The Affordable Care Act (ACA or "Obamacare") ended the insurance industry’s cynical practice of denying coverage to people with pre-existing medical conditions. As soon as that provision of the ACA went into effect, my husband and I welcomed our 15-year-old daughter "May" to our private health insurance policy for the first time. For years May had been covered by an excellent plan provided by the Children's Health Insurance Program (CHIP), also known as Children’s Medicaid, because it is subsidized by state taxpayers.
It was only right and just that we assumed responsibility for our own daughter’s health insurance, now that the law allowed us to do so. After all, why burden other taxpayers with our family’s health insurance needs?
May’s heart defects are congenital, so one might say that her pre-existing conditions were God-given. All the years she was on a taxpayer-subsidized BC/BS insurance plan via CHIPS we had low premiums, excellent coverage and no worries, because her heart defects never manifested. The doctors told us they may never manifest, yet still the insurance companies rejected May from any health care coverage at all.
Since my husband is self-employed, we are limited to high-priced individual health care plans; no group plan price breaks, no employer-subsidized premiums. Ours is a high-deductible private family plan with limited coverage. But that coverage now includes all of us, because we did not want to encumber our fellow taxpayer with even one more CHIP participant.
Within eight months of moving her to our private plan, the dreaded consequences of May’s heart defects manifested with a vengeance. Suddenly we were walking on eggshells, and interrupting basketball practice to make emergency room visits wherein May was pumped full of three and four times the normal dosages of heart-rebooting Adenosine just to bring her back to a normal teenage rhythm. She’s a strong girl, but could only take so much of that.
At her cardiologist’s urging we scheduled outpatient surgery. This ended up nearly killing May, requiring several days in ICU and a week of hospitalization, and it did not work. So May was put on strong daily medication, medication that has unpleasant side effects for a child accustomed to being able to keep up with the focus and speed required of high school basketball, until something else can be done. May slipped from potential starter to last girl on the bench. Still, despite missing so much school, she worked hard to catch up and maintained her straight A+ academic streak for the 10th quarter in a row.
And of course, high as it is, we hit our health insurance deductible last year. In fact, under the circumstances we can expect to hit it every year for some time to come. We looked into applying for a lower deductible plan, but the application asks if we have been advised that any procedures are needed. Why yes, we've been so advised: we have been referred to Mayo Clinic in Minnesota for a consultation about open heart surgery for May, and we’re going there next month. There's no way to hide this from the insurance company, and there's no way they or any other company is going to grant us a lower deductible plan with that on the horizon. As it is, they have already increased our premiums due to all the recent activity.
If we had stayed on the taxpayer subsidized BC/BS plan, our costs would have been contained. The costs to the rest of our state’s taxpayers would have increased, however, because in the last six months alone, May's heart condition ran up nearly $200,000 in medical expenses. Each cardiologist visit costs $1000 and that’s before the inevitable tests are ordered. Of course, hospital and lab costs are phenomenal. There is seemingly no end to the medical bills already, and Mayo Clinic is not likely to change that trajectory.
Conservatives insist that children with severe health problems get born, regardless of the heartache, regardless of the pain and trauma, and regardless of the expense. I have no problem with that, and would not, of course, trade my May for anything in the world. But those same conservatives don't support funding social programs to serve these children; they don’t support subsidizing schools that are burdened with paraprofessional and nursing expenses when these children enroll; and they don’t want to require, as the ACA mandates, that insurance companies cover these children. Given that, it is obvious that if conservatives get their way, CHIP programs nationwide would get the axe as well.
Make no mistake about it: conservatives are NOT pro-life. They are merely pro-birth. After you are born they don’t give a damn about you, your child, or your family. Apparently that’s what they call "family values".I regret leaving the CHIP program. But I was doing the right thing, wasn’t I? The thing conservatives say responsible people should do. I was thrilled when the ACA passed, because it also meant my daughter would not face loss of health insurance once she became an adult. Now I just hope she makes it that far. And that I’m not too broke to pay for her college when she does, because there’s not likely to be a Pell Grant for her, is there?
So how is it that I, as a taxpayer, helped pay for an aging millionaire bureaucrat to get a brand new heart, but I can’t even get my own child affordable health insurance to fix hers, so that she can even hope to make it as long as he did?
Here’s an irony I don’t think the conservatives have considered: If the Supreme Court throws out the ACA, my daughter and her pre-existing condition will go back on the state government-subsidized BC/BS plan that has far better coverage and costs me much, much less. In fact, CHIP program enrollment is likely to swell exponentially if the ACA is repealed, because these programs serve the uninsured and uninsurable.So do I hope that the Supreme Court votes this week to overturn the ACA so I can shift the enormous costs of my daughter’s health care back to the taxpayer? Or do I hope they uphold the law so everyone gets a chance to get the care they need?
If I were a conservative, I'm pretty sure I'd opt for the former, and then hope my party took just long enough to get rid of CHIP that my daughter would have time to get her heart fixed on the public's dime. Then I'd apply the current conservative credo - "I got mine, to heck with the rest of you" - and proceed to make a big stink about how CHIP programs are socialistic plots to bleed taxpayers dry and ruin America. Because I wouldn’t just be a conservative, I’d be a compassionate conservative don’t you know.
This week conservative Christian churches have sent members of their congregations to camp out at the Supreme Court so they can be on hand to witness and cheer for the historic reversal of the ACA. Where were these people when their bible classes covered the lessons about the Good Samaritan, healing the sick, or doing for the least of one's brothers? Were they out sick?
If so, who took care of them?
Tue Dec 18, 2012 at 3:42 PM PT: Since this diary May has been hospitalized four more times, including open heart surgery at Mayo Clinic last July. She is doing remarkably well now and recently passed her driver's test on her 16th birthday.
Our insurance company granted an out-of-network waiver, effectively limiting our annual medical expenses to $10,000 and keeping us in our own home. A month after the Supreme Court approved Obamacare on my birthday, we received a nice reimbursement check from our insurance company due to their failure to meet the patient margin. I sent the money to the Obama re-election campaign.
I sincerely hope no one ever has to face the struggle we did, but if they do, I hope they are people who have raged against Obamacare so they can see first hand what a godsend it truly is.
Thanks to everyone who wrote with their kind wishes, and to those who work in the medical field I'd like to say that if you want to see how excellent health care is delivered at (relatively) reasonable cost, check out Mayo Clinic. In a country as wealthy as the US, it should be the standard, not the exception.