Be afraid, be very afraid…
Folks are running around with their hair on fire complaining that the Affordable Care Act is unconstitutional and a sure sign that America has turned socialist. All sky-is-falling predictions aside, universal coverage makes economic sense for taxpayers since the cost of providing services to the 15 percent of Americans who are uninsured is passed along to us with insurance in the form of ever-escalating premiums. It also makes sense to private insurers who fought for the individual mandate because it ups their rolls by 45-50 million subscribers. Finally, it makes sense to many who, like me, have insurance, but are forced to navigate a current system that is nothing short of Kafkaesque.
Insurance coverage for small business owners
Several years ago, I took the biggest risk of my life. Shortly after my divorce, I quit my job and started a small business. Since the insurance my previous employer provided was not portable, I applied for private health insurance. As a physically fit, non-smoking, disease-free woman in her early 40s, I didn’t foresee a problem. I was mistaken. On my insurance applications, I reported truthfully that my mother had been treated for uterine cancer. The insurance companies improbably connected this dot to the dot of a pelvic ultrasound in my medical record showing what the radiologist termed a “medically insignificant” polyp. Three separate insurers declared me “high risk” for uterine cancer and denied me coverage.
Proceeding without health insurance wasn’t an option, so I looked to the state for insurance. There was a waiting list, and, in any case, the state coverage was far from comprehensive. An insurance broker friend suggested I hire an employee making my business eligible for a guaranteed-issue group plan. The only problem was the business couldn’t afford and didn’t need an employee, but because it was my only option remaining, short of folding up shop or marrying a complete stranger, I hired my first employee.
The out-of-network challenge
A few years later, my son, Stuart, was diagnosed with a rare brain malformation. He required surgery that had only been attempted by a handful of neurosurgeons in the world; the closest located at the University of Iowa. The HMO plan that covered Stuart through his dad’s employer would not approve an out-of-network surgeon, and since we couldn’t afford to pay for the surgery ourselves, we were left with either not addressing the cause of Stuart’s debilitating symptoms or finding a way to insure him through a PPO. Months went by before I was able to add Stuart to my insurance plan during my company’s open enrollment period, but he finally, and thankfully, had the surgeries he needed and now lives a healthy, normal life.
Even though I only recently paid off medical bills from his surgeries (insurance does not translate to “free”), I am grateful for the comfort and privilege that lies at the heart of being American, and understand that Stuart’s recovery would not have been possible were it not for the time and place in which we live.
How the Affordable Care Act would have saved my jumping through hoops
But was it really necessary to jump through so many hoops? Provisions in the Affordable Care Act would eliminate this circus act because my previous insurance would have been portable; I wouldn’t have been denied coverage based on family medical history; I would have been eligible for private insurance coverage through a state exchange of private insurers; and I could have purchased “Cadillac” coverage for Stuart without having to switch policies and put him through an agonizing wait for coverage.
If the naysayers prevail, and the Supreme Court should rule that the individual mandates are unconstitutional, then, for sanity’s sake, let’s pass a constitutional amendment that reads: “As the richest nation on Earth, we the people agree to use our prosperity to provide affordable and comprehensive health care to all Americans.” Because without our health, what good is our wealth?