Faces of Obamacare: The health scheme at the centre of the shutdown
Tim Walker is The Independent’s Los Angeles correspondent, covering entertainment and other concerns from the West Coast of the US. He was previously a features writer and the editor of the paper’s diary column. His first novel, Completion, is being published in January 2014.
Friday 04 October 2013
This week, the US Department of Health launched one of the central elements of the 2010 Affordable Care Act, the controversial legislation also known as “Obamacare”.
The law requires everyone in the US to have health insurance, and on Tuesday the government opened online marketplaces to help people find coverage, and to explain tax subsidies for those who struggle to pay for it.
Signed into law in 2012, and ratified last year by the Supreme Court, the ACA also prevents insurers refusing coverage to people with pre-existing health conditions, and allows children to remain covered under their parents’ insurance until the age of 26, among other provisions. The insurance plans being offered this week will not take effect until 1 January 2014.
Martin Wolske: At the hospital my son said: ‘I’m still covered, right?’
Last week my son Eric, who’s 23, was riding his motorcycle back to where we live in Champaign, Illinois. He was making a turn to go into a gas station, and a mini van that he thought was turning, didn’t turn – it hit him directly on his left leg.
His femur was broken and the ankle and foot were shattered. The femur has been repaired and will recover, but he’ll lose his lower leg below his knee. He was transported to hospital by ambulance and helicopter. He spent seven days there. Three teams of surgeons – trauma, orthopaedic and plastic surgeons – attended at different times in the process.
He underwent two surgeries, so far. And then there’s all the other upcoming events: physical therapists, prosthetic specialists. The prosthetics alone will cost somewhere between $5,000 and $50,000 each. It’s likely that, to be fully functioning, he will have multiple prosthetics.
Fortunately, the accident happened after the portion of Obamacare took effect that allows children to remain on their parent’s health insurance plan until they are 26. I’m a senior research scientist at the graduate school of library and information science, at the University of Illinois. My employment-based insurance plan has a $900 cap per person per year, so the most we’ll pay ourselves for Eric’s treatment this year is $900.
He recently completed his degree, and he’s spent the last year and a half doing internships and odd jobs. He did not have any employment-based health insurance, and he says he would not have been paying for health insurance himself if he wasn’t covered by ours.
Within minutes of our arriving at the hospital, he said, ‘I’m still covered under your health insurance, right?’ The cost was on his mind even in the emergency room.
I grew up rural poor. My family was never able to afford health insurance, but my father had a heart condition and my brother had epilepsy, so the family had to pay for their drugs, periodic surgeries or visits to the emergency room. The costs were astronomical.
I’ve voted Republican and Democrat in the past, but I championed the Affordable Care Act from day one. I work at the university’s centre for digital inclusion, and my area of expertise is working within marginalised communities. Through my work, I have very dear friends who will benefit directly from Obamacare.
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I was the director of new media at the Department of Justice while we were in the process of defending the Affordable Care Act in the Supreme Court, so I’ve always supported Obamacare. But I left the Justice Department in April to launch my own consulting business.
My dad sells health insurance, and I’m lucky that when I was younger my parents always had coverage through their employers that I was able to be on too. But I have a pre-existing condition, polycystic ovary syndrome. It’s hugely common – it’s not as if I have a terrible heart condition that costs thousands of dollars in drugs per month. But as a self-employed person with a small business, I couldn’t get coverage as an individual.
When I left my job this year, I chose to pay for the government’s Cobra coverage, an expensive temporary option that permits you to extend the insurance you had with your former employer for 18 months.
I’ve had two periods of Cobra coverage. I left another employer and became a consultant for a year previously. But Cobra expires after 18 months, so the employer-based coverage was one factor that encouraged me to go to work for the Justice Department. Before that, I had been watching the months tick by and wondering how I could get insured when Cobra’s 18 months was up.
For me, the Affordable Care Act is amazing, because it gives me time to really try to grow my own business without worrying about whether I can get health coverage. I want to be successful and have employees in the future, at which point I’ll be able to start a group coverage plan for the company. But that doesn’t happen overnight.
I found the Washington DC online healthcare exchange easy to use. It took 10 minutes to input my information and come up with three insurance plans that I wanted to seriously consider.
Kevin and Melissa McCollum: A lot of people are just one diagnosis from bankruptcy
My wife and I have both been self-employed for the past 12 years and therefore have no employer-paid health benefits. Melissa cleans houses for a living, and I sell things on eBay.
Two years ago, she was diagnosed with Carpal Tunnel Syndrome, a condition in which there is excessive pressure on the median nerve in the wrist. It can lead to numbness, tingling, weakness, or muscle damage. After the diagnosis, she applied for health insurance but was denied. Eventually, however, her carpal tunnel got so bad she had to get surgery. She was unable to sleep, or do simple things like hold a coffee cup or a hair dryer.
In February, on the day of the surgery, a nurse told us about something called the Pre-Existing Conditions Insurance Plan [a measure established under the Affordable Care Act in 2010, to provide stop-gap health coverage to people with pre-existing conditions until the Act comes into effect in full next year]. After we got home, Melissa applied with PCIP and was accepted. The plan even covered the surgery that had already taken place.
The monthly premium was only $249, which was a lot less than the $10,000 it was going to cost us without insurance. The first surgery didn’t work, so she had to go back to have another surgery on the same hand. But PCIP covered this as well.
Had it not been for PCIP and Obamacare, we would be almost $20,000 in debt. There are a lot of people like us out there, who are just one diagnosis away from potential bankruptcy.
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