"Affordable" Health Care

I try my best to stay out of large-scale political discussions. I kick ideas around with my family and read commentary from both sides of issues and form my opinions, but I like to stay away from the free-for-all mudslinging that is all too common these days. I can usually see the basic points of either side, and screaming matches based on partisan rhetoric aren’t usually good for more than raising your blood pressure and making you wonder why it’s illegal to smack people across the face. The fray might be entertaining, but it’s not the place to reach actual resolution on anything.

That said…

I will be the first to admit. I didn’t understand the details about the Affordable Care Act (aka Obamacare) when it was being argued on Capitol Hill. I didn’t understand the details about the legislation that ultimately passed. I knew what the pundits on each side of the issue said – that the other side was wrongity-wrong-wrong-wrong. The Affordable Care Act was  the best/worst (pick one) idea in all of American history. It was guaranteed to save/destroy (pick one) our society. Either way, only liberals/conservatives (pick one) could be trusted to lead our country away from absolute devastation.

There are only two points I have subscribed to without any doubt: The cost of health care is absurd, and a civilized society does not let poor people die in the street because they can’t afford insurance. There was never a doubt in my mind that the nation’s health care needed to be overhauled – I’d spent enough time on the phone with the billing departments of doctors, hospitals, and my health insurance company during Miracle Man’s health crisis to know just how expensively fucked up the business of health care is in this country. But as my own coverage has changed this year, I’m starting to wonder if the changes enacted in the Affordable Care Act are leading to care that’s - well, affordable.  

There are many and varying reasons that my employer-provided health insurance changed this year. The Affordable Care Act contributed to a lot of the changes. Without going into too much detail, Big Corporation got a new CEO who was tasked with streamlining the company. Which is executive speak for cutting out as many expenses as humanly possible without disrupting operations. Which is middle-management speak for “Just be grateful you haven’t been cut yet. Now quitchyerbitchin’ and get back to work.” Which leads to a flurry of LinkedIn activity among the worker bees.

Wait, where was I? Oh yeah. Health care.

Big Corporation seized the opportunity to drastically reduce its portion of employee health care expenses  - by drastically increasing the employee portion. One of the primary reasons they cited for needing this change was because of the costs incurred by having to cover dependents up to age 26, instead of cutting them off at 19 like in the pre-Obamacare days. Adding insult to injury, the 19 – 26 set seems to make more use of substance abuse programs (ka-ching!), behavioral therapy (ka-ching!), and psychiatric medication. (ka-ching!)

Those greedy whippersnappers!! What with their taking responsibility for their addictions and seeking treatment for their mental health issues! They should just listen to grunge music and engage in body modification like we did back in my day!! 

See how happy she looks?

Wait. Where was I? Oh yeah. Streamlining.

For 15 years I had a low-deductible health plan that made use of copays. It wasn’t cheap, but it was doable. When Big Corporation revamped its health care offerings, the standard low-deductible plan suddenly had crippling premiums. Sensing a worker-bee uprising on their hands, Big Corporation amped up their sales pitch for the new health care offerings:

Lookey here! We have these other plans with lower premiums! We know their higher deductibles look scary at first, but at least their premiums are so much more affordable than the (arbitrarily-doubled) premiums of that stinky old low-deductible plan! [Editor's note: Those "low" premiums are still higher than my old plan was before the change. Just sayin’.]

And with the new plans come a Health Savings Account, made possible by the Affordable Care Act! (Woo hoo!) Not only is the HSA a handy-dandy little tax shelter for a few thousand of your hard-earned dollars, but it can also earn interest and roll over from one year to the next! (Ooh! Ahh!) We have been freed from the tyranny of the use-it-or-lose-it Flexible Spending Account! (Yay!) But the HSA is only available with the high-deductible healthcare plans. The old low-deductible plan with the now-crippling premiums still has that stinky old FSA. (Boo!) Now be a good little worker bee responsible healthcare consumer and choose the plan that will make our shareholders happy reward you for taking an active role in managing your health!

I understand that I am responsible for my own health. I understand that reducing corporate expenses makes shareholders happy, which makes the company more profitable, which means job security for tens of thousands of people. (Knock wood.) As a shareholder I appreciate that. As an employee (knock wood) I appreciate that. I’m not saying that streamlining is a bad thing.

But here’s the thing: My pay scale is a lot lower than that of the people who structured these new plans. My income is also a lot higher than this nation’s median income, and for that I’m grateful. That said, I’m standing in the gap here. I’m not wealthy enough to cover all the new extra expenses. But I’m too wealthy to qualify for help under anyone’s definition. Yes, I can use the HSA money for health care expenses. But some days it would be nice to have enough money for health care expenses and other frivolities. Like food. And shelter. And transportation. Et cetera.

I know, I know. It’s a first-world problem. Poor little rich girl can’t eat filet mignon every day. Poor little rich girl can’t buy a Lexus this year. Poor little rich girl can’t afford her life-saving medical supplies.

Wait. What?

You read that right. I can’t afford my medical supplies any more. You see, I have The Diabeetus. For the last three years, I have used an insulin pump to help keep my blood sugar under excellent control – thereby mitigating effects of the disease that would result in even more chronic health issues (ka-ching!). For the uninitiated, insulin pumps are not internal devices. Rather, the pumps are external units that deliver insulin through a small catheter that pokes you in the belly. 

Like this, only less giggly and more stabby.

The pumps hold three days worth of insulin, and they need to be replaced with a new device when they expire. Those little delivery devices that have to be replaced every 72 hours? Expensive as hell! Before my insurance was switched, I could barely afford the copay. Now that I have an astronomical deductible to meet, and it is still early in the year, I would have to pay about $1,000 out of pocket for a new shipment - and my deductible still wouldn't be met. Quite frankly, my pockets just ain’t that deep right now. I've had to discontinue use of my insulin pump. 

Yes, I am blessed to have employer-provided insurance. I just don’t have enough employer-provided wages to pay for my out-of-pocket share. Don’t worry though – I can still take shots the old fashioned way. My doctor ordered so many syringes for me at the pharmacy that I can start a side-business selling them to heroin addicts don’t have to worry about running out any time soon. It’s inconvenient, but so far my blood sugar has remained stable. So at least I’m not gonna keel over from that any time soon.  

But my problem extends beyond The Diabeetus. My family has four people. Three of us have chronic health issues that require expensive diagnostic tests several times a year, expensive specialist visits several times a year, and expensive medication we must take every day. Of course I’m worried about how to treat my own health issues. But having been through the near-death thing with Miracle Man already, I’m worried about how we are going to pay for his semiannual MRIs and visits to Dr. Smartypants (ka-ching!). [Side note: Did you know that world-famous physicians can charge upwards of $600 per visit? Yeah, that's gonna hurt next month.] And there is no way in hell my kids are going without the care they need – I’ll sell a kidney if I have to. (I’m not saying whose kidney until the time comes, though.)

Marketing slogan:
My kidneys are totes adorbz

I can only speak to my own experience. I haven’t changed my opinion that a civilized society keeps an eye out for the downtrodden – after all, it could be any one of us very easily. (If you don’t believe that, you need to get down on your knees and pray fervently to the deity of your understanding that your world never gets turned upside down. Shit happens.) I’m just wondering when the Affordable Care Act is going to make care, um, affordable for those of us who live here in the gap. 



Brokeass Canyon
Population: Me