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Dear Facebook Friends:

Next time you are tempted to gleefully post about how happy you are to see ObamaCare repealed, I want you to think about the people whose lives are going to be affected dramatically when that happens.  I want you to think about people who are terrified of losing their coverage, who went years uninsured,  who saw doctors only when in dire need, who went bankrupt due to medical bills, who visited the emergency room for care because they didn’t have the money a clinic would have demanded up front, who spent hours researching online and filling out forms and chasing down doctors for signatures to get prescription medication payment assistance, who figured out which of their medications they could forgo in a given month, who held their breath in the pharmacy drive-through line while they waited to hear the terrible total.

You are entitled to your opinion and the ACA isn’t perfect, but it’s sure better than the nothing many people had before it was passed.  You can suggest changes and discuss drawbacks and talk policy without appearing to be enthusiastic about the fact that millions of Americans stand to lose their care and that some of them are going to die.

Consider, please, how it makes me (and others) feel when I see people who are supposed to be my friends celebrating the fact that my family may soon be without health insurance and thus effectively without care.  In my posts on this topic in the past I have always been careful to affirm my friends who told me that the implementation of the ACA had caused them difficulties like higher premiums and changes in doctors.  I was always sympathetic and willing to concede the imperfections in the ACA, as evidenced by my many honest posts  (which I will link at the end).  I agreed that improvement–although not repeal–was needed.

Remember that there are suffering people who see your Facebook posts, people who are frightened, for whom this isn’t about politics or partisanship or finances but about staying alive.  Remember that, and if you care about those people, watch the tone of your posts.

Your friend,

A Once and Possibly Future Uninsured American

My previous posts on ObamaCare:

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

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We were a little late getting signed up for Obamacare when it launched, so this month marks our one year anniversary–one full year of being insured!

I know that “anecdotes don’t equal data.”  I also know that UNBIASED data I’ve read on the success of Obamacare has been largely positive.  But right or wrong, anecdotes are what people listen to and remember.  That’s why I’ve been sharing my family’s experiences–both negative and positive–with my readers.

Obamacare has been a success for my family.  Here are the 2014 stats:

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

That’s a lot of money, but it’s $41,521.91 less than we would have paid if we DIDN’T have insurance.  Actually, what would have happened is we would have gone without care.  We wouldn’t have had the tools to improve our health the way we have this year (more on this in my next update post).  Jake would have been left with a non-functioning finger after his accident.  We would have tried to do without medications that were less essential.

If you’ve always had insurance you may not realize another huge plus:  ACCESS.  If you don’t have insurance, you are expected to pay for services up front, except in the emergency room (which is why the uninsured–and I’ve been there–head for the emergency room for primary care).  With my magic BCBST card, I can go to the doctor and pay later.  We still owe money for Jake’s surgery.  But he GOT THE SURGERY.  The only thing we had to pay in advance was about $150 to the surgery center.  Furthermore, you will pay MORE for those services because without insurance you lose the special negotiated rate, which basically halves the out-of-pocket costs.

I’ve been honest in my reporting so you already know that our experience has not been completely positive.  To recap, part of the family was not originally covered.  Although that was rectified in August, I still have not gotten a satisfactory response on the appeal I filed, which was your basic bureaucratic comedy of errors.  At this point I am probably letting it go, as the benefits really don’t outweigh the PITA factor.  The website itself is just terrible and while it may not crash as often as it did in the beginning, there are still plenty of problems with it.  On the bright side, the customer service is excellent.  They will do whatever you need right on the phone, and they are kind, pleasant, knowledgeable, understanding, and efficient.  As someone who has spent literally hours at a time on the phone with TennCare representatives, I appreciate that.

Finally, as seems to be true for many people, our premium went up at the beginning of the year.  WAY up.  It’s $200 more this year, and while it is way less than what we would pay (and couldn’t!) without the subsidy, it is still a stretch.  Many blame the rise in premiums on the ACA; I blame it on the greed of the insurance companies and think the solution is a single-payer plan, which I hope we finally get some day.

You have until February 15, 2015 to apply for your own plan!  It can’t hurt to take a look.  Maybe you will get lucky–and healthy–like we did.

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

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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

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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 http://www.healthcare.gov and apply before February 15 to be covered by March 1!

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