A space to post my thoughts and musings about anything. This includes but is not limited to community, politics, current events, relationships, LGBTQ+ issues, favorite things, and stuff that would make your dead relatives blush. I am not afraid to go there, as some can attest.

January 10, 2017


The Affordable Care Act (ACA), yes it has its issues and yes it needs work.  The one thing it definitely doesn't need is to be repealed and we end up going back to the way it was before.  It's amazing how many people seem to conveniently forget how terrible it was to try to get insurance or actually use it before the ACA came around.  I mean it can still be a pain in the ass to use medical insurance, but I can't help but recall a story from my early adult life.

Back in 2004 I was a college student out in New Mexico and when it came to any form of insurance, I had whatever my university offered, which was the basics.  I visited the student health center a few times but that was about it.  Since I was going to graduate in a year and I wasn't sure about if health care would be offered by a future employer, I looked into getting health insurance for myself.  Yes, back then there were many employers didn't offer health benefits because they didn't have to if they didn't feel like it.  Maybe there was incentive to do so for some larger places so that it would attract employees.

So I filled out an application with Blue Cross/Blue Shield of New Mexico.  I'd been under a different BC/BS with my parents and they seemed good.  A few weeks later I got a response letter with a rate quote and further details about what they would offer.  However, there was also another letter in there, one that would have become a problem if I had chosen to purchase their insurance.

Earlier that year I had landed in the ER in extreme pain in my lower back.  The diagnosis? Kidney stones.  That was a rather fun night I'd rather not have to re-live as I also learned that Vicodin and I do not get along very well.  So needless to say it wasn't pleasant.  This matters because when I went to apply for insurance, I self-reported that I had experienced kidney stones since there were questions about past medical history.  This was about to bite me in the ass.

The letter included with the packet was a change to their coverage, basically saying that they would not cover any renal events.  In other words since I had experienced a kidney stone, they were changing it so that anything involving my kidneys would not be covered by them, period.  I had a "pre-existing condition" and they were using it against me.  If God forbid I ever got another stone, and infection, or if something caused them to fail, I would have had to pay the bill out of pocket because BC/BS of New Mexico would not have covered it.  We know how expensive medical treatment gets in the US and something like that would have bankrupted me later on if anything had happened while I was starting my career.

I ultimately decided to decline their insurance and when a rep called and asked why I was not purchasing, I told them exactly about the clause they had inserted about the non-coverage of renal events and that I refused to accept it.  She then told me I could have appealed that clause.  The funny thing was there was nothing in any of the paperwork that indicated that I could have appealed any clauses or changes to their coverage.  Nope, they pretty much made it sound like I had to accept their insurance or get nothing.  I wouldn't be surprised if there were many others who felt they got the same message from their insurance companies.

The funny thing is that if the ACA had existed back when I was in college, I wouldn't have had a story like the one above because I could have stayed on my parents insurance while I was in college.  It wouldn't have affected their rates and heck, I might have been able to not pay as much as I had to out of pocket for the ER when I had my stones.

So fast forward to 2005 and I'm graduated and starting work for the Feds out in DC, which meant picking insurance through them.  Now, this is where I'll acknowledge my privilege in getting insurance via the Feds at that time (and likely further privilege today).  To participate in providing insurance, they couldn't ban you or mess with your coverage or rates because of pre-existing conditions.  Of course, they would try to do what they could to make it difficult at times or to make sure you still paid plenty out of pocket (as my bills for my later appendix surgery would remind me).

Then there were rates, and this is where I definitely see an impact from the ACA.  Back then there wasn't much to stop raising rates, even for Fed plans, and they were pretty much guaranteed to go up every year.  In 2005 I was paying about $102 a month for my medical insurance.  In 2010 when the ACA was signed into law it was at $162 a paycheck.  So in five years it already shot up $60 a month.  As of 2017 it is now $212 a paycheck, which sucks but the ACA has slowed it down and the coverage is better due to the minimum requirements that were added in the law.

I also remember when I first started dating my now-fiance and since he's a freelancer, he couldn't have insurance before the ACA so it was pretty much a situation of "Don't get sick" which meant putting off things like doctors visits for checkups and hell, not even having a doctor but using urgent care clinics to avoid the ER if that was possible.  Now he has a doctor and gets his care without waiting to get sick first.  He's on a basic level but it's more than he had before.  Still, it would be nice to see something better in the future.

So what it boils down to is dealing with medical insurance and all that before the ACA sucked, and I really do not want to go back to that way, period.  It's why I've let my Senators know not to let the repeal pass and to push instead for fixing it.  Hell, it would be nice to put the brakes on the rates because those do suck, but taking away the ACA isn't the answer.

No comments:

Post a Comment