My Health Insurance Story

If the AHCA passes, something like this could happen to you.

I’ve been self-employed since 1990. When I left my last full-time job — which did include health care benefits — I bought my own health insurance coverage. I was 29 at the time, a non-smoker, and in good health. But health insurance was something I thought everyone needed to have, so I signed up with one program or another — I honestly can’t remember any details — and stayed insured for years.

Understand that I seldom needed insurance coverage. Again, I was in good health. If I caught a cold, I went to the doctor. If my insurance covered the visit and medicine, fine. If it didn’t, I paid and didn’t complain. When I had some problems with my knee and needed several tests, some physical therapy, and finally some arthroscopic surgery to repair a torn meniscus, I ponied up the $1,000 deductible before finally getting some benefits to cover most of the other costs. I’m not rich and I’m not poor but I was usually able to afford any kind of medical attention I needed.

Each year, my insurance rates went up and I paid the new premium. It wasn’t a big deal; I made more money every year and I saw the increased expense as part of my cost of living increase. Occasionally, I’d shop around for a new policy and get one that was a little less costly. That would creep up over the years and I’d change again.

The biggest mistake I ever made

I’m not exaggerating when I say that getting on my future wasband’s health insurance was the biggest mistake I ever made in my life. Why? Because when was I diagnosed not long afterwards with a tumor that needed removal and possible cancer treatments afterwards, he told me that I might not be covered if the insurance company found out we weren’t married. Terrified of bankruptcy from medical expenses for surgery and cancer treatments, I agreed to marry him. After all, we’d been together for 23 years and “engaged” for most of that time. We’d obviously stay together forever.

I turned out to be wrong about that. But the insurance was the root of my mistake; if I hadn’t gotten on his health insurance plan, I never would have married him. It would have been a hell of a lot easier to get him out of my life when he decided he wanted a mommy more than a wife and took up with a desperate old whore he met online only six years later. (Read a few of the early posts tagged divorce if you want the details of his betrayal.)

And no, there was no cancer.

In the early 2000s, my future wasband took a job in the Phoenix area with a company that offered very good health insurance plan. Around the same time, I got a sizable increase in my health insurance premium. He told me I could get on his insurance and it would be cheaper and better. Even though we weren’t married, I assumed he knew what he was talking about when he made the offer, so I dropped my insurance and got on his.

Sometime after we married, when I was still on his insurance, I started having digestive issues. I went to a gastroenterologist connected to Wickenburg Hospital — which I will never do again — and told her about my symptoms, including pain in my upper abdomen. She translated that as chest pains and decided that I needed to get an EKG. When that showed no problem, she sent me for a stress test. When that showed no problem, she sent me for another test. When that showed no problem, she finally gave up trying to diagnose me with heart problems. She was never able to resolve the digestive issues I had. Neither was another doctor I went to see. I wrote about this in a 2010 blog post titled “Getting Quality Health Care: Apparently Impossible.”

My wasband lost the job with the great insurance got another one with good insurance. I stuck with his new plan. Then he lost that job and was unemployed for a while. He got us on Cobra, which he paid for with our joint checking account. Except he didn’t pay on time. He missed a payment and they cancelled our coverage.

He got in touch with them right away and made the payment. It was only five days late. They reinstated him immediately. But they looked at my medical records, saw the heart tests, and refused to cover me because I had a “pre-existing condition.”

Except I didn’t have the condition they claimed I had. I had never had that condition. All tests had proved negative. My heart was fine.

It took six months of fighting with Blue Cross to get insurance coverage again. For the entire time, I was completely exposed to financial loss: if I was hit with a major health problem, the cost of medical attention could easily bankrupt me. Actually, I guess it could bankrupt us — I don’t think my idiot wasband realized how exposed he was, too.

I finally got coverage under my own name, separate from my wasband, by signing papers saying I’d never put in a claim for heart-related issues. I had no trouble with that because I had a healthy heart.

And, as you might imagine, I learned my lesson and kept my insurance separate from my wasband’s no matter how good his next employer’s plan was. I simply couldn’t trust him with something that important. (That probably helped confirm my financial independence from him in divorce court a few years later.)

I have been on one health insurance plan or another since that “pre-existing condition” scare all those years ago. The Affordable Care Act (ACA or ObamaCare) made it easy to find insurance that met my requirements. Again, I’m generally healthy and I make a decent living. I have insurance primarily to prevent bankruptcy in the event of a major illness. I have assets to protect, including my home, my business assets, and my retirement funds. I’ve worked too hard my whole life to put them at risk.

To keep my premiums as low as possible, I have a very high deductible: $5,000. I take advantage of a health savings account if I can. (My new plan does not allow additional savings but I can still use the balance from my old plan.) It’s nice to have annual check-ups and special tests like mammograms covered by insurance without having to worry about the deductible. Coverage under ACA helps people who can’t afford doctor’s visits at all to make at least make one visit a year which can, hopefully, find any problems before they become serious.

I’m not at all happy with the provisions of the Paul Ryan American Health Care Act (AHCA or TrumpCare) in part because it will allow insurers to deny coverage or greatly raise rates for people with pre-existing conditions.

Will it affect me? Will I be denied coverage? Or charged some outrageous rate for premiums? Just because I had a few heart tests ten years ago? Tests that proved I had a healthy heart?

And will some test or problem you’ve had in the past prevent you from getting coverage?

And what about well-care visits? Maternity coverage? Contraception? Mental health care? Any number of items on the list of required coverages from the ACA?

(Don’t worry boys, I’m sure you’ll still be able to get your little blue pills. Republicans wouldn’t dare threaten a man’s sex life.)

With only 17% approval rating from the people, Republicans could pass the bill later today anyway. They don’t care about the people who voted them in. They care about the lobbyists and rich donors who pay for their campaigns. The people most likely to benefit from this plan.

So I guess time will tell how it affects you.

10 thoughts on “My Health Insurance Story

  1. Worry not. ‘Obama care’ lives on.
    Trump thumped, postured and cajoled….but his little hands failed to grasp the prize.
    Yee Haa! As they say, out your way.

    Republicans in congress were worried that their voters had read the small print of the new policy and realised it was fat turkey with very small wings.

    • I don’t think it’s over yet. But it sure does show how ineffective the Republican party is. They’re experts at obstruction and this time they managed to obstruct themselves.

      • Exactly right. As we say in the UK:
        “All mouth, no trousers”.
        (In translation, that means they asserted a political position and found themselves unable to perform as they had advertised).

  2. The whole thing stinks to high heaven of hypocrisy and corporate self-interest, with a ripe after-stench of mean-spirited greed and rigid partisan demagoguery. Is it any wonder why even the most obtuse of the Republitards aren’t smelling a sweet deal here?

    I’d like to think that its failure is because representatives have gotten the message loud and clear from their constituents that purging ~24 million of the sick and poor from the ranks of the insured (just when they finally started getting some halfway decent preventative care too) is counterproductive and cold-hearted, even by DC standards. I suspect the real reason they can’t get a repeal is because the states and the big hospital chains are putting some serious pressure on through their connections and lobbyists, since they’re the ones that will really be left holding the bag.

    You can’t just dump that many of the poorest and sickest back into Medicaid without disastrous consequences for the states budgets. And ever since Obamacare kicked in the Feds have taken away a huge pot of money from the hospitals that they used to chip in for indigent care, which nobody has even mentioned restoring. The hospitals know that all those uninsured will just end up right back in their Emergency rooms with the same untreated problems once they lose their insurance.

    If you want to see why the U.S.has the most expensive (though far from the best) healthcare system in the world, you need look no further that this debacle. Why need to just admit that the only way to cover EVERY American at a reasonable cost is to nationalize the healthcare system. There are so many corporate hands in the healthcare cookie jar, it’s no wonder it cost orders of magnitude more than everywhere else.

  3. Single-payer is really the only way to go if you want everyone covered at anywhere near an affordable cost. Of course, this derails the gravy train for big pharma, the health insurance mega-corps, and all the various for-profit leeches and parasites that have attached themselves to the system as it exists now. You can depend on every single one of them to fight tooth and nail against any significant change from the statue quo.

    They’ll pay the spin doctors to rail against it using terms like “long waiting lists”, “lose your choice of doctors”, and the ever-popular “government death panels”, but the real reason they’ll oppose single payer is because it will inevitably weed out the unnecessary middle-men. All the wanna-be “rock star” doctors and Hollyweird plastic surgeon types will hate the hell out of the idea too, since it’ll cut into their bottom line. Single payer systems require large numbers of (modestly paid) family practice and general practitioners, not hoards of highly-paid specialists.

    Even if we somehow magically converted to a single-payer system tomorrow, it’d still be years until our existing medical system could adapt. We’d need to look at a total revamp of the medical school system, since you can’t expect new doctors to pay off quarter-million dollar loans on what the government doctors salary would likely run. We’d need some sort of public funding mechanism for medical school students, or significant subsidies which would come with long work payback obligations.

    Our medical system is overloaded with specialist clinics and practices while simultaneously being under-staffed and under-equipped with preventative-care and general practitioners, especially in rural areas. Our Emergency Medical Service system is hugely imbalanced, with excellent response times and multiple options in wealthy / densely populated areas, while rural areas and poor communities can expect unconscionably long wait times and lengthy transports, often by minimally-trained volunteer ambulance services.

    The most ironic part is that the Trump-voter demographic would likely be the group that would benefit the most from a single-payer system. A government-run system would level the health care playing field between urban and rural areas, and between rich and poor counties. There would be lots of new local health clinics in “flyover country”, which would raise the standard of health care in nearly all of rural America, especially the poorest areas. Of course, that would come at a cost for the residents of the urban mega-cities and the bluest of the coastal liberal enclaves. Rich suburbanites might even find themselves forced to share a waiting room with people who…gasp!…ride the bus!

    And yet…if you dare to float the idea of nationalizing the nations health care system, just you see which constituency bitches the loudest and longest. I’ll bet you right now that it’ll be those same low-information eagle/flag/slogan-T-shirt voters who complain endlessly how “government ruins everything”…while sucking down their Social Security disability check and their Medicaid. The Republitards have been feeding them the Tea Party Kool-Aid for so long now that they’ve forgotten what any of the other flavors taste like.

  4. Sean diagnoses the illness perfectly.
    I have little experience of US medicine but I have seen people in pain sent away from a Maine ER because they could not prove they were insured, even when the staff in the ER were friends of one of the patients.
    My American uncle had a good job, ocean view house on Rhode Island. He was certainly in the top 15% of earners but he and his wife ended up in a very modest communal ‘home’, because of the awful cost of health care. He needed a triple bypass and afterwards found that his premiums rose exponentially. If he could not cope then there must many more millions left in either permanent fear or premium-induced poverty.
    Our National Health system, here in the UK, is also in crisis. There are too many old people with multiple needs who are hard to discharge and too many health tourists who dump their serious illnesses on our system.
    Nigerian women are famous for flying here, 8 months pregnant, to use our humane maternity care units for their deliveries, rather than their own chaotic ones. But, our NHS I still well-loved as it has an essentially ethical underlying philosophy. Everyone pays for it out of tax and the more you earn, the more you pay. If you dislike being treated with the ‘common herd’ you can opt to pay for private medicine but the surgeon will probably be the same person as you would have seen in the NHS.
    Most of Europe operates this sort of mixed system and there is none of the awful anxiety and excess greed which seems to characterise the US system.
    My US cousins have a fear of ‘socialist’ systems like ours but then no one dies in the car park in a UK hospital because they did not ‘qualify’ for treatment.

    It’s great to be a tourist in the US, everything is about half UK prices, with the exception of your medical system which is insanely greedy and hopelessly inefficient, as Sean says.

What do you think?