What The Affordable Care Act Means to Me: Personal Accountability While Allowing For Accommodation

Why do I care about affordable healthcare?  First, I’m alive therefore I am a consumer of healthcare.  Second, I have been a healthcare provider (physical therapist) for 16 years.  Third, my husband and I are small business owners and have made the commitment to provide health insurance to our employees.

In the 38 years (almost 39) that I have been alive, I have never been without health insurance.  The thought freaks me out.  I have been in the position of making a choice about where to spend my money and health insurance has trumped many things over the years.  But I also have never had a major health crisis, nor have I ever been unemployed.  Yes, I could puff my chest out and say I’m better than “those people”, but I know better.  The reality is, those circumstances are a moment away.  They are for everyone. 

I have seen / worked with individuals for whom that moment has come.  They have spent their lives being responsible, law abiding, GOOD people but something happened (health crisis, accident, job loss etc.) and the rug was taken out from under them.  I worked with a woman once who too had health insurance all her life.  After 17 years with the same company, she decided to take a temporary leave of absence for a couple of months.  One month into that absence, she had a cerebral hemorrhage (a blood vessel in her brain burst).  Her family had retirement, saving etc. but the expenses quickly piled up and that was spent. Her family had to file for bankruptcy due to her medical expenses. 

At one point in my career, although I was employed in a job I loved, health insurance was not provided. I had previously been covered by my husbands health insurance.  We divorced and I was no longer eligible for his insurance. In order to obtain health insurance, I quit a job I really enjoyed to take a job that offered health insurance. Several years later, realizing I wanted to return to job setting I really enjoyed, I contacted my health insurance company (who had been my insurer since graduating college) about obtaining an individual health insurance policy.  The only plan I could get was for catastrophic coverage.  I had faithfully used my preventative benefits but had never had a major expense. I was floored.  My thought was, “I am 34 years old, healthy and this is the only plan I qualify for?” Health insurance was now dictating my career path.

So, what will ACA do to change this?

• Individuals will have access to affordable individual health plans through the Exchanges that will be created as a result of this law. This exchanges will will carry affordable healthcare options by private insurance companies.
• Individuals, who use to have to forgo any coverage because of cost, will now be able to afford good health insurance.  This will prevent them from needing to use indigent services or government sponsored health insurance.
• Second, if you have a pre-existing condition, you cannot be denied health insurance, forcing the individual to use indigent or government sponsored health insurance.
• If your healthcare becomes costly, your private health insurance cannot drop your coverage, again forcing the individual to use indigent or government sponsored health insurance.
• If you are age 26 or younger, working to establish yourself as a responsible adult, you can stay on your parent’s health insurance until age 26.

Some thoughts on the individual mandate, the most controversial point of the legislation. People still have the right to choose to not get coverage.  If they do, they will then be required to pay a penalty (or not, depending on circumstances).  This penalty will be put into the government coffers to be used to pay for their healthcare when they require it (lets be real, at some point everyone requires it).  Isn’t this the logic used when they instituted a tax on cigarettes? As a former smoker, the smoking tax always made sense to me. If you smoke, you should pay more tax because smoking increases your healthcare cost.  If you are alive, you will require healthcare therefore you should be taxed to offset that cost.  It’s all about choices and accountability.

An example.  I worked with a man who was a successful real estate agent.  He chose to spend his money acquiring lots of stuff (cars, electronics, etc.) He also chose to not buy health insurance.  While he was spending the weekend at the lake, he chose to dive into the lake, head first and broke his neck.  Because he didn’t have health insurance, nor did he have any liquid assests, he qualified for Medicaid. Maybe, had the mandate been in place, he would have thought twice about getting health insurance and would not have ended up on Medicaid.  Or, he could still have chosen to not get health insurance and would have contributed to the government through the penalty.

In my next blog I will talk about my role as a healthcare provider in the context of the ACA.  Any thoughts? Questions?  Please leave a comment!  My goal is to inform and there is a lot of misinformation floating around.