My Cancelled Policy, and My Values

In the short term, I am the kind of person for whom the Obamacare mandate is a pain in the neck. My husband and I, both writers, have been buying health insurance on the individual market for several years, paying about a thousand dollars a month for a policy that covers us and our two children. We were among those Americans who liked our policy: we had to choose doctors from within a network, but there were plenty to choose from, including the pediatrician we’d gone to since our kids, now teen-agers, were born. We had no deductible and a reasonable cap on out-of-pocket expenses: five thousand dollars a year. We were less happy when, in early October, our insurer, CareFirst Blue Cross, raised our monthly premium by three hundred dollars with no explanation. (The only health expenses we’d incurred in the previous year were for the annual checkups that the schools required for the kids.) This was a big increase for us, especially since our writing income tends to fluctuate from month to month and year to year. Then, like many of the twelve million or so Americans who buy their own insurance, we received a letter from CareFirst in late October saying that our policy would be cancelled, because it didn’t conform to Affordable Care Act requirements. I did what I usually do in these circumstances: I procrastinated.

On Monday—it was December, I realized with a jolt—I stopped procrastinating and got on the phone with CareFirst. I wanted to know why the premium had gone up and which aspects of the policy were out of compliance, or, as President Obama put it when talking about cancelled plans, “substandard.” First lesson learned: healthcare.gov is not the only balky system around. I was on hold for forty-two minutes, mostly listening to an especially melancholy rendition of the “Moonlight” Sonata, before the agent who answered told me that she couldn’t help me with questions about individual policies, and, “with that being said,” CareFirst had been having “technical difficulties” all day. I waited another twenty minutes for a member-services representative who didn’t know why the company had increased my premium—maybe it was my age (fifty-two) or where I lived (Washington, D.C.)—or what about my policy didn’t meet the A.C.A. requirements. She transferred me to a third person (wait time fifteen minutes, listening material a jauntier, marimba-inflected Muzak), who told me that my premiums had most likely gone up thirty per cent owing to “the rising costs of health care” and then transferred me, without warning, to the D.C. Health Link, my state A.C.A. exchange. Second lesson learned: part of what is confusing and distressing about this process is that health-insurance companies don’t seem equipped, or maybe willing, to explain the implications of the new law to consumers. (Why raise a premium on a policy they must have known wouldn’t survive Obamacare?) The Affordable Care Act has not necessarily, at least not yet, made the workings of insurance companies any more transparent or accountable than they ever were.

At this point, I dropped the phone and got online, and there I figured out that my policy was inadequate by A.C.A. standards most likely because it lacked maternity coverage (not so useful for us) and vision coverage (which would be nice for a family of four-eyes, though we’d got used to not having it); there may have been other things in the fine print, too. On the D.C. Health Link, a site that, like most of the state exchanges and unlike healthcare.gov, has worked quite well since the beginning, I did some easy browsing and saw that there were thirty-one plans to choose from, with premiums ranging from $771 to $2,121 a month. On the other hand, the only options for my family that had no deductible, as we currently had, would cost more than the $1,300 we paid currently per month, between about $200 and $800 more, depending on the plan, and would come with a higher limit to our out-of-pocket costs than we presently have—as high as $12,700 (compared with our current $5,000 limit). One plan carried a deductible of $2,600, and the deductibles climbed steeply from there. Someone I know in California told me a similar story by e-mail yesterday: his family’s Kaiser Permanente insurance had gone up by eighty-nine per cent, and now included maternity coverage, which he and his partner, both in their sixties, weren’t figuring on needing. A self-employed consultant, he had “just started a new job but am not sure it will pay for more than my coverage.”

I lay in bed with my laptop and reported these figures to my husband, just late enough at night to give us both uneasy dreams. (Third lesson relearned: it really is a bad idea to take your laptop to bed.)

And then, this morning, I remembered my values. Well, to be honest, before that, I remembered something a little more selfish. I’ve had high blood pressure since I was in my thirties. I take ten milligrams of a generic beta blocker every morning, which has successfully kept my hypertension controlled. By doing so, I hope to prevent or postpone some of the possible consequences of hypertension—strokes, heart attacks—which are both debilitating and costly. That’s good preventive thinking for me, and good social policy, but it also means that I have a preëxisting condition. Like many such common conditions that people seek help for, it could have resulted, before Obamacare, in my being denied coverage if we were to lose our current policy. As a friend who worked for years in the health-insurance industry told me in an e-mail,

    Remember, it didn’t take much to be counted as having a pre-existing health condition that got you rated up or denied—obesity, high blood pressure, arthritis, asthma, depression. Essentially, at some point, anyone would have a medical condition resulting in an increased rate or denial—sometimes because of behavioral issues (e.g. smoking) but most of the time just because of genetics (a very harsh standard).

That is indeed a harsh standard, and not one I want governing my life, or those of other people. To be clear: I’m not happy to be paying more in the short term, and it may be a struggle at times. I wish other self-employed people didn’t have to shoulder so much of the burden. I wish we had a single-payer system, but that seems wildly unrealistic. And the new health-care law exists for the common good, not just the individual consumer. Vaccination provides more effective protection—so-called herd immunity—when more of us are vaccinated. Universal health insurance works in something like the same way: we are better off as a society—more compassionate, but also healthier—when we can all get the care we need.

So yes, I’ll subsidize someone else’s prenatal coverage, in a more effective way than I’ve been doing by default under the current system, in which too many pregnant women show up in emergency rooms without having had such care, creating problems for themselves and their babies, and all sorts of costs for taxpayers. And I’ll remember to be relieved that my own access to health care is guaranteed. But they had better work out the problems with the A.C.A.; if they don’t, and it doesn’t fulfill its promise of insuring the uninsured, I’m really going to feel like a chump.

Original Article
Source: newyorker.com
Author: Margaret Talbot