Everyday I wake up and I am excited and thankful that I have health insurance and I am alive to tell my story. It means I can live each day and look forward to the next, instead of wondering will I survive or how am I going to take care of myself? You see, I was one of the first people to get health insurance through the Affordable Care Act (ACA), because a little known caveat in the law created a plan for people like me who had a pre-existing illness.
When I was without traditional insurance, it wasn’t that I couldn’t afford to pay for the premium, it was that no one wanted to insure me. As soon as I told the truth about my medical problems, it was a flat-out “no”. I was too big a risk, they might lose money on me. It was devastating, disgusting, and depressing. I was overcome with questions like:
- “Would I wake up in the morning?”
- “Would I live to see my son grow up?”
- “Would I see my son marry and have a family?”
- “Would I ever be a functioning member of society again or would I be disabled and house bound forever?”
I suffered in silence. If you asked my family or my close friends, they would tell you, they had no idea I had no insurance and was why I didn’t seek treatment that they perhaps thought I should have. I was raised to be independent and strong and to have the mind set “when things get tough, the tough get going.” When I realized that I could get insurance, even though I had a pre-existing condition, prior to 2014, I was sure my prayers had been answered and maybe just maybe I could get the medical treatment I needed to get better before my illness got the best of me. I wish I could say I just applied online and “abracadabra,” got insurance the next day, but it was a process. Well actually the process wasn’t so bad. It was set up similar to the healthcare.gov web page, but everything that could go wrong, did go wrong. In fact, compared to the frustration people are having today, getting signed up, my experience was a nightmare. You can read all about the problems I faced getting signed up in this blog. (https://progressiveandproud.wordpress.com/2013/10/23/sometimes-the-best-things-in-life-arent-easy-dont-give-up-on-the-health-exchanges/) You know what, it didn’t stop me. Most people close to me, didn’t know until a few days ago I had any problems in the sign-up process. It was frustrating at the time, but I was determined to get insurance and I did. Like I said, I was raised to be tough, independent, and focused on a goal. I was raised by a single mom as my father died when I was 10 and things were not always easy, but my mom and, in fact, my entire family, lived by the premise “where there is a will, there is a way.”
Tired of cliches? Well so am I, but I am MORE tired of people complaining that:
- “Signing up for ACA isn’t simple”. Oh well, so you have to work a little to get it. The pay-off is worth it. If you are not comfortable with how to sign up, a detailed blog on how to sign up can be found at https://progressiveandproud.wordpress.com/2013/10/25/help-i-am-not-sure-how-to-sign-up-for-the-health-exchanges-the-process-from-start-to-finish-is-explored-here/.
- “President Obama ‘lied’ when he said people could change plans and keep their same doctors.” Who could have ever dreamed there would be the “push back” about this law that there has been? ACA was supposed to be a plan for people who did not get insurance through their employer, could not afford insurance, and/or had pre-existing conditions that kept them from getting insurance. This law was not written to circumvent or eradicate the employer’s responsibility to provide benefits. Somehow though, people are suddenly blaming ACA for not meeting their insurance needs even though they are employed, for their health insurance benefits changing even if the change is ultimately positive for them, and for business decisions by companies where they cancel policies either because they want to save money, reduce their adverse selection, are attempting to up sell policies to their customers or because they wish to replace previous plans with new plans that offer the “ten essential services” required of all plans based on the Affordable Care Act. I guess the employees of these companies should have just been left with the sub-standard policies (also called “junk Insurance” or “mini-insurance”) since the insureds feel so “angry” about losing them. (http://www.latimes.com/business/hiltzik/la-fi-mh-healthplans-20131030,0,5590179.story) It is clear that these folks have never faced a catastrophic illness, accident, or had insurance that cost a lot and covered nothing leave them in the lurch right when the insured needed the policy the most. Any insurance policy in effect on 3/23/2010 is grandfathered in under the ACA if there are no substantial changes. But if the customer’s insurance company makes any substantial changes in coverage, terms or pricing, the policy is no longer grandfathered in under the ACA Law and may no longer be offered. It should also be noted that a grandfathered in policy does not have to contain all ten essential coverage elements required of new policies (https://www.healthcare.gov/what-if-i-have-a-grandfathered-health-plan/.) So when a customer’s insurance company sends them a termination letter, it is only because the insurance company alone made material changes to the policy, not because the ACA law invalidated the customer’s insurance law. The Press and Pundits are directing their anger and the cause at the incorrect party. The cause lies entirely with the insurance companies, since they had the option to not make any material changes and grandfather in these policies. Had they done this, these policies would not have had to be cancelled and as the President promised, the customers could have kept their insurance, whether the policies were adequate or not.
- “People could “choose” to keep their same insurance plan.” Clearly that was the intent, but nobody could conceive that certain Congressional leaders and insurance companies would do everything possible for political gain and financial gain, while ignoring the needs of everyday Americans in favor of lining their own pockets and campaign coffers, choosing keeping their PUBLIC SERVICE JOB over the “greater good.” However this is the story of politics today, take care of yourself and your best interests and forget about any sense of community that has always brought out the best in Americans.
- “The proverbial wool was pulled over the eyes of the American people when they were told that plans through ACA/Obamacare would be cheaper. If you have a plan as a benefit of your job, the cost of that plan is not within the realm of ACA.” That is between the company you work for, the benefit plan offered and the rate they negotiated with the insurance company. “Spending on health care in the United States has grown substantially over the past four decades. In 1965, that spending amounted to $187 billion (in 2005 dollars). It more than tripled in real (inflation-adjusted) terms over 20 years, reaching $666 billion in 1985. Over the next 20 years, spending nearly tripled again, reaching roughly $1.9 trillion in 2005.” See the following link. http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/89xx/doc8948/01-31-healthtestimony.pdf. Remember, as far back as 1992, Democrats wanted a single payer plan, however that was too “Socialist” in the eyes of Republicans when Hilary Clinton chaired the Health Reform Committee after President Clinton was elected. In fact, Universal Health Care was talked about even by the Nixon Administration in a plan that has many similarities to ACA. See the following link. http://www.presidency.ucsb.edu/ws/?pid=3757#axzz2jFxVItXT. In a letter to Congress President Nixon said, “An all-directions reform of our health care system– so that every citizen will be able to get quality health care at a reasonable cost regardless of income and regardless of area of residence–remains an item of highest priority on my unfinished agenda for America in the 1970s.” Read more at the American Presidency Project: Richard Nixon: Special Message to the Congress on Health Care. See the following link. http://www.presidency.ucsb.edu/ws/?pid=3757#ixzz2jFxnZzlv. I include this small summary of the history of Universal Health Care in America just for those people who deny ACA has any roots in Republicanism. In general, the plans offered by ACA are cheaper, however in order to see how much the tax incentive and cost-sharing subsidy will impact your chosen policy under ACA, you have to complete the “enrollment” process.You don’t have to pay for the plan when you complete the enrollment, but you have to get to that point before you will see the tax incentive for the premiums along with the cost- sharing available if you choose the Silver Plan.
Frankly, I am frustrated, fed up and even angry with the senseless complaining that goes on by the media, our elected Congressional leaders, the pundits, and yes even the American people. For two years, I have woken up every morning thankful for having health insurance. As the days came closer to the final phase of implementation of ACA/Obamacare my business partner and I worked hard to learn about ACA and it’s regulations to put us in a position of being able to help individuals, families and businesses sign up for ACA, get the best plan to meet their needs at the lowest cost, and educate businesses about how ACA could help their business grow.
Yes it’s true, ACA can help a business grow, based on the tax incentives offered to businesses doing the right thing and either providing health insurance to their employees or providing some part of the premium so their employees can buy insurance in the exchanges. In fact, we have even seen businesses save enough money on insurance through the ACA and actually add new staff because of the tax credits. See http://thinkprogress.org/health/2013/09/11/2607221/employers-obamacare-wont-stop-hiring/.
Now I wake up every morning and cringe, and wonder:
- What will be the newest myth about ACA/Obamacare adding to the confusion today?
- What will be the new online sign-up drama, that the media and the GOP will hype that deceives and leaves people frustrated?
- Which Congressman will be on television trying to suggest the American people were lied to and manipulated into believing that ACA was going to cure all our medical needs in the United States?
I thought we were the country of “pull yourself up by the bootstraps,” that adversity makes us stronger, and that in America if you believe, and keep trying you will succeed. Instead, I suddenly see people complaining that the roll-out of ACA should have been perfect, that businesses are trying to cancel people’s policies because supposedly the regulations are “so tough” under ACA that it is cost prohibitive, and “oh no” birth control prevention services are required to be provided at “no cost”.
Interestingly, any businesses that claim their actions in 2013 were in anticipation of the ACA for 2014 are lying. They are just doing what they have done as a money saving strategy in previous years. The President has delayed the requirements for businesses with over 50 employees until 2015. As such, there is no reason to take any actions in mid to late 2013 or the first half of 2014 which might be related to the ACA implementation as it affects businesses. Also, keep in mind, abortion is not paid for folks, it is strictly prohibited from being paid for by ACA even though it is paid for within Romneycare.
You can’t have it both ways. You can’t say abortion is bad, birth control is bad, but pay for men to have Viagra to make them more virile and in the next breath, punish women for having children out of wedlock or while in poverty. We need to get a grip and just say, women getting birth control at no cost is better than the other options. A research study completed a year ago shows that free birth control would cut abortions between 41-71% in the United States.
One would think that those who felt that abortion was so wrong would be for free birth control since history has shown that taking away access to safe abortions does not eliminate abortions from taking place. See http://www.livescience.com/23726-birth-control-abortion-rate.html.
Whatever happened to common sense? People are having dramatic tantrums because things didn’t turn out perfect, that we have to spend some time on the web site, make a few phone calls, and horror upon horrors be patient. Yet, these same people seem to have no difficulty “camping out” before Black Friday to get the best deal, standing in line to get the new iPhone or video game to hit the market. Let’s act like adults and not just be the “want it, need it, gotta have it now” society.
How to act like an adult in terms of ACA!
- Complete your enrollment. In order to see your Silver Plan subsidies you have to do everything EXCEPT pay for your plan. Know that completion means verifying your income and your identity. (Remember all those undocumented workers the GOP keeps saying are stealing our benefits. You have to be an adult and verify your identity. Then there are the “liars and cheats”, so they verify your income through the IRS, just like in a credit check. There is one big difference they are only verifying your income, so your credit will not help you or hurt you purchasing a plan. You do not find out your subsidies (reducing the premium and cost-sharing to reduce the deductible and co- pay) until you complete the full enrollment. YOU HAVE NOT YET PURCHASED A POLICY, SO DO NOT WORRY ABOUT PAYING FOR THE ENROLLMENT, YOU HAVE NOT COMMITTED TO A PURCHASE YET until you actually make arrangement to pay your monthly premium beginning in January 2014.
- Review the plans. Decide which one is best for you. Do you choose a television satellite provider for your TV without getting the best deal? Don’t you look to see if your favorite channels are included? Come on folks, check the offered plans to see if your doctors are on the plan…it’s not rocket science. Every plan has a website that you can go to and explore the specific benefits and identify the doctor, clinics and hospitals approved on that plan. Guess what, if you find a plan you like and your doctor isn’t listed, call them and ask them to apply to be a provider. They might just do it. It is beneficial for them to participate in a variety for plans as it increases their business.
- When you get a good deal, regardless of the type of purchase, you have to weigh the pro’s and con’s. That is what you have to do with these plans too. We are talking about an age when people consider the thread count of the sheets they are going to buy, but they can’t take the time to read about the individual plans and find out about the differences between them. Even people on Medicare do this every year during open enrollment in an effort to find the most cost effective plan for them. Two members of my family changed their Part D enrollment four times in ten years.
- Quit the panic mode…“OMG someone hacked into the healthcare.gov and they are going to get all my health information.” OK, really, what health information did you give? Whether you are a smoker…yep…they are really going to be able to demand a ransom for that information. The call should be for the person who hacked into the system to be arrested and held accountable for the crime. Hacking is illegal. Healthcare.gov is not subject to HIPAA (Health Insurance Portability and Accountability Act) since they are not a “Covered Entity”, a “Third Party Payer” or a “Clearinghouse”. HIPAA admonishes clinics, doctors, and hospitals to name a few to keep your health information confidential. Any “Covered Entity”, a “Third Party Payer” or a “Clearinghouse” must give the patient notice of their rights under HIPAA. These are the only three categories that fall under HIPAA. You may have heard congress voicing concerns over HIPAA during their current hearings. These congress people are showing just how little they understand about security and HIPAA or they are simply fear mongering, because they didn’t want ACA to be the law of the land.
- Wake up and smell the roses. You have the big lobbyists, the Tea Party, the Insurance Companies, the Medical Device Industry (https://progressiveandproud.wordpress.com/2013/10/19/the-medical-device-tax-a-burden-or-a-blessing-you-decide/), the Republicans and Big Pharma fighting against this plan. Why? It will hit them in the pocket book. They are not looking out for your interests, they are looking out for their financial interests only. So, you have to learn how to differentiate between what is rhetoric and what is fact. It is the same as Chicken Little….just because he said the sky was falling didn’t make it true. These folks have a stake in making ACA fail, because guess what, this is the true free market, where you shop for the best plan FOR YOU, within the confines of an exchange and the insurance companies compete for YOUR business instead of making decisions about what YOU need.
The GOP is readying another campaign to bring down ACA. They are trying to capitalize on any issue they can, because as long as they have insurance, a roof over their head, and food on their table, they don’t give one thought to the average American, who in the past have often had to make health insurance, a luxury in their budget. Health insurance should not be a luxury. In today’s society it is simply a necessity. Just try going without it when you get ill. You will figure out very quickly the havoc it can wreak in a person’s life who isn’t “lucky” enough to have coverage.
By: Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CPC-I, CENTC, CPCO and Lynne Smith, MSSW.
About the Authors: Barbara is an industrial engineer with an MBA. She worked in the pharmaceutical industry for many years before moving into the healthcare industry where she had a company where she provided top quality coding, compliance and revenue cycle management services for physicians. She has since moved into full time consulting for physicians. Barbara is a nationally known expert known for her education, consulting and expert witness services. Lynne has dedicated her career to helping others. She has experience as a social worker in a rural county, an administrator in a large hospital network and as a College Professor. She uses the skills she developed over the years as an advocate in a variety of areas including her most recent venture serving as a Healthcare Advocate. Together, Lynne and Barbara own the ACA Healthcare Advocates consulting firm and are available to individuals, families and businesses to help them meet the requirements of the Affordable Care Act in order to meet the specific needs of the client while optimizing the fiscal considerations. Please direct your questions and/or inquiries to firstname.lastname@example.org.