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.

[jaycam, RN]

Okay turtles, let's play pretend here and pretend that all the people who disapprove are those who really hate the ACA and think it's evil, no one who thinks it needs improved or thinks we could do better. What do you suggest, do we go back to leaving the poor to suffer, drown in debt, or even die for lack of access to healthcare? Disapproval doesn't mean the old way is better. So what do we do now?

[Turtles2]

You do realize that poor people were eligible for medicaid before obamacare existed, right? Contrary to your dramatic claims, people were not dropping dead on the streets like a scene from a horror movie.

[AndyB]

Everyone with dependents at my job had the premiums doubled and tripled and the copay raised and the deductible raised drastically. The only thing that Obamacare has done is raise medicaid enrollment by 21% and caused millions of people to lose their insurance and then force them to buy Obamacare policies ... if they can afford it. Nothing like making senors and men buy insurance policies that have mandated maternity care.

[mamavik2]

Amen! I worked as a nurse for 32 years until becoming disabled by diabetic neuropathy and narcolepsy. It took over 2 years with no income to finally be approved for disability under SS. During that time I had no insurance, and didn't qualify for Tenncare (my roommate covered my share of the rent so I had a place to live). I did qualify for food stamps so we had food but I had to rely on others to pay for my medications, and had to switch to the cheapest or stop some entirely because i had no way to pay for them. My health care was through free clinics which had no docs to care for my sleep apnea or narcolepsy, but I was able to have my diabetes and hypothyroidism monitored. Needless to say, medical equipment such as my CPAP supplies, which should be replaced frequently, glasses, walker repairs were unobtainable during this time. I was told going without my CPAP WAS RISKING DEATH so I used the same mask (replace at least every 3 months) until it broke and then cannibalized my old ones for parts to fix it, the hose and water chamber used until I became eligible for Medicare (replace every 6 months). I have now been told I have beginning COPD after several respiratory infections that I feel were, if not caused, then certainly exacerbated by this. I do not fully understand all the ramifications of the Affordable Care Act, but it has to be better than letting our citizens go without any health care or minimal care as we do now.

[compumasta]

The real question is, who really wanted this healthcare law? It certainly wasn't most any progressive. Republicans claim to not want it, as do many Democrats as well. Who wanted this bill? The rich. As a progressive, this is no where near the law that I wanted. I did not want a bill that was largely drafted by republicans, modified by democrats, and passed in secret.

In case anyone hasn't noticed, they play for the same team. Do not try to pull this over as partisan, since it is most certainly not.

When money controls politics, this is what you get. The insurance companies are happy. And although they won't admit it, both Democrat and Republican representatives are happy because of that.

The only thing I am certain about going forward is that this is going to get worse before it gets better.

[MunoRN, RN]

Good day:

Reasons why I dislike the Patient Affordable Care Act commonly known as Omabacare:

1. Sold on lies.

2. 100% Partisan bill (brought to us only by one party).

3. Not read before it was signed; Nancy Pelosi's infamous statement, "We Have To Pass The Health Care Bill So You Can Find Out What's In It" -- now, as a nurse, can you imagine... "we have to give you the medicine in order to find out what's in it" would fly over well with any patient or instructor? Or we don't have to proof read our papers... etc.

4. ACA does cover abortion. For those of us who believe abortion is cold blooded murder of an innocent baby; this is a huge deal.

5. ACA does not guarantee access to Healthcare. I repeat, ACA does not guarantee access to healthcare. Since any provider (this goes for drugs, hospitals, doctors, etc) in a free country cannot be forced to accept insurance, the provider has the right to refuse service unless they are paid via vehicles of payment they accept.

6. ACA is not revenue neutral (part of the lies that sold ACA).

7. ACA involves forcing people to buy a product whether they want to buy the product or not. For those that can afford the product, they are forced to pay for coverage they will not need so as to jack up the price so that part of the money that doesn't go into the pockets of those evil insurance companies (the democrats called them evil and corrupt before ACA; do you think management changed after ACA?) goes towards paying for insurance (aka subsidies) of those who cannot pay.

The list goes on... and for all those that sing praises, as more and more doctors and hospitals rebel (as is their right in a free country) and refuse to accept insurance brought to you by ACA, then the access issue noted in #5 becomes a larger and larger picture showing that ACA was a train wreck to start, and still is a train wreck now.

Thank you.

Im not a fan of Obamacare either and I'm all for discussing how we can do this better, but least at least respect a little honesty about what we're talking about so that we can actually have a meaningful discussion about what would be better.

The ACA was written by the Senate Finance Committee, a bipartisan group, and includes many of the main requirements conservatives had for healthcare reform.

The full text of the ACA was actually available months before it was voted on. As with any law, you never know for sure how the law will be administered exactly since that is up to whatever department is responsible for administering the law. Laws are not actually fully defined by the legislature, they never have been. So until it's actually a functioning law, you don't know exactly how it will work. To use your example, it is like giving a medication; take a BP med for instance, you know the general effect of the medication, but until you give the BP med you can't say for exactly what their BP will after it takes effect.

The ACA does not fund abortions and actually adds more requirements to keep them from being funded by those who don't want to contribute. If you have evidence to the contrary please provide it.

The ACA does not guarantee access to healthcare, nor was it intended to. What it does it make insurance more accessible to those without employer provided coverage, which in turn does make treatment more accessible since lack of insurance has been well established to decrease access to screenings, preventative care, etc.

You're right the ACA is not revenue neutral, it's net effect is actually a reduction in deficit spending (it saves more than it costs) according to current CBO reporting.

Why shouldn't people be required to buy insurance for major costs? Hospitals are legally required to provide acute care, which accounts for most of our healthcare spending, so why shouldn't people be required to pay for that? If it's required to be provided, it should be required to be paid for, that's basic financial responsibility.

If we're supposedly paying all this extra money, where is that extra money now?

[Tenebrae, BSN, RN]

You're a 34 year old nurse who works in a call center as a customer service rep? Laid off 4 times in 6 years? I think I'm missing some part of this story. Why are you so unemployable?

Nursing student.

And sometimes **** happens. I found as a student especially working casual jobs, last on first off. If places need to get rid of employees it was the last hired that were let go first. During my four years of training I had five jobs at various times. One does what they have to do to survive

[Tenebrae, BSN, RN]

Glad to hear of improvements OP

I work in a country that has universal healthcare. I've worked in a not for profit and a for profit organisation. The business model does not work in regards to healthcare because healthcare should be a basic human right not something someone has to pay vast amounts of money to get the most basic of service

Ironically some of the arguments I've heard against universal healthcare including that doctors and nurses wont be free to be able to do their jobs is just ridiculous. I get to provide nursing care to who ever needs it, period. My sister is a consultant doctor, specialised in emergency medicine and she treats according to what she deems best for that particular patient. None of us have to justify treatment to any bureaucrat

[Turtles2]

Glad to hear of improvements OP

I work in a country that has universal healthcare. I've worked in a not for profit and a for profit organisation. The business model does not work in regards to healthcare because healthcare should be a basic human right not something someone has to pay vast amounts of money to get the most basic of service

Ironically some of the arguments I've heard against universal healthcare including that doctors and nurses wont be free to be able to do their jobs is just ridiculous. I get to provide nursing care to who ever needs it, period. My sister is a consultant doctor, specialised in emergency medicine and she treats according to what she deems best for that particular patient. None of us have to justify treatment to any bureaucrat

If forcing rich people to support poor people is such a good idea, why stop at obamacare? Why not force rich people to give poor people houses, cars, food, clothing, and college tuition? Sound good?

[MunoRN, RN]

Qualifying for Medicaid under the ACA is a completely different world than being in the working class and trying to afford the doubled premiums and insanely high deductibles the ACA brought to most working adults.

My deductible is so high that I end up paying cash for all of our prescriptions and in most years will never satisfy a $12,600 deductible that I pay over $500 a month for. That was the cheapest policy I would find, even through the glorious "exchanges". That's over $18,000 a year I would be responsible for before my insurance kicks in!

Prior to the ACA, I had a perfectly good policy that cost $223 a month with a 10K deductible that worked well for my needs. I saved enough money each month that spending 200-300 on medications or doctor's visits was no big deal. Funny how Obama touted if you like your policy, you can keep it! Thanks to the ACA, health insurance companies were required to add-on additional coverage to their policies, passing on the higher deductibles to the policy holders.

I wouldn't get all warm and fuzzy about the ACA until you are out of school and working and see exactly how expensive your healthcare will be due to the ACA.

I also used to have a cheap individual market plan which "met my needs" (it offered little meaningful protection from bankruptcy but was cheap). A big part of the reason why I went into nursing was to have the privilege of paying $14k a year for a real plan, which I was happy to pay for.

One of the main reasons for reform was that as the price of overall healthcare was rising rapidly (which obviously translates into higher insurance costs) individual market plans were adjusting to those increasing costs by covering less and less. Unfortunately many people who had these plans weren't even aware of this and were under the impression that their plans were comparable to employee-provided plans. In reality, individual-market plans were becoming more and more likely to not cover claims that it would have seemed they would cover, prior to reform being passed these plans were denying 1 out of every 7 claims, often the most expensive ones. This is why even during the mortgage crisis, health care bills remained the largest cause of bankruptcy, and most of those declaring bankruptcy had "insurance". This leaves these costs still unpaid, shifting them to others with insurance, typically in group-plans, which raises the cost of those plans which then causes employers to drop coverage, increasing the costs for those remaining, etc, etc.

To compare insurance coverage that is actually comparable, such as in states where individual plans were required to be similar to group insurance, the cost of insurance actually went down, as much as 40%.

With the ACA, plans have to meet actuarial value requirements, so by definition you're not paying more than your fair share, what is it you think you're paying for that you shouldn't be? Where is all the supposed extra money?

[MunoRN, RN]

If forcing rich people to support poor people is such a good idea, why stop at obamacare? Why not force rich people to give poor people houses, cars, food, clothing, and college tuition? Sound good?

If we want everyone to be able to get healthcare, which has been the law since Reagan signed EMTALA into law, how do we do that without paying for it? We either stop providing healthcare to those who can't afford it, or people who can afford it have to chip in for those who can't, there is no other way of doing it that abides by the basic laws of math. What would you suggest?

[compumasta]

If forcing rich people to support poor people is such a good idea, why stop at obamacare? Why not force rich people to give poor people houses, cars, food, clothing, and college tuition? Sound good?

I think you may have quoted the wrong person, Turtles2. Tenebrae did not say anything about forcing anyone to do anything.