At midnight tonight, several things will occur simultaneously:
- The ball will drop in Times Square.
- Someone somewhere will shout “Happy New Year!”
- Friends will clink champagne flutes.
- Couples will kiss.
- I will have health insurance again.
Want to guess which of these has me most excited?
Our recent health insurance policy expired Dec. 26. I was no fan of that policy, but I am nervous about our current status as “uninsured.” Our new (much more expensive) policy kicks in January 1, so these past few days we’ve been laying low, desperate to avoid a hospital emergency room.
And I’ve been thinking a lot about insurance, and about how our country is failing us. It’s not easy to enjoy life, liberty and the pursuit of happiness with the threat of medical bankruptcy hanging around your neck. We’re a country that claims to love the small business entrepreneur, but ignores the reality that cutting the ribbon on a new enterprise also likely means cutting off access to affordable health care.
Ten years ago, I resigned from a good government job to join Lee in our growing family business. I was excited about the personal and professional rewards of business ownership, but terrified to walk away from the health insurance.
This was pre-Obamacare, and there were no individual plans willing to cover our pre-existing conditions. We also had to pay an additional $750 per month just for maternity benefits, on top of our costly monthly premium. We absorbed the sticker shock, we even discussed foregoing insurance altogether, but eventually signed up for a plan.
In the next several years, the sub-par, high-deductible coverage caused us some heartache. There were prescriptions we needed but didn’t fill, like costly antibiotics, or epi-pens for emergency allergic reactions. Camille had a cough we ignored, knowing it would cost us $150 to have her seen (it’s just a cough, right?). So we waited until the cough became walking pneumonia (and a source of terrible parental guilt).
So I was thrilled when the Affordable Care Act was passed. We purchased insurance through the exchange, delighted to once again have coverage for pre-existing conditions and maternity care. But as we all know, implementation has been rocky at best, with most insurance companies opting out of the exchange and premiums soaring each year.
Fast forward to December 2017. Our previous insurer was no longer offering self-pay plans, and we had one single, solitary option on the healthcare exchange. That option included zero of our doctors, and would mean we’d get all our medical treatment at the local indigent care clinic.
So we gambled. Instead of traditional insurance, we bought 4 back-to-back short term medical policies, each for the max term of 90 days. This gave us almost a full year of coverage at a third of the usual price for health insurance.
There were plenty of “catches.” These policies don’t cover well checkups or preventive care, vaccines, prescriptions, etc. The deductibles are quite high, and reset every 90 days. Mostly, we’d be on our own for healthcare costs, but with this coverage in our back pocket for anything catastrophic.
That “catastrophe” came in mid-June, when Camille broke her arm at a trampoline park. She fractured both bones in her forearm, and the separation was so severe she would need surgery and titanium rods to realign the bones.
Our first insurance-related frustration came with scheduling her surgery. Our local hospital didn’t recognize our short term medical provider, and refused to book the surgery without verification of benefits.
The hospital and insurance company pointed fingers at each other for a few days, all while my child suffered with a broken arm that was trying to heal but could not. In desperation, I called the hospital and asked what it would cost for us to circumvent insurance and pay for the surgery out of pocket.
“The cost for the surgery, not including radiology, pharmacy, or the room fee, is $68,000,” said the voice on the telephone.
My pen was poised above a piece of paper, but I couldn’t write that down.
“Can you please say that again?” I asked.
“Sixty-eight thousand dollars.”
There were additional discounts for self-pay patients, etc., but the numbers were still crushing. So we hung up, my daughter still waiting for the hospital and insurance company to come to an agreement.
The good news – Camille finally had that surgery, and 6 months later she’s doing very well. At last check the bones were still busily stitching themselves back together, and she’s expected to fully recover.
Meanwhile, I’m still fighting with two hospitals and numerous providers about medical bills. I’ve received letters and phone calls threatening to turn us over to a collections agency for not paying charges that our insurance company says we don’t owe. I’ve spent thousands of dollars, and countless hours on the telephone, and created spreadsheets and lists and folders to organize it all, and it’s not settled yet.
So it’s no wonder that I felt terribly anxious this September as I sat in the lobby of the breast imaging clinic for my annual mammogram. My anxiety wasn’t so much about having cancer, but about how we’d manage to pay for treatment if I had cancer. And that is a messed up set of priorities, but an honest reflection of our current state of health coverage.
And if we feel this way, how many others do, too? We are an economically sound, middle class family, and I am terrified of the financial implications of illness or injury.
We can do better. We MUST do better.
For all the things we Americans cannot agree upon politically, can’t we agree that we all deserve access to healthcare at reasonable costs? How can we be so smart and so creative, and yet find this issue to be utterly unsolvable?
I don’t have the answer (though I have some ideas I’m happy to share), but I’m telling you all this because I want you to know this isn’t just an isolated problem. This is a problem that is strangling the bank accounts of people all over our country. Without access to affordable health care, that promise of “life, liberty and the pursuit of happiness” is nothing more than a hollow platitude.
I sincerely hope you never experience the anxiety of inadequate medical coverage. But from one American to another, please know this problem is real, and it’s a problem we absolutely must fix.