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Why the Affordable Care Act will make a real difference to many people

This is what it’s all about. The following was written by a good friend of mine, who has been eagerly awaiting October 1 and the opening of the insurance exchanges. I asked him to write about his experience with getting insurance via the exchange. This is his first installment:

It's constitutional - deal with it

It’s constitutional – deal with it

I am in my late 40’s, male, don’t smoke. I weigh almost 300 lbs, have high-blood pressure, high triglycerides, and low good cholesterol. I have a wife and two kids.

I had company-provided health insurance until my company laid me off in April of 2012. My COBRA rates were exorbitant ($1700/month), so I applied for a discounted individual policy through my affiliation with the American Federation of Musicians. After a lengthy application process, I got an email that told me that everybody on the application was approved, except for me. This was with Blue Cross/Blue Shield of Texas. I called them and talked to a representative. Evidently, my weight was considered a pre-existing condition, and that disqualified me. In addition, they told me that:

– My name was now in a national do-not-insure registry for the next two years, so even if I lost weight down to their threshold (which they would not tell me), I would have to wait for two years to reapply. And every insurance company would look at that database. She said that each company had different limits, but once they had turned me down, they all would. I verified this independently by calling United Healthcare. They told me the same thing, but at least they told me their weight threshold was 265 lbs. for somebody 6’0″ like me.
– They also told me about the “high risk pool”, but said I needed to go without insurance for six months in order to qualify.

I took another job in late 2012, but they had a 3 month waiting period for full insurance; they offered a very limited emergency-only policy until then. We decided to continue with COBRA+Blue Cross until the employee provided insurance kicked in.

In September 2013, I took a job as a consultant. Unfortunately, that meant I no longer had employer-provided insurance, although they say I will get a COBRA form soon, and that they can backdate anything to my termination date. I anticipate it being really expensive. My consulting contractor provides another emergency-style policy, which we are taking, assuming that I can get insurance via the medical exchange in January. It’s a risk that we won’t have major medical problems come up in the next few months. The extra expense for doctor’s visits and prescription drugs are still going to be cheaper than COBRA.

Cost breakdown: Me + family of four

Employer provided (early 2012): $332/month
COBRA (all of us): $1696/month
COBRA for me + insurance for 3: $1203/month
Employer provided (through September 2013): $318/month
Emergency policy: $436/month (very little coverage for non-emergencies)

I am sitting down today to sign up for insurance for my family. We’ll see what happens…

He tried to sign up yesterday after he wrote that, but experienced the same site-too-busy problems that many other folks did. He will send me an update after he successfully navigates the exchange. I’ll run that when I get it.

Lots of other people were writing about their experiences, or the experiences of their friends, who are now able to get health insurance for the first time. John Scalzi, noting a friend of his that can finally get covered, wrote how he was one of the very few self-employed writers he knew that didn’t have a no-insurance horror story to tell. Jef at Hair Balls wrote about the effect for some local musicians. Alyssa Rosenberg spoke more generally about how access to affordable health insurance will make life better for artists and small entrepreneurs because it helps mitigate risk for them. Never forget, Ted Cruz and the entire Republican shutdown caucus are fighting against the health and well-being of all these people, their families, and millions more like them. That’s what this is all about.

And that’s why they’re fighting so fiercely, because they know how bad the politics of this is going to be for them once everyone is signed up.

The juxtaposition of Tuesday’s two top stories was extraordinary.

The top story all day was that Republicans had shut down the federal government because President Obama wouldn’t defund or delay the Affordable Care Act. The other major story was that the government’s servers were crashing because so many people were trying to see if they could get insurance through Obamacare.

So on the one hand, Washington was shut down because Republicans don’t want Obamacare. On the other hand, Obamacare was nearly shut down because so many Americans wanted Obamacare.

The coming days will be a major test of the IT infrastructure supporting the Affordable Care Act. The online marketplaces were flooded with eager applicants on Tuesday — a rush that far exceeded the expectations of marketplace directors. Reuters estimates that they got more than 10 million visits. But many of those applicants faced slow pages and error messages. Some waited hours to sign up for Obamacare. Others resolved to come back later.

The Obama administration’s line is that the glitches were nothing more than a new product being hit with unexpected levels of demand. “We found out that there have been times this morning where the site has been running more slowly than it normally will,” President Obama said. “The reason is because more than one million people visited healthcare.gov before 7:00 in the morning.”

If that’s really the reason and the technical problems were caused by nothing more serious than overwhelming traffic then the law will be fine. But if the error messages and slow pages are persistent problems in the coming weeks, that’ll be a more serious problem. People will come back once or twice. But they won’t struggle endlessly with a buggy web site. And if the Obama administration hasn’t managed to set up a usable online marketplace given all the time they’ve had to prepare, then that’s a tremendous failure on their part.

Sadly, the American people are still struggling with a buggy Congress — and it’s not clear any fix is in the offing. It was strange and slightly perverse to watch Obamacare open and be flooded with people desperate to sign up for health insurance even as the government closed because Republicans wanted the law ripped out, or at least delayed. In some quarters, Republicans mocked Obamacare’s technical problems, but the jokes were wan: Overwhelming demand for the law is not a boon to the GOP’s position.

This is, of course, precisely what Republicans were scared of: That a law they loathe would end up being enthusiastically embraced by millions of Americans — and thus proving permanent. It’s Obamacare’s possible success, not its promised failures, that unnerve the GOP.

At this point, though, their fight continues even as their cause is lost. With people already signing up for insurance under Obamacare and insurers already selling insurance under Obamacare it’s no longer credible to promise repeal or delay. Republicans need an actual answer for all those people.

As Tuesday proved, there are going to be problems with Obamacare, and it’s nearly certain that the GOP could come up with ways to reform, improve, or even replace it if they were sufficiently committed to improving the country’s health-care system. But as Tuesday also proved, millions of Americans have been waiting for something like Obamacare, and now that they’ve got it, they’re going to want to keep it.

Sure there are some entirely predictable and expected problems with the rollout, problems that have more to do with high volume than anything else. That will all get worked out soon enough. The bottom line remains that the government is finally, finally doing something to help millions of people who really needed it. Sadly, thanks to the intransigence of Republican governors like Rick Perry, there are millions more who could be helped by expanding Medicaid but won’t be. That’s a fight to return to another day. For now, we celebrate this big step forward. If you have a story to tell about needing insurance and finally being able to get it now, let me know.

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4 Comments

  1. Robert Nagle says:

    One of the big changes is that medical underwriting will be eliminated for individual policies. That is a really big deal because having anything but perfect health makes it a lot harder to have insurance.

    I was rejected for coverage once for having a mole which actually was a birthmark. I answered truthfully on a form that a doctor once suggested I should have it looked at. I didn’t bother, a year later when I applied for individual coverage, Blue Cross rejected me. Later I was able to obtain a note from that same doctor indicating that it was not an official recommendation, and that there was no reason to believe it was a problem.

    Because I was rejected for coverage in 2006, I have to disclose this rejection every time I apply for individual coverage. I receive the same phone interview, the same volley of questions, the same demand that the doctor provide my medical history. All for a stupid remark the doctor made to me 7 years ago.

    Starting January, you will just be automatically approved for coverage based on demographics. That means that approval will be speedier and the choice to visit a doctor won’t be impeded by the suspicion that this visit could end up making you uninsurable.

  2. byron schirmbeck says:

    Here’s my experience, I have insurance for just me through work, earlier this year the premiums were skyrocketing and we had to switch providers and raise our deductibles just to keep the cost near where it was before. Our agent told us we were lucky because several employers he worked with were dropping people because the costs associated with it were going up anticipating ACA. I am in good health and don’t have any ongoing medical needs that require routine medications or anything else. I go to the doc once a year or so and occasionally get the flu and need antibiotics but that is about it. I am paying @ $250 per month with a high deductible for just me for insurance I hardly use.

    I actually got to the list of questions on the healthcare.gov website before it all locked up and it asked me if I made more than 48k per year which I do, it then said the programs wouldn’t save me any money over what I have now. If I checked less than 48k per year and re did it it wanted to sign me up. So the way I see it my employer provided insurance went up because of the ACA and I can’t even use the exchange to lower my premiums because I make so much God awful money of more that 48k per year.

    So now that I know the penalty is going to be low and they can’t even collect it unless you get a refund, (which I don’t I usually pay) and that if something happens and I need insurance they can’t deny me then why on earth would I keep my current insurance? That’s $3000 a year I can put in a savings account to pay out of pocket expenses at the urgent care place if I need something.

    I have had health insurance all of my working adult life and I do believe the ACA has totally incentivized me into being uninsured. Still kicking it around but I can’t see any good reason to keep it.

  3. […] the Kuff shared a personal story from a friend about how Obamacare and the insurance exchanges will make a big difference in his […]

  4. […] of people were routinely denied coverage pre-ACA. I know some of these people – they’re friends, family, classmates, neighbors. Maybe no one at the TPPF knows any of these people. More likely, […]