Once Rejected, Now Accepted: Obamacare and Me
In 2004, I left a job in Ohio to move to Colorado and start an independent nonprofit consulting practice. At that time, I had two choices for health insurance:
- Pay an exorbitant amount to COBRA my Ohio-based HMO, and if I needed to use it pay exorbitant out-of-network fees for health care; or
- Shop on the individual health insurance market.
Option number one was a non-starter. It just didn't make sense.
So I turned to the second option. Should be a no-brainer. I was in my early thirties, physically in great shape, getting healthier every day thanks to the mountain air and my outdoor lifestyle, no chronic disease that I knew of, no family history of anything except old age, I didn't smoke or use drugs, and I wasn't pregnant.
It was one of the most frightening and stressful moments of my life when I was rejected by Blue Cross for an individual insurance plan. Their reason? I had been treated for dysthymia (mild chronic depression) with an anti-depressant. I didn't have life-threatening cancer or untreated diabetes, and I had only been hospitalized once in second grade for an eye infection.
And yet, there I was, one of over 50 million Americans who were uninsured.
I remember calling Blue Cross, and losing it completely with the poor customer service rep on the other end of the line (who probably didn't have insurance either), screaming and pounding on the table. Not my style at all. My poor dogs cowered under the table.
I shopped around for other plans. The first question all insurance applications asked was, “have you been rejected for health insurance by other companies?” As soon as I was rejected by one insurance company, I became largely uninsurable by any insurance company.
A few months later, I went skiing and caught an edge on an icy run. As I flew through the air, all I could think about was, ‘Oh, sh*t, I don't have health insurance.'
A couple of points here.
First, my family has resources, unlike millions of other un- and under- insured Americans. In a pinch, if it wasn't catastrophic, I had something (and someone) to fall back on.
However, if something catastrophic had happened while I was uninsured, it had the potential to bankrupt both my family and I. Last year, unpaid medical bills were the number one cause of bankruptcy in the U.S., affecting 2 million households in that year alone. Millions more were struggling with medical bills in that same year.
Second, dysthymia (long term depression that, while not severe enough to be completely disabling as with schizophrenia, is serious enough to prevent normal functioning) affects millions of Americans every year, and disproportionately impacts women. In my experience, when dysthymia goes untreated, it has a significant impact on people's health and well-being.
This was four years before the Mental Health Parity and Addiction Equity Act of 2008 was enacted at the federal level. Discrimination based on mental health or lack thereof was rampant in the health insurance industry. Many of us, including those with milder mental health problems, could not get insurance. When we could get insurance, our premiums skyrocketed and/or mental health treatment was not covered.
Fast forward to 2012. I had once again left my salaried nonprofit job with benefits to return to consulting and freelancing. This time, I COBRA'd my insurance for about 6 months ($360/month). I decided that it made sense to explore my options on the individual health insurance market. Terrified of being rejected once again, but knowing that I might be able to conserve resources, I worked with an insurance broker.
The same company that had rejected my application in 2005 approved me in 2012, with no increase in premiums, and no restrictions. My high deductible but decent plan costs $110/month, and a plan comparable to the one I had COBRA'd wouldn't have been much more than $200/month if that. This change was entirely due to insurance companies already adjusted to their new circumstances as a result of the Affordable Care Act. Even before all of the provisions kicked in, insurance companies were adjusting to a new reality.
What else has changed for me as a result of the Affordable Care Act?
- The ACA, as of October 1st 2013 (that is, yesterday), grants me access to Colorado's health care exchange. This makes it easy to shop around for insurance plans, to compare available plans, and facilitates free(er) market competition among insurance companies.
- The ACA provides subsidies for individuals who would otherwise have a hard time affording insurance premiums. As someone who is currently building an independent consulting practice, this will greatly help while business slowly grows.
- The ACA requires that insurance plans cover basic, preventative care such as annual physicals free of charge.
- For women, it requires free basic well-woman care including annual Pap smears, mammograms, and yes, free contraception (a fundamental component of comprehensive women's healthcare).
- If I get pregnant, the ACA prohibits insurers from treating my pregnancy as a pre-existing condition as they have in the past, and also prohibits them from jacking up my premiums as a result of my pregnancy.
- The ACA expands on the 2008 MHPAEA, and ensures that mental health coverage will be equivalent to coverage for other health conditions.
As with any major new transformation, the glitches and problems with the ACA will be worked out, hopefully collaboratively and in a bipartisan manner, in the coming years.
But already, it is having a major and positive impact on the lives of millions Americans, myself included. It stimulates entrepreneurship and innovation, it frees people up to change jobs, to start new businesses, and to make sure that their spouses and children have the health coverage they need. It dramatically reduces the risk of bankruptcy for millions. It creates new jobs and fosters economic development.
Every day, I'm grateful for the leadership and courage shown by those who finally, after decades of struggle, achieved health care reform.
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