As the parent of a child born with Down syndrome, malabsorption and advance respiratory disease, I have become very familiar with how our health care system works. Not to mention that I was a Registered Nurse for 17+ years, even before I was a mom. A Registered Nurse that was laid off very early in this recession. For the last six years I’ve developed a close working relationship with the health insurance industry .
As a family, we’ve been through three different insurance company changes together (this will be the fourth), and each time we’ve gotten to know our health coverage inside and out. Out of sheer necessity, we’ve always utilized our health care benefits to the fullest. Its nothing to brag about, but our experiences have pretty much qualified me to be an expert witness on the subject. In other words, I know what I’m talking about.
I had major reservations about the health care law that recently passed, and I still do.
I did not want this law to pass, and I have been more than vocal about it. In November of 2009 , Michelle Bachman made the call, and I heard it. I made the decision to tap into what little savings our family had to attend the protest rally with tens of thousands of others. With my husband’s blessing, I flew to D.C. for a single day to rally against the HC bill.
I’ve never been much of an activist, but it was a mentally exhausting trip. Several of us were almost arrested when Nancy Pelosi sicked her thugs on us. About 75 of us stood outside her office, peacefully protesting by ripping up our copies of the 2000 page bill, but were stopped after threats of incarceration by the Capitol police. Yes I am a wimp.
Despite the massive efforts of the American people, none of our efforts were effective, and the bill was signed into law. It was a hard slap in the face, not only to me, but to the majority of Americans.
However, after my time in mourning, I decided to pick myself up, dust myself off, and shift my focus.
This wildly unconstitutional law is having a detrimental effect on the finances, and the health of many families like mine, and I refuse to be silent.
I will do my best to blog, report, send smoke signals or Morse code to anyone who will listen to the actual verifiable and destructive costs (either physical or financial) to real families who are struggling. People have a right to know that obamacare is crippling our families, and I will call out each instance as I find them.
The first twenty-two days of 2011 has shown, beyond the shadow of a doubt that this law is hitting the hardest, the ones who needed not to be hit with the extra burden of less coverage and higher costs. People like myself doing our best to manage the tight rope of health insurance coverage for our children born with special needs. Some have been more successful than others, but the task has never been easy, despite the pundits that lie about those of us with health care coverage.
Contrary to popular beliefs, having employer sponsored insurance does not equate to great health care. There is no imaginary wine or roses in our waiting rooms where absolutely every visit to the doctor, every imaginable prescription, and any test we might need are free.
The reality is much different with the diamonds in the rough being the days when everything goes smoothly, and you only have to pay a chunk of all your copays plus the obligatory 20% of what insurance doesn’t cover. While other days are coal when you hit the ever present brick wall of denials in addition to the high costs of things not covered in your so called “Cadillac” plan. Things like lab work, radiology and other things you forgot to read in the fine print. Those are the days you let the phone ring because your account went into collections.
Unfortunately obamacare has stepped into our mix to make everything worse.
Why the heck did obamacare have to come roaring in like a lion before anyone had time to tame it?!?
While certainly not the only reason, but the biggest and most publicized reason was that it had to be passed quickly, so millions of imaginary people, who were supposedly denied health insurance coverage with pre-existing conditions, would be saved.
The sad reality is those people are about to be hit with severe buyers remorse. Somehow they have convinced themselves that they will be instantly blessed with imaginary low costs for their health insurance premiums, and they will have unlimited free coverage for any health care need that might arise. While that subgroup of the population is mesmerized by the new car smell, the rest of us are being drug with our heels in the dirt, kicking and screaming to a very unpopular law with false promises that people would be spared the destructive consequence of not having health insurance coverage.
Perhaps the biggest lie of omission that people refused to see or to even admit that it exists, is that a well-established law from 1996 actually prohibits insurance companies from denying coverage for pre-existing conditions. (Google HIPAA)
I’ve covered this in a previous post, but the Health Insurance Portability Accountability Act of 1996 still protects the majority of workers (who may or may not have pre-existing conditions) who changed or lost their jobs and/or their health insurance coverage. The common sense stipulation of the law, is that they are protected, as long as they do not let their insurance coverage lapse for more that 61 days. Even then, your insurance company can only enforce a waiting period for coverage. It has specific stipulations that one cannot be denied for more than a couple of months before they are allowed full coverage.
HIPAA was enacted by President Clinton in 1996, and it made perfect sense. Not only because it protected workers, but it prevented others from gaming the system by not obtaining coverage until their house of health had already suffered a loss.
Despite the Health Insurance Portability and Accountability Act of 1996, as with any mandates, there are always a small number of people who will fall between the cracks. It always happens and there is no legislation in the world that can stop that, but it does not stop the progressives from exploiting that to further an agenda.
The small percentage of the people not protected by HIPAA were self employed people who did not secure health insurance benefits before they needed it. Contrary to the sob stories that still continue to propagate the internet and the airwaves, most of those were not small business owners, because a successful business has the leverage to negotiate insurance coverage. Plus there are a plethora of insurance companies clamoring for that business.
Most who claim to fall between the cracks are not telling the whole truth. It is actually independent contracted workers, such as performers in the entertainment industry, and other contracted labor workers from different industries such as hospitals, tech companies, temp services etc. that claim have no protections.
While that may be true, it is a well known fact that most individuals working on contract are compensated at a higher rate, and they normally earn enough money to purchase benefits on their own, but choose not to. Which just goes to show you how much of a nanny state we’ve become when there is no incentive for individuals to use their higher pay to take care of themselves or their families first, before they go all materialistic to show off their wealth. A few irresponsible people who grew up with the expectation that they will be taken care of, have created a horrible situation where everyone gets penalized.
So, the fact remains that the new law claims to save us all, but it has actually ruined an entire industry, by riding on the emotional cry for a small percentage of self-employed individuals. Those poor souls now have the false belief that they will have some kind of advantage to receive free health insurance without consequences.
While many industries and and companies are getting waivers from participating in the new law, the majority of us poor suckers drew the short end of the stick.
Which explains why an overwhelmingly large percentage of people are still against it, and still want it repealed. Not only repealed, but replaced with common sense laws that provide protections for those small special interest groups, without ruining the health care and the finances for the rest of America.
In fact, because of obamacare, families who deal with special health care needs like ours, are likely experiencing some of the highest increases in their health care costs and their insurance premiums than they have experienced in the last five years!
The health care costs that are associated with Down syndrome and cystic fibrosis can vary quite a bit from family to family, but they are usually substantial.
I make no promises, but I hope to report how our family is being affected, and I will back it up with as much facts as possible. I would find it odd if this was not a trend that is occurring across the board by a majority of the disability community.
Rest assured, ours is no sob story. It is the truth, and anyone questioning my reports, please feel free to contact me for verification. I am happy to oblige. We have nothing to hide.
So enough of the background, here is my Example #1:
Our employer sponsored insurance plan changed companies this year, and the explanation offered by our employer, was the change was directly related to obamacare. We received a letter saying the plan was changed to reduce health insurance costs to the company, but they assured us that the quality of our care would not go down.
The letter also stated that the new health care law had provisions that forced them to report to the IRS the value of our health insurance plan, and that amount would be added to our income to be taxed accordingly.
Notice that I said the VALUE of the plan, not the actual COST of our plan.
How that value is to be determined, and who will asses the value of our plan, is yet to be discovered. My worry is that it will be similar to the way property value is assessed and taxed every year or so.
This already does not sit well with me when we have been unfairly labeled as privileged and thus born with a silver spoon fed “Cadillac health Plan.” I am positive this kind of rhetoric will be used as an excuse to distribute our meager income even further than the 39% we already pay into entitlement programs that we have never, and will never see.
Social security and Medicare are all projected to fail in less than 20 years. Just like every other entitlement program our bankrupt government has tried to implement. Why there is any normal human being that thinks we should hand them another program is beyond me, but I digress.
All worries aside, when it came time for annual enrollment we happily enrolled in the new plan back in October 2010, hoping for the best. We would not know for sure how things would change until the plan took effect on January 1 of 2011.
The first thing I noticed, was that our health plan choices increased the premiums ever so slightly. Which gave me hope that at least in part, it would not be as bad as I first thought. However, after having used our plan during the first 22 days of 2011, I am starting to see there is more to this story.
While the premiums did not seem too bad, our out-of-pocket expenses have “necessarily skyrocketed.” I should have know the health insurance companies would get their profits no matter what. While boasting the little to no increased in premiums, they can pretend that they are complying with the medical loss ratios mandated by HHS.
Getting the picture yet? The insurance company gets to keep more of their slightly higher premium dollars because, not only are you are paying the premiums, but you are also paying the out of pocket costs they normally pay for different medical services.
While I’ve defended the insurance companies in the past, the truth is they really are the greedy companies profiting more from their premium dollars. At least the ones that support the liberal progressives.
Back to the real cost examples…
The feeding therapy used to be $40/visit.
Now, because our insurance wont pay the full price minus our copay, feeding therapy is going to cost us $130/visit four times a month.
The original plan was therapy once a week, but the added financial constraints will probably reduce that to every other week or less. I will try to budget out the $520 in additional costs if I can, but higher costs on everything is putting the squeeze on our tiny paycheck. This is slowly and progressively creating a significant financial crisis in our family. I still have hope that we can do it, but the term “working poor” has long replaced the term “middle class.”
The next surprise came after we refilled the prescriptions needed to deal with the malabsorption effects of cystic fibrosis. The five bottles of enzymes we order monthly normally came to us at no cost.
Now the enzymes cost $110/month.
Feeding tube supplies/formula/equipment cost $125/month plus a 40% obamacare excise tax on all of our supplies at cost. I am not sure why the huge excise tax has to come from the people actually using special medical supplies, but it is more proof that the ones that need help the most are the ones getting shafted more that anyone else.
The ER visits have gone up slightly from $100 to $150/visit +20%.
The copays for seeing the six different specialists every three months or so have gone up to $50 a pop.
BTW the copays do not apply to the high deductibles we had to choose in this new plan, so that thousand dollar chunk has to come out of our hide as before coverage kicks in.
For now, those are the cost changes I have experienced. More to come as I find out.
Doing my very best to keep calm and carry on.
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