Now I have insurance. But I can’t use it. What am I supposed to do? I know this one is long but it’s worth a read if you want to understand issues pertinent to the Affordable Care Act. My personal story illustrates many of the problems with the ACA.
I started taking notes on the Health and Human Services Secretary hearing, and I will share more as I scrutinize the hearing in more detail but let’s start with the breakdowns below and my experience with Obamacare. Here goes:
These are the breakdowns of who gets what coverage in the United States:
Medicare 18% – 52m
Employer 61% – 178m
Medicaid 22% – 62m
Individual 6% – 18m (exchanges cover 4% of the 6%–these are the people who have been forced onto the Obamacare plans)
Note: this writer is in the BOTTOM of the barrel here (Individual). Most of the individuals in the “Individual” category are either the upper contingent of the working poor, those who work for small businesses like restaurants or family owned grocery stores and the like that don’t provide health insurance benefits (more and more common these days), and/or sole proprietors like myself. Many health care providers are self employed hence we have been forced into the Obamacare exchanges if we are not high earners. High earners won’t buy on the marketplace and will purchase individual plans outside of the marketplace.
I find it interesting to note that the 22% who pay little into the system get better coverage than the 6% who actually work and pay taxes into the programs that support their health while much less is paid into the healthcare for those who work and earn between adjusted gross incomes of $23,540K (yes, exactly) and $45K per year. Adjusted gross income versus gross income are pertinent here but not necessary to go into detail about this at this point.
I have no objection to the poor being covered by Medicaid. However, I do find it OUTRAGEOUS that the United States is paying less for healthcare costs for those individuals who are actually working and paying into the system and making every attempt to rise above their circumstances. This seems to be shortsighted — at the least — as workers need to be kept healthy otherwise they wind up in the category of non-workers who will wind up on Medicaid anyway (or dead and then voila! They won’t cost the taxpayer a dime).
Before Obamacare came into existence, I had coverage through a New York State program (thankfully) that assisted sole proprietors. I paid for that program and at that time, I paid much more than anyone who had an employer-subsidized plan (a $400-$500 monthly premium was unheard of for an employer-subsidized plan but not for an individual plan; most of my clients on employer-subsidized plans did not pay anywhere near this amount for their plans monthly, at least not directly). I had Oxford Health Insurance and a decent network of doctors that I could visit a ten minute walk from my home through New York Presbyterian Hospital at 168th Street & Broadway (I live off of 181st Street).
My benefits were more limited than employer-subsidized plans (for example, I did not get outpatient physical therapy, mental health, or post-surgical inpatient rehabilitation coverage). Without inpatient rehabilitation coverage, I was screwed when I had lumbar spinal fusion surgery (L4&L5 discs) in April of 2013.
I was essentially partially crippled by an “equipment failure” and thus endured two surgeries within 48 hours. I was in bad shape and was recommended from two to four weeks of inpatient rehabilitation by the doctors. Because my insurance did not cover inpatient rehabilitation, I was sent home barely able to function. I managed for three years with little if no support from family (which is usually what socialized medicine counts on to plug in the gaps caused by nursing and other staff shortages). If one is alone and with no family support, one is essentially SOL.
I went to my first medical followup appointment alone. I could barely walk or stand. The doctor’s office found me on a bench across from the reception desk nearly passed out. That was my first visit to the doctor following major spine surgery — no help, no aid, no support.
Then Obamacare came into being approximately 8 months later and my life became a shit-show. I lost every single one of my doctors whilst in the middle of this healthcare crisis. I still could not walk more than a quarter mile, I could not even drive my car, and I’d had to shut down my midtown office due to the fact that I couldn’t physically get there. I was unable to use buses and subways since I could not manage to go up and down stairs.
I had supported Obama’s vision of providing health insurance for all notwithstanding my doubts about government sponsored healthcare. However, had I known that I would be lied to (told I wouldn’t lose my doctors), been provided with the skinniest network of doctors imaginable, and that my local Democratic party representatives would not lift a finger to help me when I could not obtain care, I NEVER would have supported this plan.
I have known people who have compared my situation to their purchase of so-called COBRA plans (those are plans negotiated by employers with much larger networks than Obamacare plans). THERE IS NO COMPARISON BETWEEN AN OBAMACARE PLAN AND AN EMPLOYER-SPONSORED HEALTH PLAN. None whatsoever.
First of all, the network of providers in Obamacare plans are — and I’m guestimating here but don’t think I’m far off — somewhere between 10-20% of the size of the network of employer-sponsored plans. Not only did I lose ALL of my doctors, the ten minute walk to my previous medical doctors’ offices became 45 minutes to 1-1/2 hours of travel to get to whatever new providers I was able to find.
I have yet to replace all of the doctors I lost. When you rip the rug out from under a sick individual by taking away all of her doctors, she is not physically capable of replacing those doctors (particularly when travel to those new doctors’ offices is near impossible and is time-consuming). Yesterday, I traveled 1-1/4 hours to get to my endocrinologist’s office from my home in Washington Heights to 59th and Park Avenue. Theoretically that trip should have taken less time however trains were slow yesterday and so a minimum of a 45 minute trip took half an hour longer.
How would I have been able to make this trip when I couldn’t walk? I couldn’t get to the midtown area in New York City for at least ONE YEAR. How was I to manage with no support at all?
Now, this is where left-wing Democrats start explaining to me that some people will “fall through the cracks.” The people who say this aren’t usually the people who do the falling so they are more than content to watch others fall.
It was egregious enough that the President I voted for betrayed me by lying to the public about the costs of these plans (my premium costs were $600 per month with the government subsidy covering roughly a quarter of that cost; my copays and medication costs were anywhere between $100-$200 per month). I met my out-of-pocket limit of $2000 which means I spent an additional $167 per month for my medical costs. This adds up to $767 per month – roughly a $150 subsidy for a network that initially didn’t even exist because BCBS had not even completed its contracts with providers, and then when it did exist, it was so thin to be practically negligible.
The only providers in my neighborhood in Washington Heights that take Obamacare policies are doctors you would not send your children to much less yourself.
I was offered “assistance” by a local church whose prayer leader met with me. The assistance she provided was a piece of paper. It was a copy of the New York State of Health’s Official Healthplan Marketplace. She could not understand why, a few months before the Obamacare plans went into effect, I was worried about losing my doctors. She thought I should “wait” until it actually happened to be concerned. This was the “help” offered me by the local Liberal-oriented church. It was more than my local congressman or senator’s office would do.
When I called my local congressman’s office to complain that I could not access care in January of 2014 because I had no insurance identification and the insurance company did NOT ANSWER THEIR PHONES for three weeks (!!!), I was told that they had no power to do anything about a “private” insurance plan. I said, “Private? I bought this policy on a New York State government website! Private? Are you kidding me?” They maintained this position and essentially blew me off.
When I attempted to find information on the internet and essentially just said “I’ve lost my doctors, does anyone have any ideas as to what I should do,” I was viciously attacked by Democrats who assumed that this sick person without any medical care was a closet Conservative attempting to knock the Affordable Care Act. I was accused of presenting a false story in the guise of a Conservative-hater of the ACA, and it was also suggested that I had a mental health disorder.
And the Democrats wonder why they lost this last election. This is what’s called willful ignorance and I direct my fury at the party that I was loyal to and that betrayed me. The Democrats have betrayed all of us and now we get this racist, misogynistic moron in place of probably the best president we have had in generations. Democrats, he couldn’t do it alone.