ObamaCare in Practice: An Update

The first year we had health insurance via the ACA, I updated y’all frequently and promised to keep doing so.  I realize that’s a promise I didn’t keep.  Now that the law’s very existence is threatened, it seems like a good time to share how it’s been going for us in the almost two years since my last post.

I’m listing here for comparison some numbers I just crunched from the three years we have been covered thus far.

2014

  • Premiums paid:  $3,796.75
  • Physician Charges:  $41,191.17
  • Prescriptions:  $9,581.96
  • Our portion after insurance:  $5,454.47
  • Total health care costs: $9,251.22

2015

  • Premiums paid:  $7,558.68
  • Physician Charges:  $10,083.20
  • Prescriptions:  $7,603.03
  • Our portion after insurance:  $2,668.16
  • Total health care costs: $10,226.84

2016 (to date)

  • Premiums paid:  $7,239.24
  • Physician Charges:  $16,849.10
  • Prescriptions:  $6,492.23
  • Our portion after insurance:  $2,613.13
  • Total health care costs: $10,452.37

You will probably notice a couple of things:  Our premiums went UP, and our physician charges went DOWN.

Well, it’s no secret that premiums are going up across the land, which many people blame on ObamaCare.  Ours would be unaffordable by now if it weren’t for the generous government subsidy we receive thanks to the size of our family vs. the size of our income.

Our physician charges went down because for one thing we didn’t have a major medical issue as we did the first year when Jake required surgery for a severed tendon, and the first year we also all went to the doctor a lot to make up for years of not being able to do so.  One of the things that has been driving costs up has been exactly this–people who hadn’t been able to access care, some of them very sick as a result, finally getting the care they need.   Presumably some of that will improve as time goes on, as it has for us.

So our experience continues to be positive.  We love our doctors.  We love that we can still provide insurance for our two adult children who are not in school.  We love that whenever anyone is sick we don’t have to worry about paying for or accessing care.  We love having regular preventive care and psychological care too.  And we love the lack of sticker shock at the pharmacy.

None of that is to say that there aren’t problems that need to be fixed.  Because insurance companies now have to cover those who they used to be able to reject, they haven’t been able to make a profit for the past three years.  Premiums continue to rise.  And Blue Cross has pulled out of Knoxville so we have to find another plan for next year.  Any day now I will have to devote a couple of hours to the hell on earth otherwise known as Healthcare.gov–which has only improved marginally since the last time I was there.

Now that I’ve got you all caught up, count on seeing more–a LOT more–on this topic over the next few weeks.

 

And here’s the rest of our ObamaCare story:

The $64,000 Question, Answered

Who Are the Uninsured?

Uninsured No More

ObamaCare Update

ObamaCare Update 2

ObamaCare:  My Latest Update

ObamaCare Revisited

More on Our Journey to Health, Brought to You by Obamacare

It’s Good to Be Insured: An ObamaCare Update

It's Good to Be Insured: An Obamacare Update

I have been uninsured most of my adult life.  Even when our kids qualified for TennCare, even when for a brief happy time we were able to insure John via TennCare Standard thanks to his existing medical conditions, unless I qualified via pregnancy, we could not afford to buy private insurance for me.  For the most part, in retrospect, that worked out well for us.  We gambled on my continued good health, and we won.  It would have been nice to be able to go to the doctor for checkups like insured folk, but I was never hit with a medical catastrophe while uninsured.
It’s a gamble taken by many young healthy people, and one some of them don’t win.
Let’s take Jake, my twenty-year-old son, for example.  Jake was covered by TennCare until he aged out.  He was briefly uninsured until we obtained our policy through the Health Insurance Marketplace earlier this year.  If it were not for Obamacare, he would have joined the ranks of the adult uninsured.
Just about a month ago, Jake was cutting some sheet rock with a box cutter when his hand slipped.  He ended up in the emergency room with a deep laceration to his right pinky.  And a little over a week later he was at the orthopedist’s office being diagnosed with a severed tendon.  Then came surgery, and now rehab.  So far, we have been to various medical providers seven times.  We are just getting started.  We will be billed by the hospital, the emergency room doctor, the orthopedist, the surgery center, the anesthesiologist, the supplier of medical equipment, and the physical therapist.
According to the Blue Cross website, about $9,000 in bills have been processed so far.  What have we paid?  About $150.  I realize we will be paying much, much more.  We have already met our deductible and have to pay 20%; but we won’t be paying $1,800 of that, because as insured folk we are offered the negotiated rate which is much, much less.  Also, as insured folk we are offered the courtesy of being billed.  Only the surgery center insisted on being paid up front.
Without Obamacare, this would have been a financial catastrophe.  What would we have done?  Well, what we would have done probably is gotten help from family members to pay the necessary up front charges, then paid off the rest in installments.  But what would happen to a young working man with no family to help him?  He could end up without the use of a finger on his dominant hand, permanently affecting his grip and his ability to write, not to mention causing disfigurement.  That should not be an option in the United States of America.
Jake has to endure two months or so of not being able to work or drive or write or do much of anything, and that sucks for him.  But at the end of it his hand will be almost as good as new, and we won’t be bankrupted by the bills.  BIG WIN for Obamacare.
Jake with Red Hair
 
 
Less dramatic wins . . . John has lost 30 lbs. since his first check up.  His cholesterol and triglycerides are now within normal limits, and his diabetes is under control.  He will see the doctor for more blood work to monitor his progress in November, and there’s a good possibility he may be able to ditch some medicines then.  My third appointment was today.  I’ve lost 46 lbs., but much more impressive and important is that my cholesterol and triglycerides are now within normal limits, and every one of my numbers improved since my last appointment.  I still have a few points to go on my blood sugar, and then I will be able to sign my name on the “normal numbers” poster on the doctor’s office wall!
Want to read the beginning of the story?  See below:
The $64,000 Question, Answered
Who Are the Uninsured?
Uninsured No More
ObamaCare Update
ObamaCare Update 2
ObamaCare:  My Latest Update
ObamaCare Revisited
More on Our Journey to Health, Brought to You by Obamacare

Obamacare: My Latest Update

I went to Walgreens yesterday to pick up some prescription refills that I had called in.  I drove up to the window and gave my name and the guy said, “It looks like there are ten of them.”  He rang them all up and I held my breath and he said, “That will be $36.20.”
Y’all, when I got home I looked at where the info sheet for each prescription says, “Your insurance saved you . . . ” and I got out my calculator and do you know how much those ten prescriptions would have cost me last year?  $590.30.
That’s a WIN for Obamacare, folks.  Those were maintenance prescriptions (and there are six more that didn’t need filling) for two members of our family who were uninsured this time last year.  One of them had in fact been declared uninsurable.  We got medicine through mail order programs; we filled out numerous Patient Assistance Forms and took them to doctor’s offices to get help from the drug manufacturers; sometimes we just went without the medicines that I (as the family health expert) decided were non-essential.
I’m used to getting soul-crushing news from the Walgreens clerk, but now our most expensive prescription is about $70.  (That’s the one we used to go without.) More usually, I now pay five or ten dollars.
John has now had his first doctor’s appointment and a visit with the nutritionist.  If you’ll recall, he was diagnosed with diabetes a couple of years back.  As a self-paying patient, he didn’t get much attention from his doctor when this happened.  He was told of this enormously life-changing diagnosis over the phone, and they called in a prescription for him.  He wasn’t offered any education or told to change his diet.  And although I was pretty sure he needed to do something different, I didn’t know enough about it to help him.  (Nor did any recommendations I attempted to make carry the same authority as a doctor’s orders would have.) So he continued to eat the same way as before–which was pretty much a “Hey, let’s get diabetes!” kind of diet.  And after some improvement due to the medication, he started getting worse again.
But our new doctor’s office is all about prevention and treating underlying causes, not just slapping medicine on an illness like a band-aid.  “Food will be your medicine,” the nutritionist told him.  And so John finally committed to going on the low-carb regime I’ve been following for the last couple of months.  It’s been very hard for him for a variety of reasons, but he’s been doing it for almost two weeks and last time he weighed he was already down 12 pounds!  (And he feels better, too.)  That’s giving him the motivation to keep going.
I convinced Jake that even though he is not sick he should get a check up (it’s free, after all!) and become established as a patient in advance of future need.  So he had his first visit with our new doctor yesterday.  When his TennCare was about to expire, just a little over a year ago, I took him for a last minute check up.  What he really wanted was a prescription for an asthma inhaler, something he needs infrequently, but does need when he needs it!  The TennCare doctor could not prescribe this without giving him some kind of test which was not available at her office and had to be scheduled at the hospital.  By the time it was approved and then scheduled, his TennCare had expired.  I am happy to say that his new doctor called in an inhaler prescription for him that was ready by yesterday afternoon.
There shouldn’t be a set of assumptions about people who are on TennCare which influences the care they receive.  There shouldn’t be different levels of care for people who have insurance and those who don’t.  But that was our reality, and Obamacare has changed that for our family.
For more on our journey from being uninsured to becoming healthy, and on my views on Obamacare in general, see the links below.
The $64,000 Question, Answered
Who Are the Uninsured?
Uninsured No More
ObamaCare Update
ObamaCare Update 2

Who Are the Uninsured?

So the other day I was looking at this sort of small boil thing on my leg (I know, I know, TMI but necessary to the story).  “Do you think this could be a staph infection?” I asked Teddy, figuring he would be the expert since things like that tend to lurk in locker rooms.  “Could be,” he answered.  “Well, if I start to see some necrotizing flesh I guess I will go see a doctor,” I said, and I was only kidding a little bit.
I went with John to his doctor yesterday.  There was no more putting it off.  He hadn’t seen a doctor for any sort of follow up since being diagnosed with diabetes in February.  They called him over the phone to let him know.  They didn’t tell him how to check his blood sugar, or what he should be eating, or anything.  And now he was out of his medicine.  He’d been out of five or so other medications for several months, but knowing so little about diabetes we didn’t know what would happen if he stopped taking that one.  So off we went.
We left $150 poorer, with a lab bill to follow, with a handful or prescriptions that will cost us over $500 every month IF we fill them all every month, and that’s after prescription club card discounts.
The last time I wanted to see the doctor, earlier this year, because my leg was swollen and I was worried about a blood clot, I went to the emergency room.  Yes, I am one of those people.  Why?  Because when I called the doctor’s office where I go when I am sick (which is thankfully never) they said I hadn’t been there in over three years, so I would be a new patient, and they would have to charge me for a check up first, and they wouldn’t be able to see me right away.  And I would have had to pay the whole bill right then.  This also happened to me the last time I got sick enough to need a doctor.  That time (I had walking pneumonia) I ended up at the Walgreens walk-in clinic (I recommend them, by the way.). See, healthy uninsured people don’t get annual physicals.  So they don’t have a relationship with a doctor.  When they get sick, they wait a few days.  Tough it out.  See if it won’t get better on its own.
Emily has student insurance because Spring Hill requires it.  She graduates in May and will enter the ranks of the uninsured unless she finds a job that provides insurance.  Luckily for her she is astonishingly healthy–no antibiotics or doctor visits for illness since the age of two.  The other kids are on TennCare but I’m pretty sure Jake gets kicked to the curb at 19–bad news, since he does take medications that it fully covers.  Teddy will have coverage in college, I suppose, and even if we lose TennCare for the little ones as we have fewer dependents, there is a program called CoverKids for them.
I could write several columns about the failures of TennCare but I won’t because despite all of them I am grateful that my kids have had insurance of any sort.  There were years when they didn’t, when I sucked it up and asked for a bill at the doctor’s office while staring at the sign stating that all accounts needed to be paid in full at the time of service, when we waited a day or two longer than other people might to see the doctor, hoping things would improve on their own, when we paid $100 for eyedrops for a corneal abrasion and used them on pinkeye outbreaks for years in order to get our money’s worth.
So how did we end up here?  Where did we go wrong?  Aren’t those uninsured people, those people who think they are entitled to healthcare, people who don’t work, or who are deadbeats, or who just don’t bother to purchase insurance?
Well no, they are people just like us, which is why I am writing about this very personal topic.  Because I think people ought to know that.
I’m not going to go through the last twenty-plus years and tell the whole sorry saga of our health insurance blues, because it would take too long and probably be boring.  I’ll just hit the high (the low?) points.
Growing up, I never thought about health insurance, and I’m sure you didn’t either.  I went straight from my father’s plan to my husband’s–I got married less than three months after I graduated from college.  I remember how fun it was reading about the plans and deciding which one we should pick.  That was right at the beginning of HMOs, and the Federal Government (where John worked then) offered Kaiser Permanente, which was free but kind of sucked, actually.  But it was a lot better than nothing.
The only problem was that when we moved to Knoxville, Cobra notwithstanding, we were screwed, because there was no Kaiser here.  So with a baby on the way, we entered the ranks of the uninsured.  I got a job at UT that had great benefits, but not for pre-existing conditions!  So Emily was an out-of-pocket purchase, paid off over many long years, as were two of our other babies.
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I was also writing for the Tennessee Register then, and I wrote a long article about the burgeoning health care crisis in this country–something I had never heard of at that time.  All the experts I interviewed said it was only going to get worse.  When I was seeking a position with the East Tennessee Catholic, I showed that article to the then-editor, and he wanted to know what it had to do with Catholicism.  Ah, hindsight.
That was my last full-time job, so I never was offered insurance again.  John was, at his first post-law-school position, but the family plan was so expensive that we couldn’t afford it, plus I was pregnant already and it wouldn’t cover that pre-existing condition–that didn’t stop TennCare from kicking me off though–because I was OFFERED insurance, even though we DIDN’T get it and it wouldn’t have covered me if we had!
Several years later, after John began practicing law on his own (that means no group coverage, people), he found a nice insurance agent who said he could get us affordable private-pay coverage.  He came out to the house and we picked a plan.  A few weeks later, we got the bad news:  because of his pre-existing health conditions, and the medications he was already taking, John had been declared officially uninsurable.
That’s right, folks:  that’s how insurance companies hold their costs down.  They weed out the people who need the coverage most.
After awhile, we did the math.  Paying monthly premiums, the deductible, and the co-pays for people who rarely if ever got sick made it impossible for us to afford the care and medications for the one person in the house who needed it.  We had to drop that insurance and it’s only become less affordable since.
In the ensuing years, there have been times (pregnancies, extended illnesses, excessive medical bills) that we’ve been able to qualify for TennCare in one form or another.  I was able to get my gall bladder removed during one of those times, happily.  In between, John only goes to the doctor for medication refills and we look for patient assistance programs and samples to cover the costs of his medications, or else he goes without “less important” medications.
Something has to be done about the state of health care in this country.  My European friends laugh at our resistance to “socialized medicine.”  They can’t understand why we wouldn’t want what they have.  The Affordable Health Care Act is not perfect, but it’s a start.  I trust the pro-life Democrats’ assurances that they are satisfied with the concessions that were made to them before they voted for the bill.  I may yet read the whole thing (900+ pages) to see what all it includes for myself.   My feelings about the HHS mandate are already on the record but I am still hopeful that it will be overturned or modified.
Reform has to come, one way or another, sooner or later.  It’s coming too late for some people.

Facebook Friends . . . and Foes?

Politics and Facebook- Do They Mix-
It’s still Education Week, but I’m taking a short detour to ask what you think about discussing controversial topics with your friends on Facebook.  Specifically, since it’s a social site, is Facebook kind of like a virtual living room, where discussions of politics and religion should be off limits unless you know the people really really well or at least know they are likely to agree with you?  Or is it like newsgoups used to be, a great place to say whatever comes into your head and the devil take the consequences?  Or is it perhaps some kind of hybrid, since you know most of the people in real life, albeit not always very well?
I have found myself feeling compelled to post or comment on several comments of a political nature recently:  Health Care Reform, taxes, and the National Day of Prayer.  Part of it has to do with the desire to educate and to inform.  When people post the equivalent of email forwards without checking Snopes first, it infuriates me.  It just does.  It’s like gossip, only worse, because it’s so easy to check.  I never forward an email without checking, even when I would love to believe what it says.  And I usually go one step further and inform the person who sent it (sometimes even all the people they forwarded it to–I’ve been thanked by several people for that!) when they have sent out false information.  When I see a suspicious posting on Facebook, I check it on Snopes and then post the link.
I’m going to write a long post on the topic of Health Care Reform one day, I really am.  I hesitated to wade into the messy debate waging on Facebook, especially since a large portion of my Friend List would no doubt disagree with my sentiments on the issue.  But on the day after the Affordable Care Act passed, I did post:  “Leslie Hunley Sholly is looking forward to being insured.”   Because I am.  And because I think it’s important to put a face on some of the people who don’t have insurance in this country, since it’s so very easy to think bad things about people when you don’t know anything about them or their circumstances.
Which leads me to taxes.  Probably I just should have been quiet when a friend made a comment about the percentage of people in this country who don’t pay taxes.  But I did want to point out that here in Tennessee the very people who are not required to pay federal income tax have to pay a more burdensome percentage of their income in state and local sales taxes on everything they buy.  And then when the topic turned to people getting money back in the form of credits even when they had no tax liability, I felt that it was dishonest not to own up to having received money back myself this year–and being quite pleased about it!
What do you think?  Do you ever make “political” comments on Facebook?  If others do so, do you comment on them?  If people do make such comments, should they be upset when their “friends” disagree?  Should I just shut up and play Farmville?  Tell me in the comments!
A version of this post was featured on BlogHer!  Check it out below.
Featured on BlogHer.com