On the Affordable Care Act

One of the Republican Party’s platforms is that they want to repeal the Affordable Care Act.  This is one of the main reasons I vote blue.

Let me tell you why….

I have had health insurance for most of my adult life; sometimes it was through a job, but for the most part, I was covered under a private plan.  I rarely had to use it and that was good because even though I paid high premiums there was very little benefit to me unless something catastrophic happened.  In 2011 before I moved from Houston to West Tennessee, I was paying around $350 a month and had a $5,000 deductible.  It did have good office visit and prescription coverage, so it was sufficient for my occasional strep throat and acid reflux.  I moved to Tennessee between Christmas of 2011 and New Year’s Day of 2012.

Skip ahead two weeks… One morning, I woke up with my neck so stiff that I couldn’t lift myself out of the bed.  I couldn’t lift my arms, turn my head or breathe too deep without electric shocks rippling through my body.  My arms were numb and my legs didn’t want to cooperate either.  For all intents and purposes, I was paralyzed.  It was a weekend, so I went to the emergency room where I was given pain killers and muscle relaxers and told to follow-up with my Primary Care Physician on Monday.  My body was throwing a temper tantrum and I hadn’t even met my doctor yet.

I went to the doctor on Monday.  It was determined that I needed an MRI to “rule out some things.”  My doctor put in the authorization and it was denied.  It was denied because only certain services were eligible outside of the state of Texas and imaging studies were not on that list.  So here I had this insurance plan that I could not use in my new state.  I had to pay out-of-pocket for the test.  When I get my MRI results, the news is bad.  The MRI in conjunction with my symptoms, confirmed that I had Multiple Sclerosis (it turns out I actually have Lupus, it just took a few years to sort out exactly how my body was revolting).  This was devastating news to me.  I was someone who had never been sick and loved being active, but that wasn’t the worst part.  The worst part was the fact that I had just become, with one MRI, uninsurable.

My premium went from $350 to $1100 and my deductible jumped to a whopping $10,500.  It still had good office visit and prescription coverage, so I had no choice but to keep it.  Thankfully, just a few months later, I got a job that offered a health care plan once I became a full-time employee.  That happened in August of 2012, so for almost 8 months, I paid more than I made every month just to go to the doctor and fill prescriptions.

It wasn’t until 2015 that I started to see how important the ACA actually was.  In 2015, I found myself in a position that made it necessary to leave my job and therefore lose my insurance.  At this point in my life, I was on seven different prescriptions a day that amounted to over 20 pills.  I never really paid attention to what that meant financially because I had prescription drug coverage, but suddenly, because the State of Tennessee cancelled my insurance a month before I expected, I had to pay out-of-pocket my medication.  The numbers were staggering.  One bottle of pills was over $300 another $150.  This was just 2 out of 7!  It took almost a month for me to get my COBRA paperwork and the news was not good.  To continue my insurance, I was going to have to come up with almost $1200 a month.  I had just enrolled in school and there was no way I could pay that, so I wandered over to the healthcare.gov website and checked it out. I had heard it was expensive and just all around bad coverage, but that is not what I found.

The process, while a little confusing at first, was easy enough to navigate.  I filled out my eligibility forms and got a shocking surprise — I qualified for a subsidy.  I was sure I wouldn’t because I had a fairly good salary at my previous job, and was living well above the poverty line.  It turns out that is exactly who the ACA is for; those who work.  In theory it was supposed to expand Medicaid for those living below the poverty line, but that decision was turned over to the states.  I found a plan that was better coverage than my plan through the state, and with my subsidy, my premium was 1/10th of what COBRA would have been.  This was so great.  The next year, I found a plan that was even better. This was incredible.  I didn’t understand why people hated this great thing so much.  Here I was, someone who desperately needed insurance and without the ACA, would be denied by company after company due to pre-existing conditions.

Earlier this year the news started to report that premiums were skyrocketing in 2017 and no one would be able to afford coverage.  Around this time, I found out that my current company would not be offering individual plans this year.  I’ve got to be honest; I was very nervous about all of this.  I am full-time student with no ability to get a full-time job with benefits and continue school.  On November 1st, I logged in with great trepidation.  I needed good insurance.  Well friends, I was shocked by what I found.  There was a plan I could afford.  In fact, I found a better plan than I have now!  In 2017, I will only pay  $696.32 in health care expenses for the entire year.

Folks, I have a chronic illness and that is not cheap.  One of my medications, if paid for out-of-pocket, is almost $600 a month and that’s just one of many.  In 2016, I have visited the emergency room 4 times, spent 3 days in the hospital in two different occasions, had 3 CT scans, 2 x-rays, 1 MRI, multiple expensive blood panels, an endoscopy, a colonoscopy, a renal stint and things I probably can’t even recall.  I had all of this done for $837 total.  Total! This amount includes my monthly premium.  Do you have any idea how much all of this would have cost out-of-pocket?  Hundreds of thousands of dollars.  This isn’t something even the wealthiest person I know could afford, and to top it off, this is how every year will be FOR THE REST OF MY LIFE.  I will always be sick; I will always need insurance.

I am just one of millions all over this country with a chronic illness who, without insurance, would be completely disabled.  My treatments and medications make me a person that can contribute to society because without them, I wouldn’t be able to even care for myself – let alone go to school, volunteer with the humane society, or take care of our lovely sheep; I would be in my bed because my immune system is literally fighting my body when not kept in check.

I understand that there are problems with the Affordable Care Act, but it needs to be improved, not done away with.  If the Affordable Care Act is repealed, Americans will lose the following provisions that did not exist prior to the ACA:

• No annual or lifetime limits on healthcare.

• All major medical insurance is guaranteed issue, meaning you can’t be denied coverage for any reason.

• You can’t be charged more based on health status or gender.

• Insurance companies can’t drop you when you are sick or for making a mistake on your application.

• You can’t be denied coverage for pre-existing conditions.

• Young Adults can stay on their parent’s plan until 26.

• New preventative services at no-out-of pocket costs.

• Essential health benefits like emergency care, hospitalization, prescription drugs, and maternity and newborn care must be included on all non-grandfathered plans at no out-of-pocket limit.

• New rules and regulations ensure that all major medical plans provide a minimum actuarial value and have a maximum out-of-pocket cost no more than $6,600 for an individual and $13,200 for a family for 2015. This is revised each year, see current limits.

For those of you who can’t afford a plan, it’s probably your state’s fault.  They didn’t expand Medicaid even though there were federal subsidies for them to do so.

Let me explain:

Family size of 1 could make up to $16,394 and qualify for Medicaid if your state had expanded the program.

Family size of 2 could make up to $22,108 and qualify for Medicaid if your state had expanded the program.

Family size of 3 could make up to $27,821 and qualify for Medicaid if your state had expanded the program.

Family size of 4 could make up to $33,534 and qualify for Medicaid if your state had expanded the program.

Additionally, under the ACA if you have a family of 4 and make between $24,300 and $97,200, you qualify for federal subsidies even if your state didn’t expand Medicaid.

Check out this website to see where you fall on the scale and what the ACA can do for you: http://obamacarefacts.com/federal-poverty-level/

Therefore, if the states would have expanded Medicaid (which most blue states did) you could either purchase an affordable plan, or qualify for Medicaid.  So, where does the problem lay?  It lies with partisanship.  Republicans blocked the ACA every way they could.  They are the reason Tennessee and many other states didn’t expand Medicaid.  They are the reason you can’t afford health insurance.  This is why I vote blue.  I vote blue for the right to be healthy and for other’s right to be healthy.  Healthcare shouldn’t just be for those who can afford it.  The problems with the ACA lie with those who fought against it not those who created it.  Stop voting against yourselves.  Do research.  Find where the real problems are.  Discern what is fact and what is just a rumor by looking at non-partisan news outlets.  Disagree if you want, but find out why you disagree and back it up with facts, verifiable facts, and stop thinking only along party lines.