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This Is the Real 'Rate Shock': My Parents' Amazing Obamacare Story


Health & Wellness  (tags: cancer, children, death, disease, drugs, ethics, family, food, government, healthcare, illness, prevention, protection, safety, society, treatment )

Kit
- 341 days ago - dailykos.com
My parents are too young for Medicare, too rich for Medicaid, and right at the age when one develops conditions that must be "managed" and not just cured with a week's worth of antibiotics.



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Kit B. (276)
Tuesday November 12, 2013, 6:19 am
Photo Credit: money.usnews.com



Just over a week ago, it was my mother's 61st birthday. She wasn't supposed to get there.
Three years ago, she nearly died because of an extraordinarily rare lung disease caused by, of all things, a freak reaction to birds. Yes, birds. Flash forward several months after the diagnosis and there was my mother, who never smoked a cigarette a day in her life, missing half a lung and on 24/7 oxygen.

Life isn't always fair, you know.

But she's one of the very lucky ones. As it turns out, her form of the illness meant she would eventually get better. And get better she did, after a year's long grueling rehab program, to the point where she didn't need all of that oxygen and could almost get back to the way things were.

When a medical diagnosis or emergency happens in life, it's doubly tragic. Not only do you ask "why" ("why did this happen to me?") but you're forced to ask "how" ("how am a I going to pay for all of this?"). Anyone who's been through a health crisis knows the answer: you don't care about money right away. The only thing that matters is surviving, cost be damned. "Fix me, whatever it takes."

The costs, however, aren't damned away into non-existence. Scroll below the fold for the full story.


MY PARENTS' CRAPPY, NO-GOOD, MAY-AS-WELL-NOT-HAVE-INSURANCE PLAN

My parents are too young for Medicare, too rich for Medicaid, and right at the age when one develops conditions that must be "managed" and not just cured with a week's worth of antibiotics. When my mother was in the ICU, they gave her steroids to save her life, leaving her with steroids-induced diabetes. My dad, a mechanic who's worked 12+ hours a day since he was a teenager, has high blood pressure. Their conditions are the usual suspects for the 60s set.

My parents were never politically active before. As immigrants, they voted but didn't really follow the ins and out of the process. That changed as I became more politically involved. When my mother voted for Barack Obama (this was before she got sick), she said she was voting for him mainly because of his health insurance ideas. "He better keep his promise. If he doesn't," she told me, "I want you to write him a letter."

I've typed up many a complaint letter for my mom. Trust me, you don't want to be on the receiving end of one of her letters.

Health care reform was the issue for my parents in the voting booth. They were, after all, spending most of their income on health insurance and health care costs.

To say my parents' health insurance before Obamacare was a ripoff would be like saying that the universe is kind of large and filled with some stars.

Their premium is $710 a month. Their deductible is $10,000 a year. Their medications are expensive. As a result, they've forgone a lot of preventative care and generally avoid doctor's visits. Here's the breakdown:

$8,520 - premiums
$10,000 - deductible
____

$18,520 out of pocket, not including coinsurance.

$18,520.

That's an obscenity that has no place in a modern, civilized society.

As their premiums have increased year after year, they've tried to shop around for better rates. Almost no one else would take them. If a company was open to taking on a couple with so many pre-existing conditions, it took advantage of the situation and quoted them prices that would have required them both to work two jobs. Ridiculous, to say the least.

Of course, I've tried to defray their costs over the years, as have my sisters. But my parents are very, very proud and refused to accept help, choosing instead to do what millions around the country have been forced to do: build a family budget around the costs of health insurance and hope that they don't get sick(er).

TRYING TO GET ENROLLED UNDER THE ACA: THE GOOD, THE BAD, AND THE VERY, VERY UGLY

As a digital strategist, I've produced more than enough websites to know how the launch process works. It's complicated, glitchy and no matter how well you test beforehand, something always goes wrong.

I was on healthcare.gov right when it officially launched around midnight, even tweeting out a picture of the site when it quietly went live.

I tried creating an account and hit the security question wall and couldn't get past it. I knew that glitches are part and parcel of any site launch. Time to wait it out.

Hours of glitches turned into days of defects, which turned into weeks of malfunction. I must have tried logging in/working the application dozens of times (no exaggeration). I'm no tech dummie, so I kept trying across browsers, clearing my cache/cookies, etc.

I finally managed to get my mother into the application phase, but her identity could not be proofed. I uploaded her ID and waited. After a week or so, I called the Marketplace again.

I will say this for the call desk workers at the Marketplace: generally, they could not have been more polite. Every person I spoke too was remarkably friendly, apologetic and understanding.

For all the hype in the press, it’s indisputable that the site has been getting better by the day. Every day, I was able to go a little further in the process.

On my mom's birthday, I asked her half-jokingly if she wanted to try logging in once more to get herself the Best Birthday Present Ever.

I sat down with her and we tried again. And finally, it worked.


THE REAL RATE SHOCK: BETTER HEALTH CARE FOR $53 A MONTH

Let there be no mistake, health insurance in this country is still outrageously expensive. At first launch, the marketplace isn't going to dramatically decrease the actual premiums set by the insurance companies. You'll still see those wince-inducing numbers on the screen as you research your choices.

The difference is that now, you may also see your taxes at work. If you're like my parents, you'll see a premium subsidy that takes the bite out of the insurance company price-gouging.

For my parents, their subsidy is a hefty one. They choose a silver plan where the premium will now be $53 a month.

Their new plan covers my mom's pulmonary specialist, all of her screenings (x-rays, CTs, etc), requires only a $1,500 deductible and $4,500 max out of pocket cost and the insurance company kicks in 100 percent after the deductible is met.

Granted, there are still glitches. Although she wanted to make a payment right away, she couldn't and the Marketplace reps say it will take some time for the information to transfer over to the insurance company.

Still, affordable, better coverage is the best birthday present she could ask for.

My parents' story isn't unique. Across the country, those who need help the most paying for their health insurance and health care costs are breathing a sigh of relief. Like the Sherburne family in Utah:


It took half-a-dozen tries over several days. But Phil Sherburne struck gold on Saturday — silver actually — with family health coverage purchased on the Affordable Care Act’s online exchange.
After plugging in particulars about his family of five, the Salt Lake City business owner was able to compare 38 plans and apply for tax credits to put toward his monthly premiums. He settled on a silver-level plan from Altius that retails for about $850 a month.

After tax credits, the Sherburnes will pay just $123 a month.
Or Joy Kramer, 54, of Georgia, a cancer survivor who may be paying just $210 after being denied :

[S]he’s grateful for the Affordable Care Act, and she doesn’t have much patience with its many critics.
“I think those people have never experienced what I’ve experienced,’’ she says. “They are shutting the door on the cancer survivors and the self-employed.”
Or Allan Pacela and his family:

I am a retired engineer on Medicare, and my wife had long been insured by Cigna, under a group plan from my engineers' society. Because of minor pre-existing conditions, she could not leave that plan, because no other plan would insure her.
The Cigna premiums increased to $5,000 per quarter, or $20,000 per year, just for my wife. This year, Cigna canceled the entire plan, leaving her with no insurance.

So, we turned to Obamacare. She found it simple and easy to sign up through an agent in a 10-minute phone call. She obtained their best plan, providing much much better coverage than in the past, at a cost of $3,000 per quarter.

My wife would not have insurance coverage at all as of Jan. 1, if not for Obamacare. And, here's the kicker - we now are saving $8,000 per year, for a very much better plan.
For more stories about how the Affordable Care Act is making health insurance more affordable, click here.


FREEDOM TO SHOP AROUND

About a month or so ago, I received a notice that my health insurance company was raising my rates. The 12 percent increase was expected. After all, health premiums have been skyrocketing for years. That alarming rate was why President Obama and the Democrats pushed for health insurance reform in the first place.

Much has been made of the president's promise that "if you like your health insurance, you can keep it." Less has been made of a much more important fact: If you hate your health insurance, you can leave it.

Now, if an insurance company jacks up your rate, you have the freedom to shop around. I plan to and I'm sure I'll be able to find a plan with better value now that the exchange has been launched.

As for my parents? Well, in writing this, I asked my mother if she wanted to append a letter to President Obama.

"Just tell him thanks," she said. Then she smiled.

"It was a good birthday."
***

Daily Kos Op-Ed | Daily Kos |
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Kit B. (276)
Tuesday November 12, 2013, 6:24 am

If this is a train wreck - bring it on. Republicans want you to be afraid, very afraid of the ACA aka Obama care. They are hoping against hope, Determined to keep the status quo that would prevent what just might be seen as a positive for you and the administration. If you have REAL insurance, this would not apply for you. If you do not have a comprehensive and affordable policy, check out the site and sign up or make a phone call.
 

Just Carole (338)
Tuesday November 12, 2013, 6:32 am

Thanks for posting this, Miss Kitty. Being caught in that same "not yet 65, but make too much to qualify for Medicaid" loophole, I understand the frustration and am glad this program is improving and having positive results for so many.

I've always accepted that certain vanity procedures should be more expensive . . . but NOT why necessary preventive and life-saving medical care should become so costly that it would render the patient bankrupt. With more and more jobs becoming part-time (and thereby not requiring the employers to provide company-assisted affordable healthcare), There are also many young workers (with children) who fall into this abyss.

I'm hoping that, as more and more evidence emerges showing the necessity of access to all citizens, this country will, eventually, move to a universal single-payer plan.

 

JL A. (275)
Tuesday November 12, 2013, 7:37 am
Thanks for helping debunk the myths the Koch brothers are funding to disseminate Kit. I'm beginning to wonder whether their reasons have to do with the fear that once the health care system is no longer so fragmented that public health suits to have those responsible for environmental toxins and contaminants proven to have collective public health impacts and costs will be brought against the polluting industries/corporations.
 

Nancy M. (201)
Tuesday November 12, 2013, 11:40 am
$53 per month and they are in their sixties. When I was in my forties, my husband and I looked for insurance and only found $900per month policies (or COBRA at $1200).

Obamacare doesn't sound so bad after all?
 

lynda l. (13)
Tuesday November 12, 2013, 12:14 pm
cool
 

Jamie Clemons (282)
Tuesday November 12, 2013, 12:42 pm
Thats nice but what about the people who can't even afford 53$ per month the cheapest insurance you can get with Obamacare?
 

Jamie Clemons (282)
Tuesday November 12, 2013, 12:52 pm
Based on the subsidy calculater a person in Wisconsin making only 10,000 dollars is responsible for paying 2,900 dollars a year for Obama Care and is not eligible for medicare. How can a person making 10,000 dollars pay it? They can't
http://kff.org/interactive/subsidy-calculator/
 

Yvonne White (232)
Tuesday November 12, 2013, 1:12 pm
Right on Carole, "I'm hoping that, as more and more evidence emerges showing the necessity of access to all citizens, this country will, eventually, move to a universal single-payer plan." The Government KNOWS that Insurance Companies price-gouge, but don't make THAT illegal. Corporate Fraud goes on & on & we ALL pay for it!
 

Julia R. (295)
Tuesday November 12, 2013, 1:27 pm
Great post! Learned a lot that I didn’t know before about Obama’s Affordable Care Act. Since I’m now self-employed and also have a systemic lung disease, I think that I could save a lot through the insurance exchange. People stories of how the health exchange is really helping to reduce their costs plus provide better health coverage is the real story here and there are many examples from people all over the U.S. cited in this article which should give people real hope that their healthcare premiums can be substantially reduced whereas before there was no hope! The people that are criticizing Obama care the most are the Repulicans who virtually offer no alternative to what has been going on for years- the insurance companies' rip off rates and those who won’t even take a little time to understand the benefits of the system because they have already made up their narrow minds. “Don’t confuse me with the facts, my mind is already made up!"
 

marie c. (168)
Tuesday November 12, 2013, 1:47 pm
Thanks Kit a great post
 

Birgit W. (146)
Tuesday November 12, 2013, 2:16 pm
Thanks.
 

Hannah Metcalf (50)
Tuesday November 12, 2013, 2:48 pm
Thank you for the story.
 

Kit B. (276)
Tuesday November 12, 2013, 3:10 pm

@Jamie - Good question, I hope this will answer you at least in part.

One unfortunate quirk: If you make less than the poverty level and live in a state that refused to expand Medicaid, you’re pretty much out of luck. Because of an infuriating shortcoming in the law, you must pay full price on the exchanges.

If you need to learn more, go to - LocalHelp.HealthCare.gov - to find help in your area. Typically, people window-shop more than a dozen times before buying. If you buy, the policy kicks in on January 1, 2014.

http://www.brookings.edu/research/opinions/2013/09/30-ten-questions-about-obamacare-aca-patel-sanghavi
 

Kit B. (276)
Tuesday November 12, 2013, 3:13 pm

Congress had rolled back Medicare for Seniors from 62 to 65, I noticed it is now back at 62. If you are not sure if you qualify go to the Social Security site. http://www.ssa.gov/
 

Lois Jordan (56)
Tuesday November 12, 2013, 3:21 pm
Noted. Thanks, Kit. So many will be helped by the ACA. My 30-something son was paying for his own health insurance, then checked the website and found that he could get a better policy for less. We kept our college-aged kids on our policy longer, too. One of my kids who "aged-out" and is presently unemployed, will hopefully also benefit because AZ signed on to the act.
Maybe some need to be reminded that previously, premiums went up without notice, policies were canceled, and claims went unpaid for various & sundry reasons. This bill was meant to rein in the insurance companies. It wasn't what I wanted.....Medicare For All; but at least we "headed them off at the pass," and the push for single-payer must be strong & loud over those who simply want to destroy the ACA.
 

Dianna M. (15)
Tuesday November 12, 2013, 3:27 pm
Just got this email from Adrian Smith: "Our health care system is broken and needs patient-centered reforms which would lead to lower costs and greater access to care." Does that even mean anything? I personally think that it's gobbledygook that sounds good until you actually try to work out the meaning. Same for the next sentence in the same paragraph: "Therefore, the House of Representatives will pursue market-based policies which reduce costs. This process has begun in the Ways and Means Committee, where I will continue efforts to pursue market-based health care solutions which reduce costs for all Americans without tax increases and onerous government mandates."

You know that sounds familiar, that and the paragraph after it . . . . oh, yeah, here’s an email from him dated July 5, 2012—the last two paragraphs are identical. He can’t even write a new email!
 

Just Carole (338)
Tuesday November 12, 2013, 3:41 pm
 
From the Social Security site:
 
Medicare eligibility at age 62
 
If I retire at age 62, will I be eligible for Medicare at that time?
 
No. Medicare benefits based on retirement do not begin until a person is age 65. If you retire at age 62, you may be able to continue to have medical insurance coverage through your employer or purchase it from a private insurance company until you turn age 65 and become eligible for Medicare.
 

Kit B. (276)
Tuesday November 12, 2013, 3:56 pm

I think Carole if you begin the process of filling out the form, you will find there are exceptions. I recently had to do this all over again and there is a blue highlighted box that iterated that some applicants will be eligible at 62. I can not guarantee that it will work for everyone. I hope it will be useful to you.
 

Val R. (244)
Tuesday November 12, 2013, 7:00 pm
Sounds to me that it took a tech geek a full week to figure it out - I luckily don't have to deal with it at this tme but still not convinced - Have you tried it personally - sounds like you may have.
 

Kit B. (276)
Tuesday November 12, 2013, 7:16 pm

It worked just fine for me, I tried when it first opened and had no problems. It works smoothly, unless people are just hoping they only have to sign up and not actually look for the different companies and decide which will best fit their needs.
 

Julie W. (21)
Wednesday November 13, 2013, 2:25 am
I'm still shocked at the high cost of health care in the US (I'm in Australia). It's not a perfect system by any means, but no-one, however poor, needs to go without treatment here. Though you may have to wait a while.
 

Gene Jacobson (255)
Wednesday November 13, 2013, 8:47 am
Wonderful story, Kit. Wouldn't it be nice if the TRUTH actually got out about this? There is so much blather and lies and outright dishonesty out there right now that the "feel good" stories, which appear to me to be the REAL story and rapidly growing need get out there to counteract the lies of the right. I know that is tough given there are just darn many of them. But I'd like to see Jon Stewart read that article on his show,or Rachel, or everyone. Because this is the whole point of the ACA. I'm in the under 65 group too and okay for now, but it is good to know this is out there because although when I hit 65, the VA will cover me for whatever Medicare pays, nothing extra, service connected disability - hearing loss (lots of things went BOOM around me a lot), I am pretty sure I would prefer to keep the health care I've had since 1978 - they KNOW me, and over the years there has been a l to know, and as the article says, I'm at an age where I take more pills than I ever dreamed I would - some of them TO dream - so I see this as a huge success and am unsurprised by the technical glitches to begin with.

Most systems of this size take YEARS to bring up, not 18 months, and any fool politician who thought it could be that big and done perfectly in 18 months is not qualified to be voting on any systems at all. And they do. All systems mandated by the Feds, from child support to the IRS, to the VA, to all of DHS's systems, everything they do is on a federally mandate system and they usually give states 7 years to design and build them. So this carping is most disingenuous. And typically, ideologically driven, not logically. Then again it IS republicans we are talking about so why should logic have anything to do with it?
 

GGmaSheila D. (172)
Wednesday November 13, 2013, 2:34 pm
Article in West Central Tribune this morning said that there've been 10,900+ inquiries so far this week to the local/MN site, and everything has been running smoothly. Forgot the number of people changing over or signing up. My problem will be when I have to switch from my state medical to ACA. Quite a few of the states are trying to get that mess straightened out - and people who are satisfied with their health plans don't want to switch. So there's some problems to get straight. It would have helped immensely if Congress could have spent their time fixing these problems instead of trying to repeal the law...
 

Kit B. (276)
Wednesday November 13, 2013, 2:49 pm

I don't know about people in the rest of the world, but Americans tend to be last minute people. I think that we will see far more activity on that site by mid December. Maybe we didn't invent procrastination but we most certainly are very skilled at how to avoid, until the last minute.
 

Just Carole (338)
Wednesday November 13, 2013, 3:32 pm

I agree, Kit. Plus, these constant stories of Republicans challenging the deadline -- in order to do more research [yeah, right] -- give people even more "wiggle room" about making an immediate decision.

Oh, what a wonderful world it would be if America would join the rest of the world's developed nations and just bite the bullet and give its citizens universal healthcare as a citizen's right . . . instead of having to go around-and-around, and then years from now, give in.

(Funny, but I never hear this much controversy about devoting TRILLIONS of budget dollars to "national offense." It only becomes seriously troubling to Congress when it has to do with citizens' well-being.)

 

Kit B. (276)
Wednesday November 13, 2013, 4:17 pm

Thanks Carole, What's that you say? Universal health care? That must be a plot by the communists to drain our democracy. Some moron from Fox said, that Lenin once said the way to undercut a democracy is to begin with socialist health. Ummmm, I wonder which Lenin he was talking about? The leader of the USSR, that Lenin did not say that, but then what's a little truth when the lie is a better story.

It's embarrassing to hear people boasting about how exceptional we are, but we can not do the basics for the protection of our citizens. If for no other reason, not using a system of universal health is vastly more expensive than having a well planned and open health care system. Republicans do claim to be the fiscal conservatives, shouldn't they know that basic concept?
 

Just Carole (338)
Wednesday November 13, 2013, 5:10 pm

Well, the extremely conservative Republicans (except those in the 1%) appear to be masochistic (with symptoms akin to the "Stockholm syndrome").

That's the only explanation I can come up with for folks who are in the same pathetic situation as their fellow Democrats, but think as if they, themselves, who are barely scraping by, are part of the 1% . . . who are delighted to have them help spew their misinformation.

Totally incongruous.

 

JL A. (275)
Wednesday November 13, 2013, 7:58 pm
http://www.whitehouse.gov/healthreform/healthcare-overview

http://www.medicaid.gov/AffordableCareAct/Affordable-Care-Act.html

http://www.cbpp.org/cms/?fa=view&id=3801

Fifty-Four Million Additional Americans Are Receiving Preventive Services Coverage Without Cost-Sharing Under The Affordable Care Act
http://aspe.hhs.gov/health/reports/2012/PreventiveServices/ib.shtml

"HHS: Premiums Under ACA Will Be Lower Than Expected.


Drug Information Daily. http://www.diahome.org

Several national and many regional outlets cover a new report issued by HHS Wednesday which shows premium prices for Federally run exchanges set up under the Affordable Care Act. The reports, many of which quote HHS Secretary Kathleen Sebelius and CCIIO Director Gary Cohen, are generally positive. USA Today (9/25, Kennedy) reports that the new HHS analysis shows that "most Americans buying insurance from new state health exchanges will have at least two insurers to choose from," and six out of 10 people "could pay less than $100 a month in premiums." Center for Consumer Information and Insurance Oversight Director Gary Cohen said approximately 25% of insurance companies have begun offering in the individual market and called it "a sign of healthy competition."
http://www.natap.org/2013/HIV/092513_01.htm
 

Colleen L. (2)
Wednesday November 13, 2013, 8:08 pm
Good information. Learned a lot. Thanks Kit
 

Past Member (0)
Thursday November 14, 2013, 1:47 am
Once again, a premium subsidy does not mean that the policy cost more, and many people without the subsidy will pay more. What's so complicated to say most people will pay more to help those in need. You would have much less people complaining if you just say it, rather than "O look, it's actually cheaper."
 

Jonathan Harper (0)
Thursday November 14, 2013, 4:19 am
noted
 

Kit B. (276)
Thursday November 14, 2013, 5:23 am

The biggest mistake with this is that it does not have a public option. The US is still trying to live in the 19th century, all developed countries and many that are becoming stronger economies have universal care.

Thanks John S - that is true.
 

Jo S. (498)
Thursday November 14, 2013, 10:59 am
Noted, read & shared.
Thanks Kit.
 

Joanne Dixon (40)
Thursday November 14, 2013, 2:25 pm
As much as I sometimes complain, I am in a privileged position with healthcare - I have been on Medicare for 3 years and instead of a supplement and Part D, I have a single employer policy because I was able to take retirement from a previous job and keep it - not COBRA - very inexpensive and with dynamite prescription coverage that is perfect for me. BUT if I had private health insurance and called the provider to learn that it didn't meet Obamacare requirements, I would not be compaining about that! I would be keeping it as quiet as possible and hoping my friends never found out I had been suckered into a junk health insurance plan! In my insurance career I never worked with life/health, only with property/casualty, but unfortunately there are junk policies all across insurance and there probably will always be people who will accept them and pray they never have a claim.
 

. (0)
Thursday November 14, 2013, 8:19 pm
but hospital care will never look the way it does on tv.
 

Jennifer C. (172)
Saturday November 16, 2013, 4:37 am
Thanks.
 

Lindsay Kemp (1)
Saturday November 16, 2013, 5:41 am
I cannot understand the mentality of people who wouldn't want all people regardless of income to have access to health care.
 
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