Why I cannot hate the Affordable Care Act (ACA)

[jaycam]

"Well why didn't you just get a new inhaler?" I felt a sinking pit in my stomach. I was at a follow up visit to my doctor after ending up in the ER a few weeks before because bronchitis had made my asthma worse and I couldn't breathe. The first thing my doctor asked me was where my inhaler was when this had happened. After all, that was in my plan. I tried to explain to her that I only had one inhaler and it had been stolen the week before when I was riding the bus. Somehow, despite my explanation she didn't understand that since I was uninsured at the time, I just couldn't afford a new one. It was only after the ER trip that a friend of mine had pity on me and bought the inhaler for me.

I lost my insurance in April 2012 because I had been working at a call center that had outsourced its customer service department overseas. This was my fourth lay off in about six years. The whole time I had been trying to go back to school but in playing musical jobs I had never managed to do so. I decided to make school my focus and work secondary and deal with it.

Because I have asthma, I've never been able to get insurance without going through my work before. COBRA would've cost me over six hundred a month, and while my state had opened a high risk pool, it was still too expensive. My NP was awesome and made sure I got refills of my medication before I lost my insurance and gave me a list of community services for when I did lose it, because she knew I wouldn't be able to come back afterwards.

I did everything I could to make sure I would be taken care of. I signed up for a prescription plan at a local pharmacy, I found local clinic that was free, run on community donations. Still there are things that free clinics couldn't handle. Waiting all week to see a doctor because you got sick on Sunday and the free clinic is only open on Saturday isn't helpful when you're so sick you can't breathe. The doctors are volunteers so there's no guarantee of continuous care. In fact, the push is to get you into a local public health or community clinic, but they often were not taking new adult patients or were an hour drive away.

It was about a month after I lost my insurance when I found a lump on my right side, along the edge of the breast tissue. The free clinic provided me a referral but when I called the places they suggested I was turned away. I was told I was too young, that the office no longer provided services, or that they were out of funds for the year. I continued to fight to find a way to access services, but without a referral from a PCP I was getting nowhere. I finally took the time to bus out to one of the few clinics taking patients. They contacted a local imaging center attached to a public hospital to get me in. This started in June, I was finally in for imaging in October. In November I would get a biopsy and find out it was benign. It took me six months from start to finish to find out what was there.

It would be another year before I would get insurance again. In that time I ended up in the ER enough times the doctors started to recognize me. There really wasn't anything either of us could do. I couldn't manage my health without being able to afford regular doctor's visits and medication and they couldn't make a solution appear out of thin air. My wisdom teeth got infected and had to be removed but had to wait two months for a dentist who would help. I was on antibiotics so long I ended up with a GI infection. Bronchitis, allergic reaction, a set of second degree burns from how bad at cooking I can be. They got to deal with it all, despite the fact that most of these things were preventable.

All if this changed in January of last year. I live in one of the states that approved the Medicaid expansion and set up their own healthcare exchange. I was there on day one to shake hands with the Governor, tell him my story, and sign up. I stood up with him to others to encourage them to use the exchange as well. It is the only day of class I've missed since I started back.

Because of the Affordable Care Act I was able to get needed blood work that I had not been able to afford. Reliable access to medication. The first thing my PCP did, remembering how just a few months earlier I had ended up in the ER because I didn't have an inhaler was make sure to get me a prescription for one so I had a backup. One thing I know is I appreciate the opportunity more than I could ever express.

I know there are naysayers out there who will tell me that those things are not really free and that someone has to pay for them. One day I'll graduate and that person will be me. I seriously hope that I am paying to make sure someone gets the care they need with the money I pay into the system. It's saner than paying for what happens when they can't. The system we have isn't perfect, but it can only get better if we put effort into it.

[MunoRN, RN]

I did not say all the unions. my direct quote is "one of the many unions or business who donated to Obama's campaign". Nice attempt at trying to put words in my mouth. Also nice try putting up a link to a 2011 Politifact when it was 2013 that Obama attempted to give ALL unions a waiver.

Review & Outlook: ObamaCare's Union Favor - WSJ

That's not the part of your statement I was referring to. Your claim was that waivers were given to "one of the many unions or business who donated to Obama's campaign.

The politifact article pointed out that there is no evidence waivers were given preferentially to unions or businesses that donated to Obama's campaign. That particular waiver was a one-year extension on total value requirements which was given to pretty much any union or business that claimed a need for an extra year to transition to the requirement.

Unions did lobby for a different waiver in 2013 that Obama did not grant. That waiver was to allow multi-employer union managed plans to utilize the exchanges and potentially have employees qualify for subsidies. The problem with that is they would be getting both the tax breaks employer-provided plans receive as well as the subsidy tax breaks. The exchange subsidies, which are tax credits, are basically a way of ensuring that people buying plans on the individual market can also get tax relief for buying health insurance, just like employees already do.

[MunoRN, RN]

One has always been able to buy their own insurance from companies such as BCBS. It isn't like you are required to find a job before you can get insurance.

You are required to find a job before you can get employer-provided group insurance, which was not the same thing as individual market insurance. I went into Nursing in part because I could no longer risk only having the rather worthless individual market insurance that I had.

From Forbes on the difference between individual market coverage then and now:

[h=3]Individual Coverage[/h]

There is currently one benefit to having individual coverage – if you are healthy and young, you can purchase individual coverage rather cheaply. Many savvy employees realize they can buy individual coverage for less money than their premiums for employer based group coverage. Why is it so cheap? Coverage is not guaranteed issue and has few required benefits. If an insurance company can cherry pick healthy people, it can charge lower premiums. With Obamacare, the potential cheapness” of individual coverage goes away because it will be guaranteed issue and provide essential benefits. The cost will be on par with employer based coverage because of these changes.

[MunoRN, RN]

It does and here is proof that it does:

http://images.politico.com/global/2014/09/15/embargoed_gao_report.html

That actually pretty clearly states that the ACA doesn't pay for abortions and even adds a requirement that didn't exist before which is that if states choose to allow insurers offer plans that include abortion service coverages then those plans have to a funding firewall between those plans and plans that don't offer coverage of such services. Where are you getting that it says the ACA pays for abortions?

[MunoRN, RN]

I'm still not sure what you would actually change? For instance, you've pointed out that we spend more than necessary because too many people are overweight, which is true, so what would you do about it through health insurance reform? Would you prefer that the law require insurance plans to address obesity, including financial disincentives for people who chose not to take part in a weight reduction program?

[elkpark]

One has always been able to buy their own insurance from companies such as BCBS. It isn't like you are required to find a job before you can get insurance.

Have you ever shopped for health insurance in the individual insurance market? I have. Private, individual health insurance has, traditionally, been ridiculously, prohibitively expensive (because you don't have the negotiating clout and shared risk pool of large employers). People who were trying to buy individual coverage were sitting ducks for the insurance companies.

I have known many people over the years who were staying in jobs they hated solely because they needed the employer-provided health insurance. Their spouse was self-employed and buying coverage on the private market for the family would be prohibitively expensive. Or, the family had plenty of money, there was a family member with a pre-existing serious condition and no insurance company was willing to sell them insurance, period.

These are the kinds of problems the ACA is trying to address (not very well, I freely admit. We'd be much better off with a single-payer system, and cutting the for-profit insurance companies out of the equation entirely).

[SubSippi]

Good day:

Since the patient affordability health care act commonly known as Obamacare DOES NOT guarantee affordability OR more importantly access to healthcare, ACA is not healthcare! Just because you have insurance (any insurance), doesn't mean the hospital, doctor, pharmacy, etc. has to accept your insurance. No acceptance without an alternative means to pay equals ZERO ACCESS.

So those of you stating people need healthcare, while healthcare is not in our constitution or bill of rights (that's a separate debate), ACA isn't bringing you healthcare because it does not guarantee access let alone guarantee controlling costs, being affordable, etc.

Thank you.

P.S. Ruby V, it continues to be covered by LifeStyle News and other sources about ACA covering abortion. Furthermore, while the Supreme Court ruled on Hobby Lobby and Conestoga Wood being able to opt out for abortion coverage, that ruling didn't extend to private citizens and other areas beyond small, family controlled, businesses. And the issue is the money I earn and use to pay taxes should not go towards areas completely opposite of my faith. If someone wants to murder an innocent baby, I should not be forced in any way, shape, or form to pay for the murder.

Do you realize that before the ACA, many of those without health insurance found it next to impossible to find a physician that was willing to see them, outside of the ED? If you think it's hard finding someone to accept your insurance, try finding someone that will accept you without insurance (unless you can pay up front). And even if you can get in, many of these people are unable to afford prescription costs.

So, with that being said, even though having health insurance and having access to health care are very clearly different things, having health insurance is a key component of one's ability to gain access to health care (especially primary/preventative care) outside of an ED.

[jaycam, RN]

Where on earth does penicillin cost $350?!

I think they are talking the PCP visit to get the prescription, although I've had augmentin and clindamycin prescriptions in the 150 dollar range while I was uninsured.

[didi768]

Some of us nurses don't want to nurse anymore and we get harassed for it. We are punished for wanting a new and different job. I don't get that.

[Turtles2]

Doesn't this require additional bureaucracy to manage what will essentially be a mortgage sized loan to a high risk borrower? As noted above, why would the private banking sector touch these folks? So aren't you implying government involvement?

Yes. I am not against some government. I am against BIG government. Helping people get loans is much better than giving them free money that they took from other people by force.

[Turtles2]

Its called universal healthcare

Universal healthcare does not exist in the USA. Liberals wanted Obamacare to accomplish this but it does not.

[Turtles2]

Why should I? As for being grateful. Most of them have very good accountants and have multiple tax dodges in place and pay mimimal tax. Why should I be grateful to someone who pays less tax than I do. If the rich person needs healthcare, they get it exactly the same as the poor person and as little old me. No insurance co pays, deductables, or insurers trying to dodge the bill.I've 37, have been working since the age of 18 and paying taxes all that time. Its nice to know in event of an acute illness I don't have to take out a second mortgage or sell a vital organ just to pay the bills

lol. You think you pay more taxes than a millionaire does?????? Millionaires pay more taxes in one year than you will during your entire lifetime. Millionaires fund most of Obamacare subsidies. You should be thanking them, but as you just pointed out, you hate them.

[Turtles2]

Yip, however if chronic conditions arent dealt with they can become a whole bunch more complicated.

Far cheaper to ensure the t2 diabetic who needs insulin knows how to monitor their blood sugars, control their diabetes through diet, increase their exercise and ensure they use of insulin or oral hypoglycaemics. Of course we could wait until their foot turns black due to uncontrolled sugars and has to be chopped off because its necrotic but it would cost the tax payer a hell of alot more money

You are assuming patients are compliant. Every American already knows that overeating is unhealthy, but most Americans overeat anyway. Giving them free medical care is not going to motivate them to eat right and exercise.