I belong to a sisterhood of survivors. Mostly breast cancer. We've lost many sisters along the way. Now we are the survivors, anxiously waiting for the Affordable Care Act to take us out of the limbo we've been living.
In my own circle of the sisterhood, each of us has been fortunate to maintain health insurance yet we have paid a huge price for that privilege. Not only in premiums and ridiculously high deductibles, but lack of choice.
We've held onto the policies we had as if our lives depended upon it. Which it did and does. Over the years some held onto marriages to keep insurance long after the marriage was dead, some held onto dead-end jobs, some held onto junk insurance, a few managed to navigate the high risk pools. But all of us have participated in the larger fraternity of the health care insecure.
Some years I could afford the insurance premiums, but I had to borrow to pay for care. I rarely met my deductible. Some years I spent $13,500+ on insurance and deductibles without receiving anything from Anthem except a protection racket.
I know I'm one of the lucky ones: I have had insurance, money to pay for it and doctors who were willing to see me because of it.
I also understand that the ACA is going to be a godsend for those who have lacked health care for a decade or two or three. Please don't accuse me of being insensitive to that. I am aware of my relative privilege.
There are other ACA stories that need to be told. This one is mine.
I began my interaction with the ACA mid-summer when I attended a town hall hosted by Indiana's high risk pool. I wrote a diary about that: Obamacare comes to Indiana The gist of that experience was that I was very encouraged about what I was hearing.
I went online to www.healthcare.gov and opened an account. I had lots of questions and read everything I could find. I was relieved and excited.
Hearing that the system was overloaded last week, I waited a few days to apply. When I did it took me 90 minutes to navigate the security around the application process. Lots of do-loops and waiting, but I got it done and finally had a chance to read the policies.
Yikes! Narrow Networks. An ugly new term that you're going to be hearing a lot more about in the weeks to come. Very. Thin. Narrow. Networks. And my medical team is divided between them so I have to choose which part of my team I am willing to give up. I documented that experience in a diary that hit the Rec list on Sunday morning: It's official: I cannot keep my doctor with the ACA
There were a couple of pie fights in that diary because there is lots of anxiety about what is coming and what is happening. Several Kossacks encouraged me to write more as I navigated my choices, so here I am.
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Let me tell you one story. A dear friend, a card-carrying member of the breast cancer sisterhood, recently moved back to Indiana from out-of-state. She needs health insurance so she asked her agent/broker to see what was available. She is fortunate to have financial resources so she doesn't qualify for premium subsidies and will have to pay the full premium for an ACA policy. So check out this email from her agent:
I'm following up regarding my earlier message about your insurance. I've run some numbers for you. First, I've looked at private exchange plans (thru Anthem) that would be effective January 1 and these plans comply with the Affordable Care Act and therefore would NOT require underwriting. I've started with three options, all HMO plans. Hold on to your seat, they are expensive.
Gold: $1,052.68/mo $1,000 Deductible with a $3,500 out of pocket maximum
Silver: $865.23/mo $2,850 Deductible with a $6,350 out of pocket maximum
Bronze $688.03/mo $6,000 Deductible with a $6,350 out of pocket maximum
Another route you can go is to try to get a private (non-ACA plan) now with an effective date between now and before January 1. I've looked at Assurant health and the cost is substantially less. These plans do not cover maternity or mental/health/substance abuse. These do cover preventive wellness at 100% not subject to the deductible. You would be underwritten and they could say "no". Here are three plans:
$2,850 Deductible, then play pays 100% so out of pocket max is $2,850: $668.40
$3,750 Deductible, then plan pays 100% so out of pocket max is $3,750: $572.79
$5,000 Deductible, then plan pays 100% so out of pocket max is $5,000: $471.84
We could raise your deductible and out of pocket max the quotes would be even less.
If we got you approved you could lock-in a rate until December 15, 2014. What would happen then is the Assurant would have to change your contract to be ACA compliant and would likely adjust your premium to something that looks like Anthem's rates. If you went this route you would at least know you have an excellent plan and lock in rates until December of 2014. Back to underwriting - Assurant wants someone to be 8-10 years cancer free. So, I'm not sure if they will accept you or not. If they do say "yes" they could rate you or tack-on a percentage to the above costs. We can try.
Here's what disturbed me about this scenario. First of all, I didn't know that underwriting was still in effect until the new open enrollment period in 2014. I thought it was a thing of the past.
So my friend, may not have an option here. She may have to take the ACA policy.
Here's the second thing that disturbs me. The ACA policies are significantly more costly. For many low-income folks who will be subsidized, they probably won't know or care but here's the kicker. Those pricey policies are narrow network policies with significantly fewer options than the traditional individual policies so the insurance companies are making money coming and going with these policies. I know, I know. We all knew this was coming, but it's important to document this as we continue to advocate for single payer.
When people are hollering that the ACA is a give-away to insurance companies, this is what they mean: the ACA policies are designed to offer less at a higher price which is being subsidized by the federal government. This would be invisible to the average person obtaining health care on the marketplace.
This isn't good and it doesn't help to pretend that it is.
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Again, let me reiterate this fact: My issue is quality care for individuals with pre-existing conditions and a trusted team of doctors who are managing it. Early on I expect that the issue of narrow networks will be my primary focus.
I can't do it all so I encourage others with the interest and passion to attend to the other things that need to be improved for other populations. You are welcome to post here as we enumerate things that need to be worked on. However, others will have to run with that ball and I'll be cheering you on from the sidelines!
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In this weekend's diary lots of great info was crowd-sourced and we learned a lot from one another. This week I'm going to be identifying the issues that are coming up. I am asking for your help.
Answers probably don't exist for all of our questions because this is so new that things are being created, literally as we speak on Monday morning. Programs and policies are being tweaked, massaged, changed and improved. This is a time to identify the issues and become issue advocates.
Let's get started:
What have you learned about the choices being offered in your area?
Is your team of doctors in the network being offered?
If not, what percentage of the cost for out-of-network services will be covered, if any?
If out-of-network services are covered, are they covered at all policy levels?
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I will respond to comments, edit and update this as a live blog for the next few days, so bookmark it and come back to share what you know. Together we will figure this out to advocate for a stronger, more progressive and secure health care system for all.