Not Repealed and Not Imploding: An ObamaCare Update

When last I wrote on the topic of healthcare back in February, I envisioned writing many posts on the ACA this year.  I was HOT.  I wanted to showcase some stories (besides mine) of people who have been helped by the law, and I wanted to encourage activism to prevent its repeal.
But I find my capacity for outrage is finite, and the constant barrage of bad news on this topic and others has stretched it to the limit.  ObamaCare has survived almost an entire year without Obama, with little help from me other than the occasional Resistbot letter to my Congressmen (who voted in favor of every lame proposal thrown up by the GOP this year despite my pleas).
In just a couple of weeks I’ll be back on the ACA website, and I wanted to tell y’all a little about the way this year–on a new plan–has gone for us.  I want my readers to see at least one story that demonstrates that the ACA is NOT imploding (Yes, it needs revision.  I have always said that) and that it is still helping people.
In addition to regular checkups for John, Emily, Teddy, and me, we’ve had some expensive extras that would have either been out of reach when we were uninsured or would have thrown us deep into medical debt had we chosen to go forward with them.  Back in March, John developed bursitis.  He went to the doctor three times–including twice to a specialist–and the chiropractor once, had two sets of X rays and an MRI, and got a cortisone shot and several medications.  All this helped us to meet our deductible early in the year (we are still paying for the MRI), but we wouldn’t have gotten in the door to run up these bills if we didn’t have insurance.  I cannot stress this often enough:  insurance equals ACCESS!
In September, John’s doctor was concerned with some symptoms he was having and ordered an EKG, and then sent him to a cardiologist for further testing.  I haven’t seen the bills yet for the stress test and heart ultrasound performed at the hospital and two visits to the cardiologist (he’s fine, by the way), but I know that we will only be paying 20% of the negotiated rate.  Insurance equals LOWER PRICES!
I had my first mammogram this year, and am scheduled for my first colonoscopy in November.  If I didn’t have insurance, rest assured I would not be getting these screening tests performed.
Finally, last week I noticed some discomfort and a coating on my tongue.  I was pretty sure I had an oral fungal infection.  Did I wait to see if it got better on its own?  Did I look for home remedies? That’s what I would have done and did do, back in my uninsured days.  No, I called the doctor and made an appointment IMMEDIATELY, got some medication, and felt better after two doses.  Being able to go to the doctor right away is a privilege I do not take for granted.
Have we had issues with the ACA this year?  Certainly.  Due to quirks in the sign up process, we were not allowed to insure Jake.  So when he wanted to go to the doctor in September, he went as a self-paying patient.  However, the fact that he has been insured the past three years meant that he had a relationship with our doctor, and she was willing to see him and even give us a discount for paying the whole bill up front.
Also, I don’t much like having to get my prescriptions at Food City with its limited hours; but on the other hand its small size means a very personal touch that I didn’t always experience at Walgreens, and a relationship with the actual pharmacist.
Look for another update after I undergo the tribulations of Healthcare.gov.  Last I heard, Blue Cross will be making a reappearance in the Marketplace, but I have no idea whether our former plan will still be available or how much the rates may rise.
For more of my ObamaCare stories, see below and click away!
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
Obamacare in Practice:  An Update
An Open Letter to My Friends Who Want to Repeal ObamaCare
Obamacare Update: Good, Bad, and Ugly
 

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

Obamacare Update 2

As promised, I will continue to update you on our family’s journey out of the ranks of the uninsured thanks to the Affordable Care Act.  Here’s where we are now:  John, Emily, Jake, and I are fully insured through BCBST.  Lorelei and William remain on TennCare which seems to be in a kind of limbo status–we haven’t heard anything from them in months.  Teddy remains uninsured but I have been contacted regarding my appeal, so we’ll see.  I really think it’s a glitch of some kind.
If you did not purchase a policy on the Marketplace because you were afraid the outlay for the monthly premium would outstrip the value of the health care received, let me tell you a few less obvious benefits of having insurance, some of which I did not know until I had it.
1.  When you visit any doctor, even the Walgreens clinic, YOU DON’T HAVE TO PAY UP FRONT.  That’s right, they send you a bill.  So you don’t have to forgo medical care if you are short on cash on a particular day.  Yay!
2.  You reap the benefits of something called the “negotiated rate.”  That means everything is cheaper for you, even before your deductible is met, than it would be for an uninsured person.  Medicines cost less.  Doctor visits cost less.  That above-mentioned trip to the Walgreens clinic costs an uninsured person $90.  It cost us $60.
3.  You have access to more doctors.  When we had TennCare, it was easy to pick a doctor because there just weren’t that many who accepted it.  And many of the ones who did accept it would not have been my first (or second, or third) choice.  And get this:  at our former practitioner’s office, TennCare patients HAD to see the nurse practitioner instead of the doctor.  We happened to like the NP, but it still felt like we were being told we weren’t worthy of the actual doctor.
John is having his first visit with the doctor today.  Jake and Emily have checkups scheduled for next month.  Jake has been to the Walgreens clinic and another specialist already. We have purchased MANY prescriptions.  And I have had FIVE visits with health care providers since March.  That’s more visits than I normally have in five years, and I’m not exaggerating.  John has met his deductible, and I believe the family one was met as of yesterday.
Now on a more personal level, how is this benefiting us?  Well, I went to the emergency room a couple of years ago because I was worried about the possibility of a blood clot in my chronically sore and swollen leg.  Why the emergency room?  Because that is where people with no insurance go for health care.  I tried to go to the doctor I occasionally saw only to be told that I was no longer considered their patient because I had not been there in two or three years.  Anyway, there was no blood clot; I was told to follow up with my (non-existent) regular doctor; and I’ve continued to suffer.
At my first check up with my new doctor, she prescribed a mild diuretic.  It was like a miracle.  The swelling is greatly reduced, my blood pressure went down, my energy doubled.  If I’d had health insurance, I would have gotten this little pill years ago.
I used to lie awake in bed at night worrying that when I went to the doctor (I was counting down the months and days until the ACA went into effect) that there was going to be something really wrong with me.  I had strange feelings (attributable to high blood pressure, and GONE thanks to that little pill) that caused me anxiety.  When you don’t have insurance you are afraid to see a doctor even if you can afford one because what if they find something wrong which becomes a pre-existing condition and makes you uninsurable down the road?  But I don’t have to worry about that any more.  NO ONE DOES.  Because there is no punishment for pre-existing conditions under the ACA.  And there’s no more uninsurable either.  I also don’t have to worry about it because I got it checked out.  I had an EKG and now I know I am okay.
As I mentioned in the last update, I had my first check up (check ups are free under my plan, by the way) in mid-March.  That’s when I got the little pill.  I also had blood drawn.  I came back two weeks later for the EKG, and to discuss the results of the blood work.  I was low on Vitamin D so I got another pill (a much bigger pill!).  My glucose, cholesterol, triglycerides, and blood pressure all need to come down.  Did my doctor throw more pills at me?  No, instead she set up an appointment with the wellness nurse (for exercise) and the nutrition nurse.  I’ve seen the wellness nurse twice (that’s $20 each time) and the nutritionist once (six visits per year are included in my plan).  I’ve learned about a new way to eat (I will write on that separately later) and I am walking regularly (as you might have surmised).  I won’t know if my levels have gone down (and I’ve been warned that sometimes they go up before they go down) until my next check up toward the end of June.  But I do know that I feel great and that I’ve lost 15 lbs.
I know that this story is only a personal anecdote, but remember, so are the Obamacare horror stories that you see in your newsfeed.  That’s why I’m speaking out on this very personal topic.
John is at the doctor as I write.  If he will allow it, I will include some of his story next time I update.  I promise to keep you posted.
If you want to read this story from the beginning, see below:
Who Are the Uninsured?
Uninsured No More
Obamacare Update

Uninsured No More

Since I’ve come out supporting the Affordable Care Act, with reservations, both here and on Facebook, and have publicly stated that my family would be applying for coverage, I thought I should let you know that as of February 1st I have joined the ranks of the insured at last!
You will see and probably have already see “Obamacare” horror and success stories in the media.  I am going to share my family’s story, and I hope you know you can trust me to be honest.  There will be no slant here, just anecdotal evidence of how this has worked out for one family.
I was excited to sign up for health care as soon as the website opened.  And that website was just as much of a mess as you may have heard.  The dysfunction could hardly be exaggerated.  I finally managed to get registered but even after days of trying could not log back in.  I figured I had plenty of time to sign up so I decided to come back and try again after the glitches were fixed.
Well, you can imagine what happened, given that the deadline for January 1st coverage was December 23, right in the middle of Christmas preparations.  I waited too long, didn’t realize how much there was to the application process, and had to settle for getting covered in February instead.
That said, the log in problem was solved with a phone call.  The process still had some glitches, definitely, but I was able to get help for all of them from customer service, and the wait times were short.  If you plan to apply, be aware that they are going to need all kinds of detailed financial information about everyone in your family who makes money.  One of the problems I had with the application was that it seemed to be impossible to leave it and come back where you left off.  The info was saved, but you had to click through all the screens again, not exactly a tragedy but a pain.
Once through the screening process, our results were mixed.  John, me, Emily, and Jake are all covered together.  William and Lorelei are supposed to be able to stay on TennCare.  Teddy was deemed ineligible.  I’m afraid he might be falling in that Medicaid hole caused by Tennessee’s refusal to fully participate.  I called a counselor, who said the results did not make sense to her, and I am appealing that part of it.
But in the meantime, four people in my family, four people who were completely without health coverage, are now insured.  About 15 monthly prescriptions are now covered.  A person declared “uninsurable” 13 years ago now has insurance.  All the pre-existing conditions don’t matter.  I can stop being afraid to go to the doctor for fear that they will find something wrong that will disqualify me from being insured down the road.
We did not choose the cheapest plan.  With subsidies we could have gotten one for about $85/month.  You can decide what level of coverage you want, what doctors you want on the plan, what your premium would be, what your deductible will be.  There are many, many plans to choose from.
We picked a plan with a $600 deductible per FAMILY.  With a $4,000 out-of-pocket limit for the year.  With free yearly check-ups, and pretty much 80% coverage of everything once the deductible is met.  Every doctor we care about accepts our plan.  We will pay $272/month.
Even with all the glitches, that’s a success story for us.  I’m going to be shopping for a primary care physician and I’m going to make appointments for the four of us with every kind of doctor we have ever wanted to see.
If you haven’t applied yet, it’s not too late to see what kind of deal YOU can get.  Go to www.healthcare.gov and apply before February 15 to be covered by March 1!

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.