(*With all due respect to my good friend @JayMcInerney)
You
are not the kind of guy who would be in a place like this at this stage of
Obamacare. With your biography, you
could've been its poster child, but now you're in danger of becoming one for
the opposition.
By
now, everyone has an Obamacare story to tell.
While the Administration touts the 8 million Americans who signed up,
many for the first time, others grumble about bureaucratic nightmares, abrupt
cancellations, or online-exchange glitches. You've suspected the truth probably
lies somewhere in the middle, but now you feel you've been had. You—an informed
consumer who advocated for such reforms for years.
You
hate yourself for writing this, providing fodder for antagonistic Republicans. It gives you what psychologists call
cognitive dissonance. As a self-employed
professional with pre-existing conditions up the wazoo—quite literally,
actually—you craved the basic fairness of the Affordable Care Act. Before it, your only option was an
outrageously expensive PPO that paid 70 percent of in-network doctor bills and
50 percent of so-called "customary rates" for out-of-network
services. For this you forked over the
princely sum of $10,408.80 a year in premiums.
But
as a "high-risk patient," you were grateful for what you got. You were born with a neuromuscular weakness
called spinal muscular atrophy; you've never walked or stood, and your lungs
are so weak that a bad cold could kill you.
People like you can't be too choosy about their health insurance. Employers rejected you, though you'd
graduated from Harvard with honors. The
only work you could secure were freelance magazine assignments. As an independent contractor, you had to
secure your own coverage. But when you
aged out of your parents' policy, in the late-1980s, you couldn't buy health
insurance at any price. So you joined
organizations—the National Writers' Union, the Media Alliance, etc.—just to
score a group plan that didn't require a medical examination. Still, carriers kept dropping you. They called you too expensive.
The
Clinton Administration brought passage of the Health Insurance Portability and
Accountability Act, which enabled you to purchase insurance without any
pre-existing-condition exemptions if you had proof of prior coverage. A terrific help, this is how you ended up
with the pricey PPO. You clung to it for
years.
But
last October you received word that it was ending, thanks to the ACA. No worries.
You would be automatically shunted into a new policy that slashed your
premiums in half and cut your co-pays to practically nothing. Even when the application process faltered,
you defended the new order. Friends and
family held you up as an example of its success.
Granted,
your gratitude waned when you learned the new, cheaper plan excluded your local
hospital and its doctors. But soon,
undeterred, you found a competitive policy and made the switch before the
cutoff date. Progress is always bumpy,
you told yourself.
You
were so innocent.
The
weeks that followed were filled with obtaining authorizations for ongoing
prescriptions. Some had to be
transferred to a new mail-order pharmacy.
Small hassles, to be sure, but you believed this was a phase that would
pass. Only when your primary physician
suggested you consult a specialist—a cardiologist for a routine scan--did a
true sense of panic dawn. "The
doctor won't see patients with any of
the new plans," the receptionist politely but bluntly informed you.
Ditto
the second and third cardiologist referrals.
Next, your beloved urologist, whom you found only last year after
rejecting several others, said essentially the same thing. Even your long-time gastroenterologist and
colorectal surgeon (six years ago you had a colectomy, hence the wazoo
reference) blackballed you.
It
seemed impossible. You had been so
careful, so sure. A physician friend
explained that the new plans are simply not paying doctors a fair and adequate
rate. Doctors who accept them are losing
money. This is how insurers are making
up for what they've had to give up under Obamacare. Soon, your friend cautioned gloomily, many
doctors could go out of business. It
could become practically impossible to find any doctors willing to practice.
You
do not believe it. Obamacare couldn't be
the end of medicine as we've known it.
Yet for now, you have to choose between seeing specialists you don't
want or paying full-freight for ones you do.
In which case, why have insurance at all? Then you remember: you don't have that choice
anymore.
You
are stuck—stuck with a cheap plan that doesn't serve your needs. It doesn't matter that you went for the
"platinum" option, foregoing tax breaks you might have received from
the state-sponsored exchange. It's still
no good. You even asked your broker if
there's any kind of supplemental, stopgap policy you could purchase. She said no.
You can't change anything until the next open enrollment in mid-November.
Will
there be a better choice then? You can
only hope.
Ben
Mattlin
Author of Miracle Boy Grows Up: How the
Disability Rights Revolution Saved my Sanity
Los Angeles, CA