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