The Affordable Care Act Worked for My Family & We Really Needed It to Work

 

ACA.001I was thinking back to where my family was when Obamacare first went into effect. I wrote the post below after we had been kicked off our health insurance & dumped into the Kansas high-risk pool. Time and again as we shopped for new coverage we were denied by insurance companies due to pre-existing health conditions. The ACA changed all of that.

I wrote back then that our legislators needed to work on the law to improve it & encourage participation. What they did instead was to act like children, stage protest votes to repeal the law, and thwart its implementation at every turn. Instead of conducting political stunts, they should’ve rolled up their sleeves and worked to improve it together. 

Today our national leaders are poised to repeal the ACA, and I can’t help thinking it seems more like politics than governing. Republican leaders are promising a plan that will provide the same coverage for cheaper prices. I am dubious, especially because they plan to remove so much money from the system by giving tax cuts to billionaires (the slight tax increase on billionaires pays for those who get subsidies. The subsidy was incredibly important for us in that first year, and it is vital to so many millions who live on the margins). If Republican leaders are dead set on repealing, I can certainly get on board as long as they produce a plan that actually solves the problems with the ACA. As of now we have seen no plan whatsoever. We need to see their plan before they simply repeal a law that has helped millions of us. This isn’t a political question for me. This is about how my family gets coverage.

Here’s what I wrote back then:

 

05 DEC 2013—Kansas City

My name is Tim Suttle. I’m married with two children under the age of ten, and I’m a pastor of a small church in the Kansas City area.

Last summer my family received a letter telling us that our insurance provider was canceling our policy because it would not meet the minimum standards set forth by the ACA when it goes into effect in 2014. At first we were surprised and a little bit alarmed. It only took us about two minutes to remember that our insurance was terrible. It had no co-pay. We pay everything up to $3k for each individual member of our family – essentially a hefty monthly charge for the privilege of having the insurance company (who shall remain nameless), negotiate lower fees.

I know that some people are pretty upset about losing their insurance plan. But our policy was being cancelled because it was not fair insurance. It was a mercy killing. Or at least we thought so at first. Then we started shopping for new plans.

We found several good private options and began to apply. Every time we went through underwriting we were denied because of pre-existing health conditions. My wife even went through the appeals process at one carrier, getting special letters from doctors to help our case. Again, we were denied due to pre-existing conditions. After a few months of trying several providers, we realized that we couldn’t get insurance.

Before the ACA, our only option was to split our family into insurable, and un-insurable groups, buy a policy for the insurable group, and then go into the Kansas high-risk health insurance pool – policies that are expensive and not very good. Instead we realized that we are perfect candidates to go on the local exchange that should have been created by our state as part of the ACA… only our state didn’t create an exchange. Our state has been attempting to thwart the implementation of the ACA from day one.

Nevertheless we waited for healthcare.gov to go live and began the process. At first we had little luck with the site. We could get further in the process than some people, but this website was pretty hopelessly broken. My wife made a few phone calls, always found answers to her questions, or got calls back with answers later on.

So we waited a little while. My wife kept gathering information, reading updates, making sure she compiled all of the right information. Then a few days before Thanksgiving, she sat down to apply again. She made it through the entire process in the course of a couple of hours. We were signed up. Within a few days we had our conformation in hand.

When the documentation came, we still had a few questions. The toll free numbers worked, the representatives were helpful. Sometimes they ran our questions straight up to a supervisor. If they had to call us back with an answer they did so promptly. Our case was far from simple. We have kind of an odd situation, as do many of those who need this coverage. But everyone we dealt with was pleasant, patient, hard working, and in the end, quite efficient.

End result? We have health coverage that is significantly cheaper than we had before, and much better quality.

I know the ACA isn’t perfect. Many people are opposed to it because they think it is a bad idea. I also know that many are opposed to it it simply because it’s an Obama idea, and it’s a political thing. I know that for years our representatives will have to work out the kinks, and we still have a long way to go. But my family really needed this to work. We were in a bind. I wrote this in order tell our story, and to say that the ACA worked for us, and we really needed it to work. I’m feeling thankful today for the ACA, and for all of those who are working so hard to make it happen. What you are doing is important. Keep up the good work.

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What Are Your Thoughts?leave a comment
  • scott stone

    Glad it worked out for you. Me, not so much. Actually it’s a yearly pain in the ass.
    On a side note, do you honestly believe 540 people are paying for your subsidy? C’mon!

  • jekylldoc

    Americans don’t like the idea of mandated coverage, but it is the only way to make risk pooling work if you want people to be covered for pre-existing conditions. Otherwise, private insurance cannot afford to cover them. Switzerland has mandated coverage – it is the closest thing to the American system among the rich countries. The other rich countries mainly just cover you automatically with government health care, like Canada, the UK, and France.

    There are absolutely millions of people who would not have coverage without the ACA. And it appears that the main problems with the ACA came down to insufficient mandate. People resisting being covered, until they were sick.

    If Obamacare is repealed, millions will be back on the edge of financial ruin and shabby emergency room care. Our babies were premature. I cannot believe anyone thinks it is okay for people not to have medical insurance.

    • scott stone

      I’ve been a huge anti-ACA from the get go. I think the ACA set back the opportunity for single payer by generations. Government got involved and mucked it all up with a poorly crafted bill and now the opponents of single payer actually have something to point to and use it as a tool.
      I like the system in Costa Rica. Everyone has to be enrolled in CAJA, even the expats. It is a mandatory system that is fairly effective and inexpensive. But, they also have a private system and private insurance. If you prefer to utilize that system, you have to pay for it, privately. I think that is a system that should be implemented here in the States. Everyone participates and contributes, therefore everyone is covered to some extent. If you want a better plan then you pay for it.
      Truth be told, no one really wants to have the conversation that needs to occur. It isn’t the fault of insurance companies. I know they are an easy target because they are evil corporations (snark) but it’s really the fault of our system. Insurance premiums are so damn expensive because doctors and hospitals charge so damn much. Simply look at a bill for a medical procedure. It’s not he fault of the insurance company that a doctor charges you $20 for a freaking Tylenol. There are not enough market forces in our system so the government needs to intervene. And that statement is coming from a right wing nut job (according to those on Patheos.)

      • jekylldoc

        I’m glad you see the advantages of single payer. I think it would work better, and could even be done with different systems in different parts of the country. My understanding is that Obama would have preferred single payer but the Dems in vulnerable districts, who came in on the tide created by the crash in ’08, were not willing to take the risk. So okay, a lot more people have coverage now, and the human benefit of that is immeasurable.

        The Costa Rican system you describe reminds me of education. People can pay for a different model if they prefer it, but as long as the basic version is adequate, most people won’t pay extra for a shinier, more convenient version.

        • scott stone

          God I hope it’s different than public education. Don’t get me started on that mess. If a public/universal health plan had the same results as public education we’d have a much smaller population.
          The situation in Costa Rica is a bit different. Most people don’t pay for the “shinier” version because they can’t. Those who can afford to actually do.
          Also, full disclosure. I’m one of the thousands of small business owners that got totally screwed because of the ACA. People like to talk about those that were helped by it but there is the other side. The act caused me a lot of stress and money once it was implemented.

          • jekylldoc

            I thought small business did not have to provide insurance to employees. Is the stress caused by required paperwork? What was the source of the money cost? Family coverage?

            My impression is that the people whose bills went up were mainly those whose former plans kept costs down by discrimination against pre-existing conditions. Single payer would eliminate that divide, but the health bills still have to be paid.

            Even though I am an economist, I am not a health economist so I haven’t been able to follow all the ins and outs of the ACA. I hope my questions don’t come across as antagonistic.

          • scott stone

            No, they are good questions. Most people aren’t even interested in having a dialogue. Yeah, I’ve been on the universal health care bandwagon for a long time. I find it odd that employers are suppose to be the provider of such an important function in our country. First off, it’s discriminatory. If yo don’t have a job you are left to fend for yourself. Secondly, I don’t pay for my employees car insurance or renters insurance, etc. Why the hell should I have to be involved in the medical insurance business.
            To your questions, Obamacare set a fairly strict set of guidelines as to what had to be provided. The minute it was implemented, our policy did not meet federal requirements. The policy got canceled. Remember the “If you like your plan you can keep it” and the “If you like your doctor you can keep him or her”? That didn’t happen.
            We actually had a good plan for our employees, one that they liked. The new plan was far more expensive and you had to work with multiple insurance providers to try and see what doctors were in what particular network so as not to cause as much disruption to employees. If you are married imagine telling your wife that the gynecologist she’s comfortable with is no longer in your new insurance network and she needs to find someone else. I’m sorry, that just is not cool.
            I always found it to be a bit offensive that I offered a gift to my employees, the gift being providing them health insurance, and the government coming in and saying, your gift isn’t good enough. Obviously the Libertarian side of me.
            So now. like clockwork, every January I get a notice that my current plan no longer exists ands I need to choose a different one. I’d say yearly increases have been around the 18% mark. The first year the ACA was enacted I remember it clearly, 37.3%.

          • jekylldoc

            I think I see the nature of the problem. I certainly agree with you that requiring employers to provide the insurance is strange, although we are not the only country that does that. In the U.S. that was a “perk” negotiated by large industrial unions in the 50s, and became a standard part of the employment package in the 60s and 70s when the economy was strong. As people realized that the uneven coverage was not just unfair but also causing bad decisions and ultimately high costs, they looked around for a way to have everyone covered. But universal coverage was proposed as early as the Truman administration, when European countries were almost all bringing it in with Labor Party governments.

            I suspect that a lot of the 37 percent increase to start out was due to requiring that pre-existing conditions be covered. That is the big dilemma that no one knows how to deal with (short of single payer, but that would be logical.) Insurance companies can keep costs down by excluding coverage of diabetes, heart trouble, cancer, or anything else you had before signing up with them. And everybody wants those low costs, but they just pray they don’t get a pre-existing condition and lose their job.

            Our preemie babies would not have been a problem that way. They were really expensive to care for, (intensive care for almost two months), but the cause was a fluke thing (having to do with twins) unlikely to happen again. So nobody excluded anything when I moved to a new job. I am just trying to imagine how different our life would have been if we had not had insurance. I know someone who died because he was uninsured and took a risk that he could get through a case of food poisoning without medical care. Multiply that by hundreds of thousands of bad decisions and you can see why the old system was considered so costly.

            I wish the promise to solve the problems really meant solving the problems. But it doesn’t look like it. Good luck with whatever comes next.

          • scott stone

            I’ve not experienced the extreme that you had to go through but I had an asthma kid and one that is deathly allergic to peanuts. They call that a pre-existing condition. Yeah, it preexisted before he was born! He’s got to carry a $400 epipen with him at all times, which expires so he’s required to buy an new one regularly. And the pen isn’t covered under any of our plans.
            I’m the farthest thing from a Trump supporter but if he would make good on a position he’s held for most of his adult life, we’d have universal coverage. I don’t know how he can weasel out of it but he’s been on record for the last 20-30 years that we need universal coverage. This should be interesting. Imagine if it’s the orange guy that pulls it off. I’m not holding my breath but that would rock the foundations of the left/right divide in this country.

          • jekylldoc

            Well, as someone who doesn’t care much for the left/right divide, I would gladly trade tax cuts for the rich for universal coverage.

            Incredible what happened to Epipen prices last year. That’s what hedge funds and private equity are about: see a chance to make money that hasn’t been exploited because someone cares about their workers or their customers? Swoop in, buy it up, and stick it to the ordinary people.

          • cvryder2000

            Public education is a mess because people like Betsy DeVos and the supporters of so-called “school choice” and “charter schools” have made it that way. If public education was run the way it was supposed to be, it *wouldn’t* be a mess. but don’t get me started on that or I’ll be here all night.

          • scott stone

            That is really not the case. Federal spending per student ranks as some of the highest in the entire world. The OECD, out of Paris, has only Luxembourg, Norway, and Switzerland spending more per pupil than the United States on primary education. Charter and Choice have nothing to do with the poor results we have. As a general rule of thumb, only one political party has dominated the public sector leadership in our education system.

          • cvryder2000

            I can only assume you aren’t old enough to remember when it started, back in the days of “white flight” academies, which led to “school choice” and the rest of this insanity. But from the tone your rhetoric, it’s also useless to try to educate you. I bid you good day.

          • scott stone

            I can only assume you are a product of the public education system. Good day to you as well.

  • Nimblewill

    It only took us about two minutes to remember that our insurance was terrible. It had no co-pay. We pay everything up to $3k for each individual member of our family – essentially a hefty monthly charge for the privilege of having the insurance company (who shall remain nameless), negotiate lower fees.

    I promise, with no exaggeration, this describes my insurance AFTER the ACA. For 25 years I paid the co-pay and it all changed overnight. My premiums skyrocketed and I have gone in debt with doctor bills. I think this is called a redistribution of wealth.

  • Nimblewill

    What no one seems to want to talk about either is that medical bills are high because insurance will cover the inflated costs. A visit to my doctor for something minor costs about $400 for a 15 minute visit and I end up paying $100.

  • Nelson Lee

    Interesting story and many including myself were in a similar situation. While Obamacare worked for your and your family… it has been an $80k disaster for mine. Suffice it to say that there is nothing that makes me more furious than the discussions about Obamacare and the fools who think they know what the solution is. If there is anything we have learned from Obamacare, it is that the US government cannot be trusted to do anything right.

    Believe it or not, I actually believe that all insurance should be underwritten by the Federal government… not just health insurance. How much sense does it make for me to pay a third party for insurance when it is in their interest to deny my claims. There are 2 problems with private insurance… 1. Limited capital means that a significant event could bankrupt private companies. 2. The profit motive is a significant additional cost and a conflict of interest that needs to be eliminated. Only the federal government with the backing of the national treasury can adequately cover the risk that is present and eliminate the profit motive.

    The Federal government should form a separate agency called the National Insurance Fund that operates similar to the Federal Reserve. This agency should operate with independence so politicians can’t manipulate the insurance system for political purposes. The agency would set rates based on risks and the costs to operate from year to year. Private Insurance Brokers should be used to sell and service the policies and provide customer service. But the funding and rates all come from a single source… the National Insurance Fund.

    People should have the option to buy whatever insurance options and features they have had in the past through private companies. The Federal government can provide grants for the poor who need subsidies. The grants can be handled behind the scenes and there is no chance of fraud because the middlemen are eliminated.

    As long as a person has had continuous coverage, there is no pre-existing conditions if they change plans or brokers. If a person decides to not have healthcare insurance then they lose their preexisting protection. You don’t have to mandate coverage and the risk pool will be plenty big without mandated coverage.

    The rate differences should be based on risk associated with lifestyle. If you smoke and drink then you should pay a much higher rate. But you shouldn’t pay a higher rate for a genetic problem – such as high blood pressure, high cholesterol, diabetes, etc.. Women and men should pay the same rate.

    Under no circumstances should the federal government replace the private provider network and the federal government should not own any healthcare facilities. God save us all if our healthcare is entrusted to the US civil service. Can you imagine the customer service nightmare that would create?

  • Sergio

    Yawn…..OK, so it worked for a few folks at the onset until the premiums began to skyrocket and for most of those I have spoken with…it never worked. Why? Because when the choices are limited…a lack of competition always drives up the price for any and all goods and services.

    As a member of the medical community I can honestly state that the physician who knows you best is the person that can most effectively diagnose an illness because a patient’s medical history is crucial to formulating a treatment plan. I can’t begin to tell you of the number of patients that have suffered at the hands of staff physicians who failed to contact a patient’s primary physician before moving forward and making an errant diagnosis.

    The unaffordable health care plan forced many people to change their physician. Many thanks for the untruth spoken at the onset of this failed healthcare plan…if you can even call it a plan. “And you can keep your doctor.” Yet another untruth and sadly, the progenitor of the plan was told by those who worked on the plan that folks would have to switch physicians.

    Take about government intervention! Did you forget that those folks who did not want government healthcare and needed the opportunity wanted to make a free market choice of choosing a provider were penalized via the IRS if they had not selected a provider before a given date.

    Obviously we need reform, but it needs to start with those who deliver care. Example: I assisted on the placement of a central line. The nurse knocked the kit off the table and onto the floor; hence, it was no longer sterile. Who should pay for it? Would it surprise you that the hospital billed the insurance provider for two central line kits to the tune of $600.00? Such incidents are a common in hospitals.

    Who knows, maybe a successful businessman can get the hospitals to become responsible for their mistakes.

  • jimoppenheimer

    We just have to keep up the work of chipping away at the childish resistance to good health insurance.
    Of course it would be nice if the GOP would start telling the truth for a change, but you can’t ask a zebra to change its stripes…..

  • Brandon Roberts

    i’m glad it did for you however aca was deeply flawed and at least the republicans are putting in a replacement plan so credit where credit is due. frankly i think we should get on universal health care or find another policy or plan to implement affordable care

  • BdgrGrrl

    I had very good COBRA coverage after the ACA kicked in. During the two insurance “years” the premium increased by only 12%, with no change in network, co-pays or deductibles.

    I now must rely on the ACA for health insurance since I have a pre-existing condition that private insurers won’t touch. Kinda crazy, because it’s well-controlled by generic meds and specialist visits about every 2 months. I’m in the oldest age group and don’t qualify for a subsidy. I buy the best Gold level plan available ($1,250, another $5,000 at 80/20, $25 for primary care doc visit, $50 for specialist visit, good HMO network). It costs ~$900/month, but is worth every dime.

    Thanks for telling it like it is, Rev. Suttle. Mend the ACA, don’t end it. Try single – payer pilot projects, but don’t take away the ACA.