Winter 2013 – Note to self: don’t get sick in December

In the fall of 2013, I decided to enroll in an Affordable Care Act health insurance policy. Everyone was written a letter by their health insurance companies giving policy holders a little time before then end of the year when all insurance plans expire.

Little did I know how close all those would be to home until I enrolled under ACA and was also a recipient of more than my fair share of medical care during the hectic Obamacare transition period.

For most people, there wasn’t much of a transition if covered on the job or some other public program.

I don’t think most people who have real jobs and a personnel office that annually negotiates group insurance realize that insurance actually lapses at the end of each year keeping coverage, apparently, seamless.

Nor do I think most people in insurance groups bother to read their coverage fine print.

Back when I had a real job, I was surprised to learn that as a single guy, in my group plan, I was covered for maternity care.

But when it was explained to me that to spread around the risk, I am obliged to pay to help cover my colleagues who have families or may want to start one. I viewed it as being a good community member.

This was in the 1970s – 1990s and it has been that way since. Now that I’m self employed, I’ve had to annually negotiate m y policy.

Opponents of the Affordable Care Act (ACA or Obamacare) began to point out what they considered to be unnecessary coverage, like maternity care for single guys.

As a quick primer, the ACA was proposed by President Barrack Obama approved by the US Congress and signed into law March 23, 2010. It set up centralized health insurance exchanges where users who weren’t covered by their employer, the Veteran’s Administration, Medicaid, Medicare, or some other program could sign up for health insurance.

Of the US population in 2015, 49% are covered by their employers, and 43% by some other form of coverage leaving around 8% needing health insurance coverage including self employed people like me.

Other than mandating health insurance for all as a means of diversifying the national insurance pool, there are provisions like not being denied coverage for pre-existing conditions and young people being covered under their parents’ policies until they are 26.

I’m one of the self-employed people who has had the same insurance carrier for the past several years. My insurance is routinely “cancelled” when the company annually changed the terms and conditions, deductibles and more times than not raised the premium prices at the end of the year.

I could either take the new plan or be cancelled. I always opted to stick with my carrier, but had to call up every year to see what options I had. Generally, I settled for higher deductibles to keep my payment close to what it was before. In my estimation the insurance industry is a big legal ponzi scheme, if you ask me, but thank God I have health insurance!

… and I knew I wasn’t going to get dinged for a preexisting condition.

People who are shocked or surprised that their policies are routinely changed tossed out letters from their insurance carriers as junk mail.  In March of 2012, I was informed that my insurance would be grandfathered under the ACA if I wanted to go that route – keep my doctor and everything in tact.

Pioneer that I am, I set up an account on the Connect for Colorado Health exchange website and after a few delays and glitches, was a approved for a way better plan from my existing carrier for less price.

So I was “double-covered” with my existing policy and my new ACA policy because I didn’t quite trust the new system.

I finally gained confidence in the ACA and canceled my higher deductible plan which was a good thing.

Politicians have been trying to “Repeal and Replace” Obamacare since its approval. I chuckle when I see the political action committees running ads on TV about the small group of folks who claim to have fallen through the cracks when they didn’t take personal responsibility to take care of their health insurance business during the one-year window during which they had a chance.

Rather than be accountable for their irresponsibility, Obama and all the other socialists are to blame for their current misfortunes.

You know what?

Obamacare, socialism, public / private partnership – whatever you want to call ACA, have nothing to do with reality. Health care reform only has to to do with people like me who were flat on their backs pushing the hospital room call light hoping a nurse’s assistant will come by to empty the urinal or patch a bed sore.

Truth is, Trump, McConnell, Ryan or any other politician can’t help anyone, let alone improving advice individual patients get from their doctors and their staffs. Anyone who disfavors ACA hasn’t been sick lately.

Before I get into the gory details, I have to tip my hat to health care workers in the trenches, namely nurses and certified nurse assistants. The world wouldn’t turn without them. I’ll jump ahead a bit and say that I’d never really had a hospital stay before and after being flat on my back for six weeks.

I couldn’t walk, stand, wipe my butt. The nurses and CNA’s were there to meet my every need, particularly when I got very low and bummed out.

This raises another big topic of self advocacy. Being flat on my back, I was complacent and didn’t advocate for myself as much as I should have. My partner in crime, Diana, was a big advocate. She questioned what was happening and kept on the nurses and doctors, to their annoyance.

She brought over a couple friends and neighbors, Nicki and Evie who also had experience advocating and helped particularly early on when I was first admitted.

I can’t say enough about having a strong advocate. I’m pretty sure, my doctors weren’t waking up in the morning wondering how I was doing.

Over the course of the fall and summer, I was being treated for various types of pneumonia and eventually went to the hospital. I was quite out of it because I had lost a lot of weight – eventually 30 pounds – had no energy or stamina, and no appetite.

What happened next is a bit of a blur, but, my lung doctor did a biopsy to figure out about my pneumonia.

Did I mention the morphine pump?

Meanwhile, I was on steroids which led to a perforated ulcer and stomach contents were leaking into my body cavity causing sepsis. I don’t know this as a fact, but I’ve been told that I was not given much chance of making it through the emergency surgery to patch up the ulcer – mostly because of the lack of eating and general indifference, translated into “failure to thrive.”

I read through my medical record and I was also classified as anorexic. That sounds worse than it is. It means I was very skinny.

So I have this emergency surgery and am being fed pablum through a tube bypassing my stomach and intestines while the ulcer patch heals. This causes me to lose weight and strength. I’m flat on my back between ICU and a regular hospital room and rehab for six weeks.

Since my parents died a few years ago, celebrating the winter holidays have been different every year. I wrote a stage play about this which was produced by Hitching Post Theater a few years back – I’ll have to dig out that story.

This was no different being being in a hospital with the second tier help on duty.

This stint in the hospital was good in that when the biopsy results came back from the University of Michigan, the results figured out about my lung condition as being an auto immune pneumonia now being treated by steroids, which is a good thing – particularly for those of you who had to deal with my hacking and coughing over the summer and fall.

Not so good with the ulcer recovery, I still had a rubber tube sticking out of my stomach that was. removed after a week. So getting to the bottom of my pneumonia was good, the state of my physique, not so good. Then I was kicked out of the hospital.

Meanwhile, I can’t stand, walk or otherwise take care of myself and I’m lifted into a wheel chair and strapped into an ambulance to go to rehab at this place in Denver.

Unable to move on my own, I start sliding out of the wheel chair and bouncing around like a rag doll. I felt like the dead guy, Bernie, in that bad movie “Weekend at Bernies”. The driver pulled over at the cooking school on Quebec and got me repositioned before getting to the rehab center in Glendale, which is a neighborhood in Denver.

The rehab center was an hour from Boulder, served mostly geriatric patients and I was the youngest one there. It was good meeting some folks from Denver.

This rehab center has it figured out. Everybody there gets about an hour or two of rehab each day and the other 22 hours, they feed everyone high protein and lots of carbos. It got a little monotonous plotting out the day based on meal time.

I am totally amazed that I received enough physical and occupational therapy after two weeks to walk out – albeit with a walker, compared to when I arrived as a total invalid.

My diet was simple – eat anything, particularly high protein and sweet stuff – a lot of rare steak and ice cream floats. It takes a long time to gain back wright. I was up 15 pounds during rehab and stabilized after getting 30 pounds chubbier.

After being out of captivity since the first week in February 2014 and getting stronger every day I was getting back in to the swing of things. Being self-employed, I had many ongoing projects.

I think it’s also an Asian thing to be totally self reliant – but this experience has taught me that it’s okay to ask for help. Many thanks to Michael and Barbara for keeping mud in my entrepreneurial cracks over the past couple months of my recovery.

After being out of rehab for a week, I attended the Boulder International Film Festival over President’s Day weekend – I’m on the BIFF Board of Directors. It was my first outing “off campus” since Dec. 16th – prior to this, I was in an ambulance, hospital, ambulance, rehab center, in my condo.

I’m also back in the editing booth – I cut together a tribute to Shirley MacLaine that screened Saturday night at the BIFF.

It’s been a big wake up call for me, particularly about big picture issues – mostly around downsizing and relationships with people.

Small picture issues, I’m now more serious about plotting out some exit strategies for projects I head up and handing off projects to others and getting ready to “retire”.

Even though I’m mostly recovered, I’m still planning for a long road ahead, I still consider myself “disabled” and will likely be recovering for awhile. I may be out and about, but I anticipate plenty of limitations.

I still encounter steps and small inclines and places without banisters or elevators that I didn’t notice before.

My message to the politicians? Keep muddling through the ACA because here’s no turning back.

 

 

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My Experience with the Affordable Care Act

I’ve had health insurance since my first “real job” in Gillette, Wyoming back when Sen. Ted Kennedy was touting universal health care and had Richard Nixon not screwed up with Watergate, would have joined forces with Kennedy and we wouldn’t be having this Obamacare fight today.

Nonetheless, back in 2010, I received a letter from my insurance carrier – Kaiser Permanente – that since I had coverage before ACA went into effect, my policy was “grandfathered” and could keep it or change it with no repercussions from any “pre-existing conditions” that I had or may develop in the future.

I just heard several thousand Kaiser Permanente policy holders got their pink slips that their coverage doesn’t meet the minimum requirements of ACA? What kind of coverage is that? Like a barbecue grill warranty at Walmart? The ACA naysayers have been finding stories about us self employed people who have had their policies handled. What’s the big deal? For the past 10 years, my plan has been cancelled like clockwork on December 31st. If I want to reup, the policies are similar, but the price has always gone up. I’ve had to increase my deductible over the years to keep a reasonable price. ACA or not, my carrier will be cancelling my policy December 14, 2014 as usual and every year after. But at least they can’t kick me out for some medical reason.

When ACA was in its infancy, my premium price dropped, not a lot, but a few bucks. Meanwhile, there was no national health care exchange, but many private ones out there. Since I couldn’t be denied coverage, I did shop around on a private exchange and ended up finding a less expensive plan that had a little better coverage from my existing carrier – it’s a medium deductible co-pay plan – and the plan I’ve had for three years or so. Over the past couple years, my prescription prices dropped to grocery store levels ($5 or buy 2 get one free).

Private healthcare exchanges

On October 1, I signed up with the Colorado healthcare exchange. On day one, I had a few problems getting my account set up – I was bumped off the site a few times, timed out a few times, but eventually was able to get a good connection. After all that and to my surprise, there were no plans offered with coverage even close to what I purchased on the private market.  They all had very high deductibles and premiums that were nearly double what I was currently paying. Apparently, the income-based tax credits would lower the costs dramatically, but the coverage is still terrible, at best. The Connect for Colorado Health support has been great. I’ve been called a couple times to help me get finally through the process which has been goo.

I imagine it has something to do with the actuarial tables that show that low-income people tend to have bigger health problems than the general population, which is why all sorts of people are necessary in the risk pool. These “low-end” policies end up costing less with the tax credits applied. If you’ve been denied coverage all these years, this type of policy is probably considered “gold”. The premiums are likely based on the probability that mostly uninsured, ergo unhealthy, and low income folks will be the ones who apply. I also surmise that places like Wyoming that chose to opt out of the Medicaid expansion plopped all those “high risk” people into the general risk pool, which was a contributing factor to higher premiums.

The Mississippi experience

Rural areas lack competition

There are dental plans offered, but none from my current dentist, which is one of the publicly-traded dentists, Perfect Teeth. I may switch over to Delta Dental if after comparing my Perfect Teeth discount program, it turns out to be way better. Kaiser doesn’t offer dental coverage.

I looked around on the Kaiser Permanente site for plans and found one that had a lower deductible than I currently have and the cost was a third less and called about it and found out that I could switch over, but it would expire for me at the end of 2013 and if i kept it, the price would jump up to the Colorado Health Exchange price, which was over double what I currently spend.

The Kaiser Permanente member service representative on the phone said that they figure out ACA tax credit eligibility too. They have an entire staff designated to Medicaid and Medicare paperwork and I would imagine is very good at working through each state to figure out any ACA red tape.

The upshot?

In my case:

– ACA saves me a few bucks on premiums and lots of bucks on prescriptions

– ACA gives me peace of mind about the future because my insurance won’t get cancelled

– ACA covers a whole bunch of people who won’t be using the emergency room staff as their primary care physicians which, in the long, run will keep my premiums lower by putting their risk in their own pool and not mine.

ACA has caught on and will only improve as more people previously uninsured participate. I think that the national health care exchange is good if you don’t already have coverage and income eligible for tax credits. I heard the dead-beat states that let the federal government run their exchanges are missing the boat and the can-do states that tailored their own are having pretty good success.

State run exchanges more successful

Most people have coverage and If you do, I suggest sticking with learning information from your carrier and not mess around with the national exchange. If you’re in the market or curious as to what choices are out there, also check out the private health care exchanges. You’ll be asked for the same personal information as the Obamacare website asks. Like all other internet commerce, be careful!