Wednesday, January 19, 2011

The Repeal of the Affordable Care Act Would Be Unforgivable

Most Republicans and all the Tea-Party elected Congressmen and Congresswomen will vote today to Repeal the Affordable Care Act that became law in March 2010.  They will not get it through the Senate.  President Obama would not sign it if it did.  Why are they going against the tide of history to try and kill even these modest reforms to health care in America?  They obviously do not understand the real problem and costs to Americans who do not have or cannot afford health care.  For those of us who do have health insurance, we are paying more and more of our income and savings for the privilege of having access to health care. Without the reforms made in this law, many of us who leave an employer with health insurance will be shocked to find we cannot obtain new insurance because of "pre-existing conditions" that affect 129 million people in America today. On the House floor today,  my Congressman Martin Heinrich (NM1-Dem) cited my experience with getting denied insurance because of  "pre-existing conditions" and the high premiums I pay for an insurance policy although my medical conditions are well managed and I am overall healthy. Under the Affordable Care Act of 2010, I will be able to shop for a competitive insurance policy beginning in 2014 as I cannot be denied insurance for "pre-existing conditions." To repeal the law that allows me to choose my own doctor and medical care without bankrupting my family would be unforgivable.

I am a middle-class 60 year old woman who is individually insured because, although I am employed, my employer does not offer health insurance. My husband is on Medicare and as a disabled veteran, receives his medical care free from Veteran's Administration Healthcare; therefore I am not eligible for his medical care as a dependent.

The main reasons for my support of the Affordable Care Act that became law in 2010 are that I want access to affordable health care for myself, my family, and all Americans. I want to be able to apply for and receive insurance coverage despite “pre-existing conditions”. I want the millions of uninsured Americans to be covered for preventative care, immunizations, physical exams, doctor’s visits, hospitalization, and medicine. I think that the uninsured of our country postpone care, get sicker, develop more serious conditions, and utilize emergency rooms at a very high rate for non-emergency care and that this results in uncontrollable and unsustainable increases to both taxes and in the insurance rates of those who pay for insurance (both businesses and individuals).

Also, people who need insurance because of existing health conditions need to be in a large insurance pool to spread the risk for insurance companies and keep rates low. However before Health Care Reform, insurance companies could deny individual applicants based on “pre-existing conditions.” We had few choices after being denied by the insurance company we wanted coverage with. If we met federal poverty guidelines, we might be eligible for Medicaid. If not, we could go without insurance, pay as we go, and risk losing our assets if a major illness or accident arose. We could go with an insurance company who issues riders to not cover treatment for “pre-existing conditions.” We could go into a “high risk pool” (if available) and pay very high premiums or lower premiums with minimal care catastrophic coverage with very high deductibles Even if those in high risk insurance pools live healthy lives and manage their medical conditions, they still have escalating premiums that eat up their assets and may even drive them to bankruptcy.

Also, because of their medical conditions, many people limit their lives and their careers to stay with an employer just to retain medical insurance. I had a colleague in my company in San Diego who had a liver transplant. She wanted to change careers to nursing and spend more time with the grandson she was raising, but couldn’t think of it because her monthly prescriptions (to prevent organ rejection) were very expensive and she could not obtain insurance on her own if she left the company. She plans to work for the same company until she is 65 and eligible for Medicare. I only hope she isn’t laid off like I and eight other colleagues over the age of 50 who lost our jobs and medical coverage in 2005. My story is attached.

My Story:

My family enjoyed the security of affordable health care for 27 years when I worked for General Dynamics (later BAE Systems) in San Diego. Both hourly and salaried employees had a choice of Aetna and two HMO’s. I enrolled in the Kaiser Permanente Plan, had two babies in Kaiser Hospitals, and continued my Kaiser insurance through COBRA after I was laid off Dec. 31, 2004. I had two daughters in college who were on my plan and I had dental coverage: the total cost to me under COBRA was $495 a month. I moved to New Mexico in February, 2005. I had to travel back to San Diego for routine care as I could only use Kaiser Doctors and hospitals - except for emergency or urgent care. I started working for Smith’s Food and Drugstore in Albuquerque in August, 2005; however, they did not provide medical care benefits for the first year of employment (Smith's is part of Kroger, Inc., the largest grocery store in the USA with sales of more than $76 billion in 2009). I left Smith’s because I wanted an employer that offered medical benefits immediately. I married in January, 2006. My husband is a disabled veteran who received Medicare and VA hospital benefits. Because of this, he didn’t have an insurance plan that I could enroll in as a dependent. I started working part-time as a Substitute Teacher for Rio Rancho Public Schools and for Educational Testing Service, Inc. as a Test Scorer. Neither provided medical benefits so I continued my COBRA coverage for the remainder of the 18 months I was eligible for. Because I now lived in New Mexico, I wasn’t offered Kaiser coverage during open enrollment period under COBRA in January, 2006, so I selected Aetna because they offered the Presbyterian HMO Plan and I was very happy with my Presbyterian doctor and their care. The cost under COBRA continuation was $478 for myself only (no dependents) and included dental coverage. In June, 2006, I was notified that my COBRA benefits would expire and that I needed to select a new insurance plan. I applied for an Individual Presbyterian Health Plan (HMO) and was denied coverage. I showed them my Evidence of Continuous Coverage from Aetna. Presbyterian Insurance said that they did not have to honor it for an individual plan. I was shocked and angry. I had been a member of the Presbyterian HMO for six months. I appealed my denial and met with underwriting where they declared they would not provide me an insurance plan due to pre-existing conditions. I had recently been diagnosed with high blood pressure and have had high cholesterol for 15 years. I could not afford to go without insurance as I was 55 years old, owned a home, a car, and had savings that I could lose if I was uninsured and met with an accident or major illness. I applied for a short-term “gap” policy for the month of July and searched for someone to insure me. Mega Insurance issued me a very limited policy but it had a Rider that excluded coverage for my pre-existing conditions. Before the 60 day limit after my COBRA coverage had expired, I was able to get an individual policy with the New Mexico Health Insurance Alliance. I selected the Presbyterian HMO option and my monthly premium was $421 for myself only, no dental. I thought that it wasn’t so bad, the same plan as when I had Aetna except the co-pays were higher, but I kept my same doctor I had used since I arrived in New Mexico. To help pay for my medical insurance and my kids’ college tuition, I had already taken an early withdrawal of a portion of my IRA. Then the premium went up 9% to $457 in 2007 and increased 13% in 2008 to $516 - plus they increased my co-pays. Now my medical insurance and co-pays were one third of my income. I needed help to pay my medical bills so I applied for my retirement pension early at a reduced monthly amount. In 2009, my medical insurance premium was raised to $547 and in 2010 to $605. I turned 60 in December so I got an age-based increase to $633. I earned $40,000 last year from part-time work and pension income. My insurance premiums were $6998 and my unreimbursed co-pays for medical visits, prescriptions and dental care were $1,888.34 which is 22% of my income for 2010. I have 5 more years to go until I am eligible for Medicare. I was pleased that the Affordable Healthcare Act passed in 2010 will allow me to shop competitively for an affordable insurance policy without pre-existing conditions affecting my eligibility. I will be 63 in 2014 and still need to self-insure for two more years. I don’t want to have to take reduced Early Social Security just to pay for medical insurance.

1 comment:

  1. Vicki - thank you for telling your Health Care/Health Insurance story in such organized detail. Republican support of the repeal of the Affordable Care Act is waning - as of the news last night, so hopefully their shameful political ploy to theatrically repeal the Affordable Health Care act - will go down in flames. Kathy and Joe