Because we know how well THOSE work, right?
I write this as a member of the transgender community in America. Most of us occupy the lower end of the socio-economic strata, myself included. We are far from the only ones on the bottom rung or even struggling to get onto that first rung. But it is rampant in my community, largely due to the employment obstacles we also face.
Results of the 2015 US Trans Study, which included 28,000 participants (approximately two percent of the total estimated US trans population) showed that unemployment among us is four times as high as for our cisgender counterparts. A similar Study, with fewer Respondents, conducted in 2011, came to the same conclusion.
For full disclosure, I was a participant in both Studies, and in both cases, I did not indicate I was unemployed. In 2011, I was working part-time while on disability and going to online school for Medical Transcription. In 2015, I was running my own barely fruitful medical billing and coding company, the same I run today. Underemployment is absolutely rampant in my community, and that is the area into which I fall.
Because so many of us are unemployed and underemployed, or like myself, self-employed, we tend not only to fall into the lower socio-economic strata, but we also generally cannot depend on employer-provided health insurance, meaning we are left with Obamacare, or the ACA...for those, like me, who make JUST A BIT TOO MUCH to qualify for Medicaid.
And it is this group of people who find ourselves with this wonderful new Trumpcare Health Plan, called “Thoughts And Prayers.” Transgender people are NOT the only people in this particular boat, but it is the experience from which I can speak, and the reality I endure on a daily basis. And it is a really super-duper plan...that is if you enjoy taking it on the chin (I am trying to be polite here)
So, let me trans-splain how it works...and it’s a doozy, by the way, so buckle up tight and let’s go for an interesting ride!!
Many trans live in states where employment discrimination is 100 percent legal. I am one such, living in the best of all states to be trans in America...NORTH CAROLINA!! Remember?? That place that sponsored Hate Bill 2? The one that elected a Governor who said he would help us...and boy howdy did he...NOT!! THAT state.
So...the Affordable Care Act...or what is left of it now that Trump destroyed it...leaves many of us, myself included, on the super-duper Thoughts And Prayers Healthcare Plan! Here is how it worked in my case…and mine is not dissimilar to others in my same boat.
North Carolina, like many states, has but one insurer who will even write Marketplace plans, so, if you live in North Carolina, you get to choose from Blue Cross/Blue Shield of North Carolina...or Blue Cross Blue Shield of North Carolina!! CIGNA has started writing some plans here, but not in all 100 Counties.
It has been this way since United Healthcare pulled out of North Carolina and several other states in a huff over the fact that the Federal Government would not approve their merger and takeover of another insurance company. That happened in 2016-2017.
So...in 2016, I had United Healthcare. I paid, after subsidy, about $21 a month. It was great. It did not last. In 2017, my choice being limited to BCBS-NC or BCBS-NC...I took BCBS-NC — and my shiny new Silver Plan cost me, after subsidy, out of pocket, $53 a month, which I was barely affording, but managed. It carried a spiffy $800 deductible, and a $5/$20 copay. Not a bad plan, actually. Not as good as I’d had with UHC, but similar in coverage, if not in out of pocket cost.
Enter “He Alone Who Can Save Healthcare In America”...Donald J. Trump. Enter his threats to not pay the CSR’s (Cost-Sharing Reduction payments) which are mandated by Section 1402 of the Affordable Care Act. Trump claims that Congress did not specifically appropriate the money for these and so the government is not going to pay them...and he does this at JUST THE RIGHT TIME...when insurers are figuring their rates for the upcoming year. (Incidentally, I should note that Section 1402 of the Affordable Care Act mandates that insurers offer the CSR’s even if the government does not pay for them...but BCBS-NC did not offer them to me.)
The net result? The spiffy Silver Plan (which qualified for CSR payments that were not offered) — in 2018 was set to cost me, after subsidy, out of pocket...$175 a month!! Now, I do not know about the rest of you, but I know I sure as the hell do not have an extra $120 a month hanging around doing nothing! So, under duress, I was forced to drop to the lower Bronze Plan...which does NOT qualify for CSR payments. And, after subsidy, that plan costs me $0 a month out of pocket. BUT...there are reasons why I was forced to sign up for this plan, and under duress.
Firstly, the tax penalty for not having health insurance. Guess what, folks? It is still in force for this year! Those who did not sign up, thinking the tax penalty went away...are in for a nasty shock when they file their taxes next year!!! The tax penalty does not go away until 2019. And there was no plan in between the $175 a month plan I could not afford, and the $0 a month plan I did not want. Additionally, as a diabetic and one who has been diagnosed with chronic depression, I have pre-existing conditions. Even though my diabetes is 100 percent managed by diet and exercise it is STILL a “pre-existing condition.” SO...to not get insurance was not an option for me. It would trigger the “pre-existing condition” surcharges, which would essentially price me out of ever again having health insurance until I am old enough to qualify for Medicare, some nineteen years from now...if they do not screw it up by then!
The Thoughts And Prayers Healthcare Plan carries a spiffy $6,650 deductible. It will pay NOTHING for my healthcare, until I have racked up $6,650 of out of pocket expenditures. Not a single doctor visit, not so much as a bottle of my thyroid medication, which I need...and I need for life. There is no getting off Synthroid for me. The generic equivalent, Levothyroxine Sodium is not terribly expensive...what is expensive and not manageable...is the doctor’s office visit and labs required to GET the prescription so that I CAN get the relatively inexpensive medicine that I need, and need for life. There is nothing a doctor’s office visit or labs will tell my doctor that is not already known. I need the Levothyroxine, that simple. And I have not filled it yet this year. Thoughts And Prayers, folks!
It gets better, though. You see...for this wondrous shiny new Thoughts And Prayers health insurance plan I have...the Federal government will pay, to BCBS-NC...roughly $6,000 in subsidy money...for me to get no care! For me to carry an essentially worthless card in my purse. The only benefit I derive from this is that I avoid the tax penalty...and I avoid triggering the “pre-existing condition” surcharges since, ON PAPER, I am insured. But, essentially...in practice, I lost my health insurance. And the best part?? Because I am insured ON PAPER...the Federal Government gets to NOT COUNT ME AS UNINSURED. GETS TO NOT COUNT ME AS ONE OF THOSE WHO LOST THEIR HEALTH INSURANCE BECAUSE OF DONALD J TRUMP. But, essentially, that is exactly what happened. Thoughts And Prayers yet, anyone? You want on this plan yet??
Wait!! I am not done yet!! Because I have lately had ideations of death, because of my extreme poverty condition, and likely undiagnosed and untreated transgender-related PTSD, I need mental health care. When you actually start wishing a good old boy would just come and end it all for you, you need mental health care! But I cannot get it. You see...residents of Wake County, North Carolina who do not qualify for Medicaid...can get therapy through the IPRS program. BUT...because I have ON PAPER...insurance, I must use that, and I do not qualify for the IPRS help...meaning I must pay full freight, out of pocket, for any mental health care I might get. Which we have established I cannot afford.
This leaves people like me with a Hobson’s Choice.
1. Pay full price, self-pay, out of pocket for mental health care.
2. Cancel my existing insurance (if I even can, since it is $0 a month out of pocket) — and thus trigger the pre-existing condition surcharges and the tax penalty for this year
or
3. Do not get the mental health help that I need.
Nice choice, isn’t it? Thoughts And Prayers YET, anyone?? And yet, Trump and the Republicans talk about the failure of the mental health care system in America in the wake of the Parkland shooting!! As if they actually cared!! THEY SET UP AND DESIGNED THE SYSTEM TO FAIL!!
Like Lucy pulling the football, they have held it out there that help is available...and then make damn sure you cannot avail yourself of it. Or if you do, you are punished for life for being poor and needing help! In the form of a coverage gap triggering pre-existing condition surcharges pricing you out of the health insurance market for the rest of your life. Because those only go away after you have had insurance again, for at least a year. And since we cannot afford that first year...that first year never comes! Neat, huh? And OF COURSE they blame YOU for not taking the offered “help” when the “help” is actually a life sentence of no health care. Remind me again who had the death panels?
So...this is what I am now doing...and what I suspect many others in my boat will be doing. I have cancelled all my doctor appointments. I get no monitoring of my diabetes. No monitoring of my thyroid condition. No mental health care...except that which I might afford out of my own pocket. And there isn’t much there. I still owe my bankruptcy attorney $500.
I have been socking away the $53 I had been previously paying to BCBS-NC last year. I am using that money to get my prescription medications online, where a prescription is not required, because the prescription is out of reach. And I am self-medicating, with no medical supervision of any kind...with drugs that I know that I need, that I have been on for years. Specifically, Levothyroxine and my girl juice (hormones.) And my diabetic test strips?? Fuhgeddaboudit!! A vial of fifty strips for my current meter cost $197. And any diabetic could tell you that fifty strips do not last long. Not if you are properly monitoring your blood sugar, anyway. So I have another online source for those, where I get 250 strips for a different meter I also have...for $35. Plus, I am now taking only 1-2 readings a day, instead of the 4 that I should be.
And that is what the $53 I am saving per month is paying for. The drugs I know I need, and the test strips. No health care. No mental health care. And of course, though this is out of my pocket, it also will not go against the BCBS deductible, since I am getting them from “unapproved sources.” And I have to hope I do not get sick, or have some kind of accident. Especially not AFTER the bankruptcy is filed, because then I won’t even be able to bankrupt out of it. Not that I want to do that...which is why I cancelled the existing appointments with my doctors. I did not feel right going to them, knowing they would not be paid by my insurance, and that I would simply have to bankrupt out on them.
Thoughts And Prayers, anyone??
By the way, I have written to Senator Tammy Duckworth about this. I called their office today, because my two Senators from North Carolina are worthless. Were I to go to them with this story, they would say “yeah, yeah, sure, sure” and file my story in the back of Drawer Number 86, and it would never see the light of day. And I WAS born in Illinois. And I personally admire Tammy Duckworth. I admire her for her ongoing and previous service to this great nation. I admire her for the sacrifices she has made for this great nation. She makes me proud to be an Illinoisian by birth.
When I called, I explained I was NOT a constituent, but that I was born in Illinois..and that my own two Senators in North Carolina...both of whom march in lockstep with Trump...would do nothing to help. I told her office I did not expect THEM to help me either...because I am not a constituent...but I wanted my story heard...and advised them that many of their constituents are quite likely ALSO on the Thoughts And Prayers Health Plan. They asked me to write them a letter and I did. I will update this with any reply.
And if I get one, I plan to write every other Democratic Senator that I think will listen to me. Starting with Tammy Baldwin in Wisconsin. In my not-so-humble opinion, the two best Senators we have in America are both named Tammy! I might even write the likes of Susan Collins and Lisa Murkowski. Will keep advised of this as more happens.
I am also considering seeking legal counsel (it has to be pro-bono) concerning the fact that BCBS-NC did NOT offer the CSR’s in spite of the fact that the law (Section 1402 of the Affordable Care Act says that they HAVE TO...even if the government will not pay for it.) So this could get real big. I am not a lawyer myself, but I believe BCBS-NC’s actions here may have been illegal and caused me great harm. Stay tuned.
Meanwhile...send me a few more of those Thoughts And Prayers...willya?