The main three pre-existing conditions are my age (57), my residence in Monterey County, California, and my 2012 income that was 413% of poverty. While I rejoice for those who are going to have a taste having health insurance after years of anxiety, I am overwhelmed at how Obamacare will be affecting me. I can either go back into that pool of the uninsured (where I have been before) or continue happy crappy coverage and pay significantly more for it than I pay now. My current plan with Blue Cross has been $410 per month (after California went after Blue Cross and made them reduce their premiums) but purchasing an individual plan for 2014 via the exchange will be a minimum of $550 per month, 13.89% of my annual net income. I'll still have a $5000 deductible and 40% co-pays. I'll still be buying my name-brand medication from Canada for $83 per month because the $5000 deductible includes medications. The extra $140 premium per month will have to come out of the amount I am able to put away for retirement, which is already sketchy and continues to get sketchier.
So, I'm riled up with all the reactivity I am seeing in the diaries and comments at Kos about people's complaints about Obamacare--the accusations of lying (I'm sure some people are), of being too ignorant to understand (I'm sure some people are) and of being part of the right-wing nut factory (I'm sure some people are). Yes, it's a better system than what we've had, but it's also completely inadequate, too complex, and doesn't do nearly enough to contain health care costs. I'm a person who doesn't mind paying taxes--who wants to! to support those things that make a livable society for all. I want to see people fed, housed, receiving health care, educated, having access to public utilities (including internet and phone), public recreational spaces, etc. through public/community funding. I know that when I need a plumber, a carpenter, a mechanic, a teacher, a cashier, a good moisturizing product, I am benefitting from public education. I appreciate being able to drive to work on roads that are maintained by county, state and federal funds. I recognize that access to clean water, to electricity (and to the minds that figure out how to store and distribute those things), are available only because we come together to pay for those things. That's a good system.
At the same time, I am angry that I'm going to be subsidizing the health insurance companies, and only secondarily other people's access to less-than-adequate insurance that still will turn over a profit for the insurance companies. I am discouraged at best, outraged at worst. According to Covered California, I am not eligible for any subsidy. I have three options for a Bronze Plan (two are Blue Cross) at monthly premiums of $550, $552, $558. The lowest premium for the two available Silver Plan options is $736, the other is $806 per month. A 30-y-o will pay $256-$343 for Bronze; a 45-y-0 $326 to $436 for Bronze. From what I can find on the Covered California site, I am eligible to have the tax penalty waived if I don't buy insurance. Or I can purchase a "minimum coverage plan," which is nowhere explained and no resources for finding such a plan are to be found on the siute, so I can't see that I have any other option than to do without health insurance if I can't afford the premium. And to think the Bronze Plan on the exchange is going to be a vast improvement over the plan I have now is a false assumption.
In insurance language, a $5000 deductible is not met by paying $5000, but by the insurance company's determination of what they WOULD HAVE PAID HAD THE DEDUCTIBLE ALREADY BEEN MET. So, for instance, with a Bronze Plan and 60% co-pay, only 60% of the charge will be applied to the deductible. So if you have a $5000 deductible, and only 60% of what you actually pay gets applied, then your deductible is really $7000--$5000 plus the 40% that the insurance company doesn't count toward the deductible. After that $7000, you could pay $6350 (the stop-loss amount), which brings you to a total of $13,350 that you'll be liable for. If the $6350 is determined in the same way as the deductible, then it's not $6350 but 40% more, $8890. Add in $6600 of premiums and you come up with $19,950 or $22,240 per year. I make 2.5 times $19950 per year. How many years do you think I can sustain those kinds of costs if I should get seriously ill or injured more than one time? Or have a long-term illness needing long-term treatment? "Affordable" is an egregious misnomer. Though the Covered California site states "It is important to think about how much health care you will need" it is impossible to know, and also useless to know if you can't afford better coverage even if you have the foresight to know you'll need it. If I need a lot, I won't be adequately covered by the Bronze Plan anymore than I'm adequately covered until Dec. 31, 2013 by the plan I currently have, to be discontinued by Blue Cross on Dec. 31. I suppose that all plans that cost less than the plans on the exchanges will be cancelled. After all, the health insurance industry exists for profit. They can blame the government for why they are cancellling all their crappy plans that don't offer the 10 ACA essentials.
An additional painful irony is that if my income was $128.33 less per month in 2012, I'd qualify for a Bronze Plan with a premium of $106, or a Silver Plan with a premium of $291. The plans stays the same, but the premiums would be $421 cheaper for Bronze than my "windfall" of $128.33 a month nets me. Get that? I'd save $421 per month if I didn't make that additional 13.89%. I am expected to pay FIVE HUNDRED PERCENT of the premium that someone who makes 400% of poverty will pay. Who came up with this math? Why can't I pay 113.89% of what their premium will be?
More irony below the fold:
While none of this is necessarily the fault of President Obama, the fault does lie in the fact that insurance companies are still in the loop, which is the principal that guides Obamacare (a conservative, profit-oriented Heritage Foundation plan, after all). I have been longing for single payer for many years. In 1994 I worked on a referendum to institute single-payer in CA--before I was self-employed, but while I was ineligible for my small employer's insurance plan because of a pre-existing medical condition. I made house visits to educate people about it then. As I recall, the plan was to be paid for by adding 2% tax on your taxable income, or $50 per year, whichever was larger. It was going to cover dental care for children immediately upon implementation, and later, include dental for adults. It was a universal plan, with access to mental health, prescriptions, reproductive care. Now that's a plan that's affordable and simple to comprehend and simple to utilize as a consumer or provider.
What probably doubles or triples my anger is that I depend on health insurance companies for the majority of my income. I am a mental health provider, and nearly all my clients access their insurance to cover the cost of treatment. In 13 years of private practice, I have not received a raise in reimbursement from the insurance companies. So while I have increases, like everyone else, in groceries, gas, rent, health insurance, utilities, supplies, liability insurance, I have gotten no increase in pay. It's true that I can work more hours and have access to more income, which is a pretty significant benefit of setting one's own work schedule. However, I find that the more hours I work, the less energy and enthusiasm I have for helping my clients. There is an optimum point over which I cannot go without decreasing my effectiveness and concern for clients. For this reason I turn potential clients away almost every week, and I can only imagine having to turn more people away when more people have insurance--but I hope more providers will be able to make a living via insurance despite the challenges of dealing with the health insurance world. There will certainly be plenty more people requesting services who now have the possibility of accessing services! That's a very good thing.
What I don't have, as a self-employed person, are retirement benefits, sick pay, vacation pay, access to SDI if I become short-term disabled, or any ability to negotiate with insurance companies on reimbursement. I can say "yes" or "no" to the contract they offer. Saying yes means I get somewhere between 50% to 89% of my fee, depending on the insurance company policy, but I get referrals and people able to afford treatment. Saying "no" means that potential clients will go elsewhere where they can get assistance paying for their treatment. Do you know that my professional colleagues and I cannot even talk about doing something to get insurance companies to increase their reimbursements without being guilty of a federal crime? No collective bargaining available, no guild or organization able to even DISCUSS reimbursements without the risk of being charged with conspiracy (the Sherman Anti-trust Act). Also, when clients fail to pay me, which amounts to several thousand dollars per year of services rendered but not reimbursed for, I can't deduct that from my state or federal taxes because I didn't put money out in the first place--I put out services, and those lost hours of pay don't get the status of business loss because they aren't based on material items or cash changing hands. Never mind that I still paid my utility bills and student loan payments that allowed me to have this practice in the first place.
So the buying power of my income steadily declines as I am caught up in the health care system dysfunction, and I will have to work till I die or can no longer function. And then I fear I will be joining the ranks of the poverty-stricken, and can get my health care paid for by the government.
Thie data in this diary about Obmamcare is based upon my studying the Covered California site. Discussions with my insurance agent are pending as she is swamped and trying herself to figure all this out. I requested contact on the Covered California website on October 1, and understandably, have not yet been contacted. If there are other options I have yet to discover, I'll let you know.