Many folks have already discovered that the ACA is not the great solution to healthcare woes in America. Usually, this revelation comes when there is a medical emergency that requires attention. Where we used to call doctor's offices, clinics, and hospitals to see if our insurance was welcome, now when you call those facilities, they want to know if you have insurance and what type before anything else is discussed. Many medical providers do not accept many of the insurances that people are paying hard earned money for each month premiums. And now, instead of your doctor determining who the best person to handle your problem might be, you are bounded by networks and hospital affiliations that are limited in the extreme. In fact, buried in the fine print of most ACA polices is a powerful word: "may". This is the escape clause for insurance providers both in and out of the exchange marketplace. If you seek medical attention outside your network, the policy "may" pay up to 50% of the costs. "May pay" is certainly not the same as "will pay". It is a game of Russian roulette, and many folks have been left holding the proverbial bag of charges without any sort of payment from their carriers. And you thought that the ACA was supposed to insure that nobody was forced into bankruptcy due to necessary medical care.
There are also huge holes in the ACA programs. For example, even with a marketplace policy, there is a period of anywhere from 30-90 days before you are eligible for any benefit at all. That is aside from the large deductibles that need to be satisfied before any benefit can be paid. And I am sure that many of us have heard that as long as we had no periods in excess of 90 days without insurance coverage, we wouldn't be subject to ACA penalties at tax time. It sounds so reasonable and fair, but the reality is far from it. Just imagine that you suddenly lose your job. Perhaps the company closed, or cut back on staff. This is a pretty common scenario in the state of Illinois these days, and with your job loss, so too, you lost your health insurance. Without income, nobody is going to pay for COBRA benefits. A person could expend the entire of their unemployment and still not cover that COBRA premium, so the unemployed find themselves without insurance. Granted, they could go and purchase an ACA policy, but the premiums would be based on their income at the last tax filing, when they had a job and an income, not on the present situation, and in that case would also be more expensive than they could possibly afford on unemployment. Doesn't matter though, because they still have that waiting period and approximately $13,000 in deductibles and co-payment before anything is paid on their behalf. Isn't that the same as having no insurance? And it isn't necessary to lose your job either, as folks who purchased the Land of Lincoln insurance discovered when the State of Illinois shut them down for insolvency and not paying claims. The premiums paid are simply lost and the folks must start all over with another insurer, pay more premiums, and begin at zero again with regards to satisfying deductibles. So, right here, we have found two examples of people, in compliance with the mandate, completely without coverage. Nothing in the ACA addresses those gaps or waiting periods.
Our family experienced another unemployment shift, and with it, the loss of health insurance. Fortunately, this time, a job presented itself well within the 90 day window of ACA. And my husband gratefully started the new job, anxious to complete the probationary period of 90 days, so we could once again have and afford health insurance. Less than two full pay periods into the probationary period, we experienced a medical emergency. There was no warning. Literally, one day things were fine, and the next morning, my husband couldn't walk or stand without falling over. Less than 12 hours from hale and hearty to complete panic at not knowing what was wrong. As he has already experienced kidney stones, a minor stroke, and underwent quadruple bypass surgery, it seemed prudent to gain immediate medical advice. We went to the local clinic where payment is based upon your current income. We did not see a doctor, but rather a nurse practitioner who attributed the whole thing to a virus, and suggested that my husband see an ENT specialist. The clinic would make a referral, but it could take a week or more to find a doctor who would see us without insurance. Given the medical history, this didn't seem like a great place to leave the situation. Even though we paid for an office visit, I certainly didn't hear anything that indicated that they understood the previous medical issues or understood our concern that this sudden onset might represent something far more serious than a virus. A quick consultation in the parking lot and we were in agreement that we didn't want to go home and potentially be calling for an ambulance in the middle of the night should things become worse. Who would pay for the ambulance fee? So, we headed to the emergency room.
I chose the hospital where all our family medical records were, everything from the birth of our kids to the kidney stones, the stroke, the bypass surgery. Most of the doctors who had assisted our family are still on staff at that hospital. My thinking was that time and money could be saved by not having to hunt up records from the four corners of the world, and mountains of patient release forms required by patient privacy could be averted. Silly, silly me!
In the emergency room intake, the attitudes were the direct opposite of the clinic. Everyone, including the emergency room doctor, were convinced that we must be dealing with another stroke and adjusted what they heard accordingly. Nobody was listening to the patient. After having a stroke, he knew full well that he should be looking for pain, tingling, dizziness, blurred or double vision, loss of coordination/strength, loss of memory, slurred speech. None of those symptoms were present. And of course, they pointed to elevated blood pressure as confirmation of their diagnosis instead of considering that the patient was in full blown panic mode. If he was sitting or lying down, he could do anything he wanted, including navigate the computer, watch TV, read. While they were yapping about his blood pressure, I would be willing to bet mine was higher than his. Not only was my husband concerned about the medical issue at hand, but the fact that being a probationary employee, he could wind up losing the job he just got due to absenteeism during training, adding to his stress.
The hospital decided to admit him after four hours in the emergency room, a raft of blood tests and a CAT scan. By the next morning, they had ruled out stroke and heart issues, but wanted another expensive CAT scan to be sure. The attitude of the staff was horrid, particularly when they discovered that we were in between insurances. At one point, the charge nurse indicated that they would want to send my husband for physical therapy, but that everyplace that offers physical therapy would want insurance before accepting him as a patient. The closing remarks were: "So I don't know what you are going to do about that." The message was that physical therapy was needed, but we weren't going to get it. I had a question, but nobody seemed to want to listen to me either. If the medical staff had not determined what was wrong, then how do we know physical therapy was needed?
Even my teenage daughter (usually wrapped up in the world of concerts, friends, fashion) noted how rudely most of the staff spoke to us when we would ask questions, or request assistance. We had gone from being hard working, middle class people to trailer trash because a medical emergency occurred during a gap in employment. Somebody came up with the brilliant idea that my husband had MS. A neurologist was called in to stand at the foot of the bed and explain that given my husband's age, a progressive disease such as MS would not simply occur overnight. I am certain the short conversation will be a large charge on the line item bill. And after three days in the hospital and, God only knows, how many tests, they still had no answer for the situation. He was discharged and told to go back to the "family doctor", which in this case was the nurse practitioner who called it a virus.
Once home, we took the initiative and went for a complete and comprehensive eye exam, to rule out any vision abnornalities leading to a loss of balance. Even had three dimensional photographs taken of eyes to make sure that there was no nerve damage, detached retina, pressure on the eye, and of course, everything came back clean....other than needing a different lens prescription. The eye doctor was most thorough, and was anxious to refer us to yet another hospital and medical group, who of course would want to run their own set of tests for which we have no insurance coverage. And that would be premised on them even being willing to see my husband without insurance. No guarantees there either.
And until a doctor releases him, signs off with some sort of explanation, my husband cannot drive and cannot work. The car insurance wouldn't have to cover an accident without a doctor's release, and his new employer doesn't want the responsibility of him having an incident at work and being considered responsible. But as nobody seems to want to step up and explain what happened, if it can happen again, what warning signals we need to be aware of, nor does anybody want to "release him" as they didn't diagnose him, we are stuck with mounting bills and no income and no diagnosis. We are living the situation that the ACA was supposed to prevent from happening. The two recommendations made by the hospital was to call a toll free number for the State of Illinois Department of Social Services and that we get my husband a walker. Ironically, there was no prescription for the walker, as medically necessary equipment, so we could neither have insurance cover part of the cost (if we had insurance), nor could we write it off as a medical expense against a deductible or even a tax deduction.
Based upon this experience, it would be safe to say that Obamacare actually should be defined as "I don't care!", unless of course, you have a big fat insurance policy that will pay. Fewer and fewer folks in Illinois have the luxury of health insurance given through an employer. Unemployment and underemployment have swelled the ranks of people who fall through the huge cracks in this ill considered program. If you were not working, you would not qualify for Medicaid until you had been out of work a year (eligibility is based upon the previous year's taxable earnings). And if you were to be given subsidy, once employed again, you could be charged and required to pay back, all or part, of the subsidy you were given. Thanks to politicians, we have European healthcare, complete with long waits, too few providers for too many patients, and surly medical staff who are overworked and short on rest and compassion. If you wait long enough, people will either recover or die-problem solved!