Affordable Healthcare...We Can't Afford

I'm going to start right off the bat by saying I'm not 100% educated about the current health care system we have in this country. I know there are a zillion pieces to this puzzle, that I still have a lot to learn, and that there are a variety of sides to the story. I'm also going to say that I speak for a good many educated Americans when I say that however the system works, it's not working well. I'm enraged and outraged by this current system, and I know I'm not alone. While the new "affordable healthcare" incentives may be helping some people - maybe even a lot of people- it certainly has caused more damage for my family and many others I know. I also want to say this: I'm not belly-aching as if our situation is unique or insinuating that "our life is worse than yours." I'm not into playing that game. I'm merely being honest about OUR situation, and I'm inviting a conversation. We are one little family in this big picture, but this is our perspective of how we are struggling with "affordable care."

Let's take a step back first to examine the whole story. I have always had medical and dental coverage, and shortly after Sam's accident, he finally agreed that he should be covered! Health, wellness, and preventative care are all extremely important to us. We want our children to have access to health care, and we want to know that we can go to doctors we trust and have established trusting relationships with whenever we feel ill or need medical attention. So, we have always made paying for health insurance a priority.

But, when I resigned as a school counselor to stay at home with my year-old son, I gave up having benefits. At that same time, Sam started his own law practice. He elected to continue coverage through his former employer utilizing the very expensive COBRA plan. We were paying over $1,000/month for our family of 3 to have medical insurance which did not include a dental plan. For nearly 18 months, Sam's business grew slowly but steadily, and over $1,000 of each month's income went straight to his former law firm to cover our medical insurance. During that time, I gave birth to Quinn (in September), and of course, we hadn't paid a penny towards our deductible which had reset in June. With a crappy plan through COBRA, we still owed over $7,000 to the hospital for Quinn's delivery and nursery care. Needless to say, we are still paying that bill off.

Then, in January 2014, the COBRA plan was no longer an option, and we did research to find the best plan for our two young boys and for ourselves. We signed up for Cigna, and only 2 weeks into the new year, we had our first well visit on our new plan. Quinn's 4-month check-up went great, but 1 week later, we were back in the pediatrician's office with a sick baby. When I went to the window to check-in, the receptionist told me that the office no longer accepted this particular plan of Cigna's. "Are you kidding me? We were just here last week," I reported, to which the receptionist said, "I know, we just found out that we won't be on their plan starting January 2014; we just got notification late." I went on to say that we had selected this plan because all of our doctors were on this plan. We had specifically checked in December! The woman understood but couldn't do anything to help me. She asked if I wanted to cancel my appointment. Well, with a very sick infant, there was no way I was giving up my appointment. Turns out, Quinn had RSV, and we needed to be seen that day. Then, we ended up with a hefty bill from the doctor's office. I went home to check on our other doctors, including my OB/GYN who I had just seen a week before, assuming my well visit had been covered. However, NONE of our doctor's were on our Cigna plan. With "Obamacare," insurances were rapidly changing, and doctor's offices were rapidly changing.

By February 1st, we were uninsured. It was cheaper that way, anyway! Luckily, our doctors worked with us for the uncovered January visits. But, we needed to figure out something before the March "Obamacare" deadline to have health insurance. March 1st was the first day of our new coverage; this time, Bluecross. We went with two separate plans - the boys had a Silver plan, and Sam and I were on a Bronze plan. Our grand total per month was $780.33. That's a total in 2014 of $7,803.30 (10 months). But, that's not all. For every sick visit, we pay co-pays. For Sam and I, our plan only allows an adjusted rate, no actual payments by the insurance company. So, my annual mammogram and sonogram that could have cost me over $950, I get to pay $424 instead. And, yes, that's nice. But, I'm already paying a ridiculous monthly premium. Quinn had a doctor visit to the ENT back in July, and the (literally) 10-second procedure cost us $285 for the hospital fee (which we were not told about ahead of time), and another $285ish to the doctor for professional fees. And, just recently, Quinn was prescribed a nasal spray, and when I got to the pharmacy to pick it up, the pharmacist chuckled with understanding when I said, "What?! You're kidding, right?" to him telling me that his little nasal spray which would last a month costs $100. And, I'll save you the financial details of Banner's X-rays and specialist visits when he broke his ankle. These are just examples of other expenses we incur on top of the premiums.

These bills infuriate me. And, what infuriates me even more: our premiums went up for 2015 for the exact same plans. I'm so disheartened by this system - a system that may prevent me from staying a "stay-at-home mom." I will have to go back to work next school year just to pay for health care. Maybe we can afford dental coverage then, too. Or not. Who knows? But, what I do know is that I'm an angry mother. I'm pissed that I have to think twice before taking my child to the doctor. I'm pissed that I am forced to pay for a product (insurance) that I don't like. I'm pissed that the insurance companies boost prices, that doctor's offices aren't getting what they deserve, that the government hasn't figured out a better plan, that I can't count on having continued care with really great doctors with whom I've developed respectful relationships and who my children have come to love and trust. I don't want to go to just any doctor simply because he/she is the only one who takes the meager insurance I can afford. I don't want to worry that the medicine my doctor prescribes is going to be too expensive for us to afford because my insurance (which I am forced to have) won't pay for it. 

Health care is the only industry that Sam and I can think of where you can't just purchase the service or the product you want. There are too many people involved. For one visit, you see the doctor, and there may be a diagnostic company involved, a third-party billing company, the insurance company, even additional physicians like a radiologist you may never even meet. Say you have a question about your bill, and there is such a run-around just to get a clear response. The billing company can't answer it, you've got to call the doctor to call the insurance company. Maybe the diagnostic company isn't covered by your insurance company - which you had no idea about. Maybe you even went in to a surgery at a hospital that takes your insurance, but the anesthesiologist is not in-network, but you were assigned the anesthesiologist. Now, you're screwed with an outrageous bill for something you weren't in control of. The whole situation is disgustingly obnoxious.

Don't get me wrong. There are definitely aspects of new health care laws that I support. Mostly, I'm ecstatic that it's finally unlawful for insurance companies to turn away people because of "pre-existing conditions." It's discriminatory, and it's a good thing it's not allowed anymore. I'm glad someone woke up and realized how wrong that is - that just because a woman once (or twice... hi, mom!) had cancer she was "uninsurable." Frankly, though, the government has it wrong. The problem is not that people can't afford health insurance. The problem is that there are insurance companies at all. Perhaps if there weren't insurance companies, doctors wouldn't have to jack up prices for procedures. Personally, I believe health care should be free - like education. We say we value education, so we pay for it for all. Why not health care that we claim to also value so highly? And, just like you can pay for private schooling, you could pay for private doctors if you don't like who the government chose to treat you.

Imaging being told by our government that you have to buy cable TV. Imagine it costs so much each month that you can't even afford to turn the TV on. What irony, right? That's how I feel about this health care system. I'm complying by insuring my family, but every time I decide to actually go to the doctor, I wrack up another co-pay or another hefty bill on top of what I'm already paying. And, many months, thank God, I'm paying for absolutely nothing. And, honestly, I pray that these bills stay minor - and that we don't have any major or catastrophic issues that we have to deal with. But, when something does pop up - a sleepless night with Quinn crying for hours and I know it's just GOT to be another ear infection, or a cough that plagues Banner for months, or even my mammograms at a young age because my mother was diagnosed with breast cancer when she was younger than I am now - I have to decide if I can even afford to use the health insurance I'm spending thousands of dollars on already only to spend more on tests, co-pays, facility fees, diagnostic tests, etc. We spend so much of our monthly income on health insurance that I can't actually afford to go to the doctor! I'm not necessarily upset by the hefty monthly premium; I'm upset about the additional fees each time I have to go to the doctor. It makes me wonder what the hell I'm paying for!

See, really, "affordable care" is a misnomer. The act has little, if anything, to do with the cost of health care itself - or even health insurance, for that matter. In order to get the law passed, almost all of the price-control language was taken out of the bill - controls that would have directly challenged hospitals' and some other providers' charges. The "Affordable Care Act" assumes that by requiring Americans to pay potentially thousands of dollars more a year for health insurance, they will necessarily be able to afford health care. To the contrary, our family spends so much on health insurance that Sam and I  have to seriously consider whether or not to go to the doctor when we have a need, as we've spent the money on premiums (we make it work when the boys need to go). And this makes sense if you think about it: insurers charge higher premiums (ours went up 12.5% for the boys and 25% for Sam and me), and pay less. The care providers have no choice but to up their rates to stay in business when the health insurers pay them less per code billed. Either that or the providers don't take insurance, in which case your policy premium is a complete waste in the truest sense. Affordable care? Where?

Sam's business is flourishing, and he's doing really well. But, some months are rough and clients don't always pay. I'm proud of him for everything he's done these past 2.5 years! I'm pretty sure President Obama's campaign included supporting small business owners, but I think he failed to understand the complexity of it all, especially just how expensive it is for people like Sam to be on their own for providing health insurance for their families (and/or employees). It's really enough already. This system might help some people, it may have lowered some people's monthly premiums. But, for us, we are struggling. Sam and I are both very bright individuals. We're highly educated, we give to our communities, we are sending our kids to preschool, we have opted to forgo a double income so that I can be there with our kids, but health care -and yes, student loans- are strangling our plan. We cannot think of a way out of it, and we grapple with just taking a penalty on our taxes to pay for NOT being insured. Yet, this goes against everything I was raised to believe. Health care is a must. It's just - we can't afford it.
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Update: This post was originally written over a month ago. In January 2015, we paid our December health coverage. We usually were about a month behind in making payments. With slow business and slow-to-pay clients at the end of 2014 and into the new year, we waited to pay January and February until early March. Unfortunately, we were not aware that we had to be completely paid in full by January 1st to continue our coverage. So, when I went to pick up Quinn's prescription one day in early March, the pharmacist was the one to inform me that our health insurance had been terminated. When we called to inquire, the representative explained that not only were we not covered but that we had missed the "grace period" to reinstate our plans. No phone call or email or message of any kind was relayed to us about this problem. I'm not blaming the company, although I feel that this was a poor customer service move on their part. Sam and I take full responsibility for lack of payment in a timely fashion. That is absolutely NOT how I like to handle my obligations and responsibilities. However, we are doing the damn best we can - like all Americans. It is what it is, right? I mean, if the money isn't there, the money isn't there. So, who knows what will happen to all those doctor appointments and prescriptions we picked up between January 1st and March 1st. . . of which there were quite a few. I'm sure we will see a hefty bill for all of that, when we thought we were "covered."

Since we didn't know we weren't covered, we missed the open enrollment period. The only way to get health insurance now for the remainder of this 2015 year is to get a "temporary" plan. These plans are more expensive - or they don't cover preventative care - or they just plain suck. Quinn has a doctor's appointment tomorrow, and we will have to figure out where he can/will get his vaccinations that would otherwise cost us about $250-300 per shot. (Ha.... we found a "perk" to health insurance when it actually helps us!) In the meantime, we've "saved" over $2400 by not paying for insurance this year so far. I know we'll be penalized when tax time comes around, but I'm still questioning what to do about being insured or not. I certainly hope we don't regret not having any, but we're kind of screwed right now. Just praying that this healthy family stays that way until I can get a job with benefits! :)