The uninspiring terms of the AHCA

The mission of this blog – and my coaching business – is to inspire better physical and mental health and a passion for life.  Not having affordable and adequate healthcare coverage could certainly undermine one’s ability to be inspired. So, just 5 days after the House voted to repeal and replace the ACA, I feel compelled to discuss healthcare.

We often make judgements based on our own perspective and fail to see how others are affected. I am not immune to that. Let’s go back to 2005, when as the CEO of a small non-profit I was tasked with finding an affordable healthcare plan for our 5 full-time employees. Not an easy task given our census. I was also aware that given the size of our organization, we were not required by law to provide healthcare insurance to our employees at all.  But many of our employees were heads of households or single, and providing insurance was part of a compensation package that would allow us to retain a good experienced, staff. Truth be told, I wouldn’t be able to stay in my position there had we not been able to offer full medical coverage.

Training for the NYC Marathon at the time, I was working out regularly, eating right, getting lots of rest and, in my opinion being “responsible” for my healthcare.  I required only preventative care, as did the other members of my family. We were all young and healthy. In spite of the contradiction of being CEO of a cancer support organization, I was of the mind set that people who took a proactive approach to their health – people who invested their time and money in regular exercise, good nutrition, and other healthy habits – should be rewarded with lower health insurance premiums. Makes sense, right? Like drivers who don’t have accidents and tickets verses those that do.

I made the decision to go with a low-premium, high-deductible plan with an HSA (Healthcare Savings Account) to which the organization would make an initial contribution to fund the high deductible for year one. The thinking was that, at least in the first year, employees would see no real increase in their healthcare expenses and in subsequent years – if they didn’t spend down their HSA – they would actually see their costs go down. And after the initial investment in funding employees’ HSAs, the organization (which I will note was a non-profit always on the verge of bankruptcy) would save a significant amount of money.

Every employee with a healthcare issue (read: “pre-existing condition”) — which was pretty much everyone but me and the finance director, had an issue with the plan. But it was a done deal. I had reviewed all the figures and it appeared to be our only option to keep the staff covered and the organization out of bankruptcy. (I’m not completely sure I wouldn’t still make the exact same decision today, except that I would involved staff in the process, be more curious about their needs and concerns, and share with them my concerns about the financial viability of the organization, and I would be completely more empathetic to the issues they faced. Read on…)

As healthy as I was, in early 2006, I began to develop sciatica. I spent through my HSA trying to remedy it, and because I had family coverage, I still had $2500 of my deductible to cover out of pocket. As a result, I took some pain meds saw a chiropractor for months, and opted out of more expensive diagnostic and treatment options. I never fully recovered until it came back worse than ever in 2011 after a fall. Thankfully I was under a much better plan with a new, larger organization, got the MRI, a Lumbar Epidural Steroid Injection (LESI) because it had gotten to the point where I could barely walk and running wasn’t even an option. That was followed by months of physical therapy.  With the exception of some minimal co-pays, it was all covered by insurance and I was healthy again! I got back to running in 2012, even completing 13 Half Marathons in 2013.

But, would I have not saved the insurance system money had I just addressed the issue in 2006 when I probably wouldn’t have needed the LESI?

At the beginning of 2014, I was training for the NJ Marathon and never felt stronger or healthier. Eleven weeks into the 16-week training plan I was diagnosed with stage 1 evasive breast cancer. Between the lumpectomy, numerous doctors visits, and 4 weeks of daily radiation treatments, I ran up a bill at Memorial Sloan Kettering Cancer Center of over $50,000, all but about $250 in co-pays was covered by insurance. Suddenly, the $750 monthly premium I was paying for employer-based heath coverage seemed cheap.

Moving to a new job last year, I switched healthcare plans. I’m back to a low-premium (if you consider a $996 a month COBRA payment “low”), high deductible plan ($5,000 for me and my daughter). “Preventative care” is supposed to be included. Because I am only 3 years post-op, my mammographies are considered diagnostic, not preventative. My by-yearly appointments with my oncologist aren’t covered either. $1600 in total toward my deductible. At year end, I will probably spent about $15,000 on healthcare and still not cover my deductible.

I’m sharing this with you because if you think, like I did, or like Alabama Rep. Mo Brooks,  apparently thinks, that people who “lead good lives” don’t get cancer, or have back issues, or fall or have plethora of “pre-existing conditions,” you’re wrong.

My understanding is that (the new proposal) will allow insurance companies to require people who have higher healthcare costs to contribute more to the insurance pool. That helps offset all these costs, thereby reducing the cost to those people who lead good lives, they’re healthy, they’ve done the things to keep their bodies healthy. And right now, those are the people — who’ve done things the right way — that are seeing their costs skyrocketing. – Alabama Rep. Mo Brooks; watch the full interview here.

Not only may we all see our health coverage become cost prohibitive, more and more people aren’t going to get treatment when they need it thus creating bigger – and more expensive issues – later on.  I’m not even going to go into what the AHCA bill will do for treatment of mental health issues (and if you need a reminder about what can trigger or be considered a mental health issue, read this post from last May).

The ACA certainly wasn’t perfect. As a self-employed consultant, I purchased insurance for my daughter through the Marketplace in 2015 while I kept myself on my previous company’s plan through COBRA. A policy through the ACA would have required that I only see doctors in New Jersey and I was being treated at Memorial Sloane Kettering in New York City. Thankfully I had the resources to make that decision. So, while acknowledging that the ACA wasn’t perfect, it was a step in the right direction. It saw that everyone was insure and had protections for people who actually got sick. The AHCA as it goes to the Senate, is a step backwards.

When it comes to health care, readers should be wary about claims that important changes in health-care coverage are without consequences and that people are “protected” – or that the changes will result in massive dislocation and turmoil. There are always winners and losers in a bill of this size. In this case, if the bill ever became law, much would depend on unknown policy decisions by individual states – and then how those decisions are implemented. – “Here’s what you need to know about preexisting conditions in the GOP health plan, The Washington Post; read full article here.

Obviously people currently under a doctor’s care – those of us with “preexisting conditions” – might believe we have more at stake. But this affects anyone who may get sick, may change jobs, or who may have a change in marital status. In other words, this affects all of us.  Please don’t think you’re immune. It is my hope that I have inspired you to educate yourself; to know the facts and if you don’t like what you’re seeing, I want to inspire you to speak up. Call your representatives! Ask them to look at this from the prospective of someone who is actually going to be insured by this system (they are not).   Click here, if you need their contact information.

And to get you started on your research, here are two recent articles you may find helpful:

 

IMG_3756Ramsey, New Jersey. May 2016.

 

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