Wednesday, July 17, 2013

Health Insurance... the ACA can't come soon enough

Two weeks go my son-in-law lost his job.  That is bad enough under the best of circumstances... but the circumstances are anything but "best."  My daughter is 7 months pregnant.   They have health insurance through the end of July... but the baby is due in September.  They had decided to do their birth at a birth center with a midwife which involved negotiating with their insurance company to begin with...  They live in one of the most expensive areas of the country .  Of course, if they move, they have to find medical systems for the birth of the baby and find health insurance.  If they stay, they have to figure out how to pay rent plus get health insurance.  Christian got a job quickly although that income will render them ineligible for any government aid... and he is not eligible for health insurance at his new job for 90 days.  Of course, he has not started as they wait for his drug test to return from the lab.  And there is the ever there and overwhelming shadow of student loans which equal monthly payments higher than rent in most areas of the country.  Those bills have made it impossible to accumulate any savings... so there is no money for COBRA or as a buffer against other costs.   The ACA would make things easier for them... but it doesn't kick in completely until January.

My son has not had health insurance for over two years... and that makes us very nervous.  He is an athlete and plays basketball, softball, and flag football at least twice a week.  One injury and his life would be a mess.  John rarely gets ill but when he does, he does.  Since childhood he has run very high fevers.  A year ago, he got some sort of virus and woke in the middle of the night with a fever of 104.  You can imagine the fear and the number crunching that went on that night... does he got to the ER?  The bills would be far beyond his ability to pay.  Even to wait and go to Urgent Care in the morning would be devastating to his finances.  He was able to get his temperature down and he went to Urgent Care the next morning.   His income is minimal so he will be eligible for the MediCal part of the ACA beginning in January.  It is not good insurance but it is something and I will breathe easier.

The same day Christian was fired, I received a note from MMBB, the benefits board for our denomination.  As of January 2014, MMBB will no longer offer health insurance.  Since moving to California we have gotten our health insurance through them.  It is a reasonably good plan but is extremely expensive.  Due to California insurance laws, the only other option for me would be to get insurance as an individual.  Because of my familial hyperlipidemia no insurance company would offer me insurance at any price.  Through the years, the MMBB medical plan became the plan of last resort for clergy in my denomination.  Anyone who could get insurance elsewhere did.  This led to an increasingly smaller and higher risk pool in a demographic group that is already higher risk than the general population (clergy tend to be older and have more stress and lifestyle related problems than the general population).  That adds up to obscenely high premiums.  My church pays health insurance premiums that are almost equal to my salary for my spouse and me.  Our son is eligible to be included but the cost is so prohibitive that neither the church nor us can shoulder that additional cost.  It is not an easy situation for the church but without this option, I would not have been able to accept the call to this church.

Because of the expense, I have been asked to search out other options every year for the past few years and each year have received the same answer from the broker - "not insurable at any price."  It doesn't matter that we've known about the condition since 1987, it has been under control by medications, I've had no incidents, and every test shows that my coronary arteries are healthy.   I assumed that this year, I would be asked to investigate the insurance exchange set up via the Affordable Care Act.  I did not expect that there would be no option via MMBB.  It does make sense that we go with the exchange.  The price for roughly equivalent coverage looks to be at least 30% less than the church is currently paying and according to the ACA, they cannot deny me coverage because of my condition.  Still, the letter felt like a punch in the stomach... and every headline that I see stating that groups are trying to completely derail the ACA literally reads like a death sentence for me.  Without the medications I likely would have died within a year or so of my diagnosis in '87.  Indeed, the meds were new enough that they were unsure whether they would really help someone with my condition.  One cardiologist told me,  "We're hopeful, but just in case, get your affairs in order."  If I had to stop them now, it might take a couple of years... and then I would begin having heart attacks. 

One might say, "you could continue the meds, you'd just have to pay for them."  True... sort of.  The meds require regular blood tests, require a physician to monitor them and prescribe them (our experience in CA is that the primary care physicians don't want to do this so I'd need to see a cardiologist), and none of those costs are inexpensive.  At this point, they are still significantly less than what the church has been paying in premiums but one small incident...  Add that my wife is likely going to need a hip replacement in the next year or two...

Others might ask why they should shoulder any of my medical risk or costs?  That is a real question and comes down to how one feels about community responsibility or the fact that we've been paying health insurance premiums for these years, supporting costs for the health care of others (and salaries and profits for the health insurance industry).

All of this is just to rant about a system that is clearly broken, looks to get better in 2014 but still is not nearly what it needs to be, and which is frightening and frustrating for me.

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