling people like me with Type 1 diabetes as “sick” and expecting the “healthy” to balance the insurance seesaw, guess who’s going to rise to the top? Guess who’s going to sink to the bottom?

The government’s new Diabetes Prevention Program is taking people with prediabetes down the wrong road, says nurse David Spero. Bookmark DiabetesSelfManagement.com and tune in tomorrow to learn more.

  • Kim Z Franklin

    It’s wrong that you have to rely on health “insurance” in order to be able to receive more affordable health “care”. But as a “healthy” person, viewing this debacle from a different perspective, I simply can’t afford the post-obamacare premiums for health insurance that are now so high because they are meant to help offset those with pre-existing conditions and/or those who are being subsidized. Not to mention the rates will again raise in 2017! I don’t think the healthy middle class should be responsible for having to level out the risk pool – we simply can’t afford it either!

  • RG

    1) Why would you go on vacation knowing that you would have difficulty paying your insurance bill, especially with some predictable, extraordinary expenses coming up?

    2) You don’t have to buy everything new or all at once for back-to-school. A few notebooks at the outset would suffice. And you can always shop at a consignment store for clothes for the kids if you need to.

    Sorry, but you lost me at “just coming back from vacation in Maine.” Some of us don’t go on vacations when we have bills to pay and limited resources.

    Priorities. Budgeting.

  • Tossaway

    If you don’t think health insurance should be for-profit, then start a non-profit one. People think there is something magical about the words “non-profit”, that somehow something labeled “non-profit” is exempt from the laws of economics. Guess what? The for-profit issue is irrelevant, because for-profit or non-profit, if the costs exceed the revenue, it goes out of business. Thanks to Obamacare, the insurance companies can’t use proper business practices and account for risk to ensure they are available for their customers, they are forced to take anyone who walks in the door, and can’t adjust premiums for risk. All that means is that everyone has to pay more, and the penalty for not having insurance is less than the cost of insurance, so it makes financial sense for healthy folks to pay the penalty. While the premiums for some people are less, the premiums for other folks are substantially higher and the total cost of insurance is much higher, thanks to Obamacare. People who say they pay less are not including the cost of their subsidy; they pay less because their neighbors pay much more. As I diabetic, I depend on insurance, and I know my insurance company is getting screwed and may drop my coverage because of Obamacare. Too many people mistake health insurance for health care, and they are not the same. My insurer does not control my health care; while my insurer has said that it will not cover certain things, it’s never threatened me or my doctor for daring to defy them and get treatment I paid for myself. I may not always be able to get the treatment I want or need, but that’s not my insurer’s fault or responsibility. I don’t want my insurance company dictating treatment, and refusing to cover something that isn’t in the contract is not dictating treatment. We are collectively worse off, thanks to the (un)”Affordable” Care Act.

  • Kim Z Franklin

    I can only tell you what the solution is for myself and my husband. We save the money we would otherwise be paying on premiums and deductibles and use it in the event of an illness. Because we are not eligible for a subsidy, the lowest cost plan for us would cost us over $26,000 dollars a year after premiums and deductibles before it actually kicked in. And $26,000 buys a lot of actual health “care” for the year! I was hospitalized once this year and I paid it in cash, money I wouldn’t have had if I had been purchasing health insurance. This hospital bill almost met our $12,600 deductible and so I would have ended up paying the bill as the deductible regardless of whether I had insurance or not! So, I actually saved quite a bit money by NOT having health insurance!!! Granted, this was a short illness, but as I stated in an above post, I refuse to be held hostage by fear, fear of a longer, life altering illness. If one hits me, well then, I guess I will risk the chance of dying – I refuse to be afraid of this. And as I also stated, health insurance companies bet on the fact that you WON’T get sick – that is how they profit. Well, I too am betting on that fact. And so far, I’m profiting. And so far I’m sill alive. And I’m not being held hostage in the mean time.

  • Lewis Wadsworth

    Could not have said it better myself
    I am in exact the same boat except my premiums and deductibles are over $20,000/year.

  • RAWLCM

    Knocking the ACA isn’t going to make diabetes any less expensive. It just plays into the hands of politicians that work for the insurance companies instead of their constituents. We could have Universal Health Care in this country, but the public has been convinced that taking care of sick people is a communist plot.