There was a time when I would've considered the ACA unnecessary. That I would've been annoyed by it. This was also a time where I had little to no interest in politics. It's funny how life has a way of humbling a person and teaching them something new about themselves on a regular basis. This is a story about how I ended up needing the help in order to make myself better.
"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.
I understand that we only pay a portion. I'm talking about these people on these employer plans that still pay $800 a month. What exactly is the employer contributing.
i am paying $600 for a PPO from my employer.
The dental coverage is shoddy; they only cover $1000/yr and after that you are on your own.
Someone mentioned above that having insurance does not equal healthcare access.
I find that to be true.
I have a PPO and i still have to wait months for an appointment with my primary physician.
I know many physicians refuse to see patients getting Medicaid; however,i have also known physicians who treated "Medicaid patients only".
Until last December, I paid $800/month for 2 adults on my employer's health plan. It was pretty good coverage, but everything was expensive. According to my calculations, my employer paid 32% of the cost.
My daughter and son in law both work jobs without insurance coverage [they are in college] and the best/most affordable policy they could get is the same as the one you have. Adding insult to this injury my daughters only prescribed med, her birth control pills, have more than trippled in price with this so called insurance. Since neither one of them have any chronic health conditions [thank God] the odds of them ever actually going beyond their deductible and receiving any kind of benefit from this ridiculously expensive plan is pretty slim.
Three federal agencies recently made public statements saying that insurance companies have to provide no cost contraceptive coverage. Even if it's a brand name with no generic if your daughter's PCP states it's the best birth control option for her, they cannot legally charge her a copay for it. This was recently done within the last week or so, so I thought I would let you know.
Specializes in Critical care, tele, Medical-Surgical.
FAQs about Affordable Care Act Implementation
May 11, 2015
... Plans and issuers must cover without cost sharing at least one form of contraception in each of the methods (currently 18) that the FDA has identified for women in its current Birth Control Guide.(12) This coverage must also include the clinical services, including patient education and counseling, needed for provision of the contraceptive method...
... The plan or issuer may not impose cost sharing with respect to anesthesia services performed in connection with the preventive colonoscopy if the attending provider determines that anesthesia would be medically appropriate for the individual...
Specializes in Management, Med/Surg, Clinical Trainer.
Good day:
"I think too many people who lived without insurance for a long time need help accessing healthcare."
The problem with the above statement is that insurance DOES NOT equal access to healthcare. As I shared in the past, a doctor, hospital, pharmacy, etc. is under ZERO obligation to accept any insurance. If access equal ability to afford, and they don't accept Obamacare insurance, OR only specific tiers of Obamcare insurance, then there's no access.
Thank you.
Agreed the facts are the facts. These statements do not suggest anything dire, they are just the facts. An MD office has NO obligation to accept any form of insurance, nor are they obligated to have an office location close.
Are we hoping for equal access to care? I am sure many would like to see that, but frankly there is no way to achieve that. If someone lives in the South side of a rough city the nearest MD who will take their insurance may be many miles away. And often it is those same people who rely on public transportation. This would mean that if they get an MD they could spend the better part of their day getting to the MD office, waiting to be seen and then getting home.
What about the people who live in the rural areas. They may also see the closest MD many miles away. The difference with these folks is that they may not have a hospital or Urgent Care anywhere close either.
Access to care does not only mean, an MD willing to accept the insurance.
My PCP hasn't accepted insurance since been going which is >25 years. You either pay by cash or check and they will fill out your insurance forms for reimbursement. Here in NYC that has been the standard for many private practice physicians and has been so for some time. Of course those connected with networks or hospital run facilities are a different story. As for why they all give pretty much the same response; the cost of employing staff to deal with insurance companies and or Medicare/Medicaid. They just don't want the bother.
Here in NYC urgent care centers like CityMd vary, that place takes all sorts of insurance including Medicare and Tricare (but not Medicaid IIRC), also is in network for a good number of private plans.
Specializes in Management, Med/Surg, Clinical Trainer.
Here in NYC urgent care centers like CityMd vary, that place takes all sorts of insurance including Medicare and Tricare (but not Medicaid IIRC), also is in network for a good number of private plans.
Two thoughts on this topic.
One is a repeat of an earlier comment, having the medical card does not mean access. If the person who got an ACA plan can get a doctor they could get a primary MD visit for free, but if they cannot find an MD in their area who will take their insurance and they need to see an MD they will go to the Urgent Care but they will pay a co-pay.
Thought two, I agree with the statement above many Urgent cares do not take medicaid - and by extension they would not take the lower level of the ACA, as it is an expansion of medicaid -- so these folks may not have access to a PCP or an Urgent Care. Where are they going for care? the ER.
Specializes in Critical care, tele, Medical-Surgical.
My dermatologist only takes Medicare. Before I was 65 she gave me a detailed receipt to mail my insurance company for reimbursement.
Much of her practice is cosmetic that insurance doesn't cover.
I know a family practice physician who does the same. Most of his patients are old enough for Medicare. he took over his father's practice and owns the building his office is in.
One is a repeat of an earlier comment, having the medical card does not mean access. If the person who got an ACA plan can get a doctor they could get a primary MD visit for free, but if they cannot find an MD in their area who will take their insurance and they need to see an MD they will go to the Urgent Care but they will pay a co-pay.
Thought two, I agree with the statement above many Urgent cares do not take medicaid - and by extension they would not take the lower level of the ACA, as it is an expansion of medicaid -- so these folks may not have access to a PCP or an Urgent Care. Where are they going for care? the ER.
Despite New York State's participation in the ACA and roll out of its own insurance exchange ER's in City and elsewhere are still crowded. Persons continue to use them as a substitute for PCP and it is causing all sorts of problems including staffing related issues. ERs in critical condition, nurses say; patients cite long waits | SILive.com
Leaving aside the question of insurance (or lack thereof) and finding someone to accept there is the problem of physicians keeping "banker's hours". After a certain time of day or on weekends/holidays you often will be hard pressed to get in touch with or see a PCP. The "ER" Lenox Hill opened at the former St. Vincent's campus is 24/7 IIRC, but not everyone lives near or wants to trek down to the West Village.
You are the only person I've seen with that low of a deductible....everyone else's are 10000+. It is income based. The more money you make the higher the premium and higher deductible. And I don't see how it is really that affordable...I know people on min. wage and even at $300 a month, they can't afford that when they are being required to have it by law. That's a difference in keeping lights on and food in the house. I'm all for everyone having access to insurance, but it is flawed.
smartnurse1982
1,775 Posts
i am paying $600 for a PPO from my employer.
The dental coverage is shoddy; they only cover $1000/yr and after that you are on your own.
Someone mentioned above that having insurance does not equal healthcare access.
I find that to be true.
I have a PPO and i still have to wait months for an appointment with my primary physician.
I know many physicians refuse to see patients getting Medicaid; however,i have also known physicians who treated "Medicaid patients only".