InTruBeauty: The Uncertainty of Obamacare

Monday, October 7, 2013

The Uncertainty of Obamacare

Despite being a political science major in college, I rarely write about politics and really haven't done so on my blog before. With all the recent changes to healthcare and health insurance however I feel a need to voice my own opinion and personal experiences on the matter. I've also worked at a health insurance company before and have studied healthcare law extensively. This is based on my own personal situation and I'm not an expert by any means.

I am self-employed and therefore 100% responsible for paying for my own health insurance. I was one of the unlucky ones to graduate from school and within the same day be kicked off of my parent's insurance, forced to buy expensive cobra continuation coverage until I could find long-term comprehensive coverage which was a hefty task to say the least. I had to apply to many insurance companies and be rejected despite my young age (25) and absolutely no health problems solely due to my weight. I finally found a health insurance application that did not have underwriting questions such as asking you how much you weigh and I was approved for catastrophic coverage. I had to reapply for coverage every 6 months. 

My first job after obtaining an advanced degree did not provide health insurance. As per my contract, after 1 year of working there, I was to be provided health insurance. After my 1 year anniversary of working there, I was given an additional $100 per pay period ($200/month total) and a card to call an insurance agent. Literally. Shortly after that I branched off and started my own business. Hell, why not! It's not like I was passing up a great benefits package to have to struggle on my own. 

So for many years after graduation and entry into the full time work force, I had catastrophic coverage only. This means you pay a very low monthly premium and if something catastrophic happens like a car accident or a serious illness, some of your costs will then be covered and you may not have to file for bankruptcy. The American dream. I've also gone without health insurance for over a year in order to try to apply for insurance through the state. You have to have been uninsured at least one year. So I crossed my fingers and hoped for the best during that year. After that year, I applied and was put on a wait list for a program which was frozen and no longer accepting any applicants and in fact had kicked people off of the program. The only doctor I could see would be my obgyn since I did have family planning coverage. That one doctors visit (actually I always went to a nurse practitioner to keep costs down), became my sole form of health care for years. My obgyn essentially became my primary health care practitioner since that was all I could afford and even then some visits cost me between $200-400, which I had to pay off in monthly payments. 

So, here I am: young, healthy, motivated, highly educated and employed. And without health insurance. 

Finally, finally after about six years in this limbo of COBRA continuation coverage to short term catastrophic plans to no insurance to family planning coverage only, I found an affordable comprehensive plan that would not discriminate against me solely because of my weight. 

I applied for our State's High Risk Pool. I had heard of it before and kinda sorta understood what it was about. But high risk? Me? Nah, I'm young, healthy, no pre-existing conditions besides allergies, happy, motivated young woman. I never thought this would be my only option for actual health insurance, but it was. So for $143/month I receive comprehensive coverage and 100% preventative care coverage. I still rarely see a doctor because I end up fighting medical bills for months after for improper coding and billing. Yet, it was still a relief to have actual  health insurance, despite its imperfections. And it only took me about six years after graduation to find!

This is basically one of the problems that Obamacare was meant to swoop in and solve....affordable coverage for those that can't otherwise obtain coverage. But that already exists in most states (35 states to be exact) in the form of high risk pool. For me HIRSP was my saving grace
Since the first state high-risk health insurance plans were established in Connecticut and Minnesota in 1976, risk pools have grown in number and have evolved in their role in addressing inequities and inadequacies of the health care system. Today, risk pools are accepted, proven programs that serve special needs, and contribute an element of stability in key individual markets of the insurance system.
Health insurance risk pools serve two primary roles-- they provide a means for guaranteed access to insurance, that enables individuals to protect themselves from catastrophic medical bills; and they are increasingly recognized for the role they play in helping to keep the individual insurance markets viable for companies to continue to compete in.
First of all, I do not consider requiring everyone to purchase health insurance as healthcare. The limited information I can find about these plans offered in the Obamacare marketplace at first glance do not have a lot of coverage (sometimes 50% of the cost being attributed solely to the patient after a high deductible). Available insurance plans are dependent on which county you live in. Yes, which county. I live in a town of around 60,000 people with two major hospital systems, but what will people do in rural areas or with transportation issues?

I have two options for health insurance in my area. They are both through the two hospital systems. There are no big name private insurance companies in this game, just the two hospitals dueling it out to keep their bread and butter at their facility. What happens if I travel outside the boundaries of my cozy county as some people often do in this global world?!?

But what's the problem? I have insurance through HIRSP. Not so fast! Because Obamacare swooped in to "solve" the problem of people with pre-existing conditions and no coverage options, my Republican governor has decided to sunset my insurance program. 
Recently, Wisconsin passed a new state budget that sunsets the Health Insurance Risk-Sharing Plan. The language approved in the budget establishes the last day of coverage for HIRSP and HIRSP Federal Plan members as December 31, 2013 unless the federal Health Insurance Marketplace (also known as the “Exchange”) is not offering coverage with an effective date of January 1, 2014. The federal Health Insurance Marketplace is the key feature of national healthcare reform.
So now you're taking a person who has comprehensive affordable coverage and ending that program, forcing that person to now buy from very limited selections in the Obamacare marketplace. Or I can decide to buy my own private insurance and not be eligible for a premium subsidy. Which I'm going to need since the plans I've seen are about twice as expensive and with less coverage than what I already have. Isn't this the opposite intent of what Obamacare was meant to do?

What I hate about the current situation:
  • It's so hard to find exact information! All I want to know is how much this is going to cost me and what is and is not going to be covered!
  • It's super confusing, even for educated people with access to resources 
  • Limited options (I only have 2 insurance options in a medium sized county)
  • Navigating the application process with repeated technical issues
  • 90,000+ People within 101%-250% of the federal poverty line are being kicked off of our State's insurance. This causes a lot of problems for social services and may cause a lag in the type of work that I do. This is a population that still doesn't have a lot of money and who may have a hard time navigating the system and affording any premium. So we end with a situation of two programs being cut or sunset like mine and thousands upon thousands at the mercy of Obamacare. This is because of decisions on a state level.
What I do like:
  • No pre-existing conditions can be considered
  • Mental health coverage
  • Preventative care covered 100% 
  • Women's access to healthcare increased
  • Women can not be charged more than men
  • Requiring people to purchase insurance they can't afford which may have limited coverage is not health care! 
  • Only those under 30 can even chose to purchase a less expensive catastrophic plan
So okay, I'll stop my belly aching because I have but one option and that is to purchase coverage in the Obamacare marketplace or be fined. So, I'll do do that. Oh wait, the website doesn't even work and I can't even register or set up an account. I've tried twice in a week and no dice. The most frustrating part is the only way for me to figure out how much this is going to cost and if I qualify for a subsidy is to apply for coverage, which at the time I can't even do. I called and was told to try again and then try at a later time when there was less traffic. 

Almost there......or are we?

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