I feel sick. My head is pounding and my stomach is unsettled.
No, I don’t need to see a doctor. I feel this way because of the current state of our health care system. Yesterday, the Republicans unveiled a so-called plan to repeal and replace the Affordable Care Act (ACA) that has been in place for the past 7 years, also known as Obamacare. It claims that it will lower health care costs (for whom?), bring down artificially high drug prices (again, for whom?), and give people greater choices in selecting health care that meets their needs. Let me tell you about my own personal experience with the ACA over the past five years and you will see why I am so disturbed.
I left my full-time job in 2012 due to health reasons. My job had provided outstanding health insurance for our family of three. This was especially critical for me, as I was undergoing treatment for Stage 4 breast cancer. Upon leaving my job, I was able to remain on my current plan through COBRA for 36 months, until October 2015. This was a blessing because I needed life-saving health care, but it was a curse because it cost approximately $900 a month, which we could not afford. Thankfully, a generous family member assisted us with the payments until the fall of 2013, when I began treatment at the Cancer Treatment Centers of America (CTCA) just outside of Atlanta, GA. Through an aid program for persons in financial need, CTCA paid my health insurance premiums for the next two years. This was a tremendous gift, to put it mildly.
In October 2015, my COBRA coverage ended. Because of the Affordable Care Act, I was able to purchase individual health insurance and therefore continue the life-saving and extremely expensive treatment I needed. Prior to the enactment of the ACA, also known as Obamacare, in Connecticut I was ineligible for individual health insurance coverage due to my pre-existing condition. When my husband and I were married in 2005, and his job provided inadequate coverage for spouses, I investigated individual insurance and was told that because of my pre-existing condition (two previous cancer diagnoses) I was not eligible. I was told I could join a high-risk pool consisting of persons who had been previously diagnosed with serious illnesses, but the costs of such a pool were exorbitant, so this was not an option. This was a shock to me since I had moved to Connecticut from New York State, where affordable health care for all was provided regardless of pre-existing conditions.
Like many employers today, my husband’s job still provides inadequate health insurance for families.
Fortunately, due to the ACA and its tax credits, he and our son have affordable monthly health insurance premiums. Because they are both in great health, and since preventative services are covered, this is serving us well. However, should one of them get sick or require surgery, we would go into debt, since the annual deductible for EACH of them is $5685. This means that if our son needed surgery, we would have to pay $5685 out of our pockets before insurance kicked in. In a medical situation that required ongoing treatment, this is not affordable for the average middle class family, which we are. And if my husband also became sick and needed treatment or surgery, we would have to pay the same amount for him. This would total $11370 PER YEAR. There is an annual out-of-pocket cap of $13,100 per family. Do you have $13,100 a year of disposable income set aside for health care? We do not.
From November 2015 – November 2016, I had individual health insurance through the ACA. At the monthly cost of $548, this was not cheap, but we economized to pay for it, along with the $300 monthly premiums we paid for my husband and son’s insurance. In sum, during this period of time, we paid over $800 a month for life-saving health insurance for me, and for basic health insurance for my husband and son. This does not include the cost of co-pays for doctor's visits, medications, tests, and deductibles. Fortunately, the deductible and annual out-of-pocket limits for my plan were much lower than in my husband and son’s plan. Since the combined cost of my monthly medications was almost $12,000, this was a good thing. One cost $11,000 and the other cost $900. I’m not kidding.
In November of 2016, I became eligible for Medicare since I had been receiving Disability benefits for two years because of my health. If I had not been eligible for Medicare, I was facing an increase in the monthly premiums for the plan I was on to over $700 a month through the ACA. We would have gone into serious debt were it not for Medicare, which costs about $400 a month.
President Obama’s Affordable Care Act was a necessary and courageous step forward in improving American health care and provided health insurance for millions of people in America who did not have it. It benefits single young adults and does not discriminate against people with pre-existing conditions like me.
Frankly, the ACA saved my life, and for this, I am extremely grateful. However, in order to meet the needs of all Americans, improvements need to be made.
Monthly premiums, deductibles, and out-of-pocket costs all must be lowered so that average working Americans will not go bankrupt trying to pay for basic health care. We need a system that provides affordable, comprehensive health insurance and health care for every citizen in this country regardless of employment status, health condition, and financial situation. It is a shame that this does not exist now, and the proposal put forth yesterday to replace it is not an improvement.
If you have comprehensive and affordable health insurance through your employer, you are fortunate. However, if you are like the increasing numbers of Americans who do not have access to health insurance through their jobs, are unemployed, or like me receive health insurance through Medicare or Medicaid, we have work to do. We must raise our voices to let our representatives know that affordable and comprehensive health care is a RIGHT and not a privilege to be held by a select few. Truly, this is a matter of life, death, and debt. I’m a witness. See you next week.