The Affordable Care Act: a personal experience

The media is swamped with news about the roll-out for the Affordable Care Act, from newspapers and broadcast media outlets and blogs giving primers on the act's machinery, to Republicans mounting a last ditch and futile effort to derail it. The efforts to derail it are laughable, and veer into Looney Tunes territory; the fact is that the law will be in effect come next Tuesday, and a tsunami wave of information about it is starting to come out detailing its parameters and costs. Politically, this means that the act will be the defining topic for the 2014 elections; once people start applying for coverage, and fully discover all the benefits, they'll start to appreciate it, and look very askance at any politician who wants to repeal it.

You can't swing a dead fly on Twitter without hitting a tweet about Obamacare's imminent birth. But this one struck me quite strongly:
Let that sink in. Over 100 million of our fellow citizens have a pre-existing condition. Before Obamacare, if they had insurance from their job, lost that job, and found work with a company which didn't provide health coverage, they would either be denied coverage on the open market, or only be able to buy expensive and almost useless insurance.

I'm one of those 129 million people.

Yes, I'm a librarian, work for the public, and have great health coverage. But I've been a librarian for only five years. Before that I toiled away in the telecom canyons of downtown L.A., working for a start-up company which held on by its fingernails, and which never provided any benefits, certainly not health care.

Now, I was healthy, in my 30s, and seemingly the prime demographic for purchasing health coverage on the open market. There was one slight problem.

Ever since childhood, I've lived with a stutter. Part of the reason I toiled for no-name companies in L.A.'s telecom canyons was because it was, quite frankly, difficult to find remunerative work with my condition. How much of that was a fact of people judging me, and how much was a result of my prejudging myself tends not to matter. One bled into the other, and I was just happy for any job I could get.

Then about ten years ago I was introduced by a family friend to a doctor who was experimenting with a medical treatment for stuttering. By this time, after a lifetime of frustration, I was ready to try anything. So, I put myself under his care, started the treatment, and the rest, as they say, is history. Within six months I saw a marked improvement in my speech, so much so that new acquaintances had no idea that I stuttered, taking my occasional disfluency as the normal hiccups everyone has. I certainly could not do the job I do now without this treatment. I'll have to continue with it for the rest of my life, but the alternatives are not worth considering.

But, there was still the issue of getting medical coverage. I had just started library school, so I didn't want to add searching for a new job to my list of things to do. In general I was comfortable where I worked, had money, and figured that buying individual insurance would be an easy thing. So I filled out questionnaires for several carriers, and waited for the offers.

I was rejected by every carrier to which I applied. My stuttering was a "pre-existing" condition, and I had to be stable on my medication for five years before they could insure me (at, I'm sure, inflated prices).

So, I re-applied, omitting the stuttering. This meant that I couldn't buy my medication with insurance, which was one of the main reasons for getting insurance. Until it went generic, my medication was quite expensive, so this was no small sacrifice. So on top of paying an insurance premium, I had to pay for my medication out of pocket. Somehow this contributed to having "the best health care system in the world".

When opponents of Obamacare fulminate about repealing it, what they mean is that they want to allow insurance companies to discriminate against people like me and my wife, who have pre-existing conditions. They want to toss 129 million Americans unto the tender mercies of an unregulated market, where the conditions mean that, if they have insurance through employers, they are tied to those employers in a semi-feudal state; if they have no coverage from their workplace, then they're out of luck.

"Affordability" takes on many guises in this act. Yes, the premiums people will pay are proving to be even cheaper than first envisioned. But affordability extends to no copays for yearly exams, mammograms, and cancer screenings. Affordability extends to closing the prescription doughnut hole for Medicare recipients. Affordability extends to forcing insurance companies to spend 80% of the money it collects in premiums on health services, not overhead and administration. And affordability means that 129 million Americans with pre-existing conditions will be able to get affordable health coverage, not tied to work, something which was denied to them for decades.

I have no intention of leaving my job any time soon. I love the work I do. But now many people who would stay with a job they hated solely for the benefits can strike out and try something new—write a novel, start a new business, work for a non-profit—without worrying that they're one illness away from homelessness. Telling someone that they can't get health coverage for a condition which is the entire point of getting health coverage is not the mark of a civilized society. That it's the implied position of one of the two major political parties is very instructive of their ideology, and how they see the people whom they say they wish to serve.


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