Adventures In Healthcare (or Trying Not To Be Too Political)

Today is the inauguration of President Trump. Those of you who follow me on social media probably know how I feel about this, but I don’t want this post to be all about political parties. But with a new president coming in, there are some things that do concern me as a citizen of this country.

Almost all of the things that concern me are related to healthcare. Mainly, the idea that the Affordable Care Act will be repealed (and potentially replaced with something to be determined later). While I always have had healthcare, it wasn’t easy for me before the Affordable Care Act. And now with the threats that it will be taken away, I’m worried for me and the millions of other people who are in a better situation because of it. And so on inauguration day, I want to share my story of why the ACA matters to me. Maybe you don’t care if it goes away, but hopefully you can at least understand why it is something that scares me.

I was born into having amazing health insurance. Thanks to my dad, I had great coverage through Kaiser growing up. My insurance was covered under his job and we didn’t have to pay a monthly bill and almost everything I needed was covered under my insurance. I was totally spoiled with my awesome insurance and didn’t realize it wasn’t like that for everyone. I just assumed everyone could go to the doctor and it would be taken care of. Even with my hip surgery and all the craziness around that, it was completely covered and all of my bills said that the patient responsibility was $0.

When I aged out of my dad’s insurance coverage (which fortunately was right after my hip surgery), I applied for regular Kaiser insurance. All of my doctors are with Kaiser so there was no question to me that I would continue using them for my healthcare. I applied and assumed that while it wouldn’t be free anymore, I would get insurance and everything would be fine. But it wasn’t.

I got a rejection letter from Kaiser saying that they would not cover me because of my pre-existing conditions. Among my pre-existing conditions were my hip issues, my eating disorder, my weight, having a history of strep throat/tonsil issues, and having a history of gallstones. I was not a desirable person to insure and Kaiser didn’t want to cover me. Being rejected for pre-existing conditions sucked. I had an option to get COBRA for a year or so, but it would have been something like $3,000 a month to be covered.

Fortunately, I talked to someone at member services at Kaiser who explained that there was something called conversion insurance. Basically it was insurance for patients with pre-existing conditions that are considered too high risk to insure but previously had Kaiser insurance so Kaiser didn’t want to reject them completely. I was eligible for conversion, but instead of being about $100 a month (which is what it would cost for a woman to have regular Kaiser insurance), it was over $500 a month. That’s a lot of money, but because I needed health insurance my parents helped me out so I could get insurance.

I didn’t have as amazing of insurance as I did before, but it covered most of the things I needed. When I had my tonsils out, it cost $250. When I needed birth control refills, it was $30 a month. The out-of-pocket costs without insurance would have been insane, so having expensive insurance with higher deductibles and costs was worth it.

Then the ACA passed and I became eligible for regular insurance again! Not only that, Kaiser could no longer charge me more because I am a woman so things would be even cheaper than I thought. My new insurance is about $250 a month (I’m also eligible for subsidies because my income level is below the limit) because I got a silver level plan knowing that I would have more doctor appointments than the standard patient. And this was before the liver tumors so I’m more grateful now that I’m covered.

When I recently had my breast MRI, there was a debate if it would be fully covered by Kaiser. With my dad’s insurance, it would have been totally free. With my conversion insurance, MRIs were not a covered benefit so I would have paid full price. With my ACA coverage, MRIs are $250 but cancer screenings are free so it wasn’t known what my MRI would be classified under. I didn’t pay that day, but the other day I got a bill.

I got charged the $250 that is my standard MRI deductible. But you can see that if I had my old conversion insurance, it would have cost almost $2,700 to get this cancer screening that my mom’s geneticist recommended that I do. To know that a test that doctors felt I needed could cost more than my rent is ridiculous. I don’t know how people could afford that if they had to pay the full rate. That’s so expensive and it made me even more grateful for my ACA coverage.

With my upcoming liver surgery, I know I’ll hit my out-of-pocket maximum for the year. That maximum is about $8,000 (much lower than the $50,000 maximum my conversion insurance had) and while that is still a lot of money, it is a necessary cost and a fraction of what it would cost if I wasn’t insured. I’m not going to worry about the money now because I know I will get help to pay for it and my health is more important than money. Plus, on the positive side, I believe that once I hit my out-of-pocket maximum that I won’t have to pay for doctor appointments for the rest of the year!

I know I will be ok for 2017, but I’m scared what will happen to me after the year is done. If the ACA is gone, can Kaiser tell me that they don’t want to insure me anymore? I’m even more high risk with my pre-existing conditions now. If an insurance company could reject me, I totally understand why they would want to. But for me, I know I need to have insurance because of my pre-existing conditions. I will always have my hip issues, I will be considered high risk if I ever get pregnant because of the tumors (even if they are taken out, there is a risk of them coming back with pregnancy), until I stop getting treatment for my eating disorder that will always work against me if an insurance company can reject me, and I’m assuming that having to have part of my liver removed will make me even more high risk.

I know a lot of people get insurance through their employers and they are mad that their premiums have been going up. But that doesn’t have anything to do with the ACA. Premiums have been going up for decades every single year because health insurance companies can do that. It’s the same as car insurance premiums going up or home or renters insurance going up. And for those people who will have nothing change with their health insurance if the ACA is repealed, I can understand why they don’t care too much either way. But for me and millions of other people, losing the ACA can be horrible. For me I know it won’t be a death sentence, but I have friends who could have their lives at risk if they can’t get insurance to help pay for life-saving medication. Hoping that you can afford to live shouldn’t be something that people think about.

I know that there has been a lot of backlash from the threat of repealing the ACA, especially with no replacement in mind yet. I’m hoping that politicians will listen to how scared their constituents are about this. Maybe President Trump will worry about being popular and liked and realize the majority of people do not want the ACA to go away (or go away before we know what the replacement will be so we know we won’t be uninsured). I can only hope that next year, I will not be worried about this and I will still be able to get the healthcare that I need to stay healthy.

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