First, a little background. In May 2013 I relocated to a state which has not expanded Medicaid coverage, and where able-bodied adults are not eligible for Medicaid coverage.
I've been working part-time at a hospital since mid-June, and was therefore not eligible for health insurance coverage per the hospital's policy. Hospital policy does not cover employees until they are regularly scheduled for an average of 36 hours/week or more. So while I worked in health care at a hospital, I had no health insurance coverage through my employer, the hospital.
I'm lucky, though. I make slightly more than poverty-level wages, so even though Medicaid has not expanded in this state, I'm able to obtain coverage through the Affordable Care Act.
More on this story, below the orange squiggle.
In July 2013 I had rotator cuff surgery on my right shoulder, following an injury sustained in April 2013. Without the surgery, I was unable to lift my arm more than to level shoulder height to the front and side. After the surgery, I was informed that it was a good thing I'd had it; otherwise, my arm was not going to recover to normal range of motion or strength.
My COBRA payments consumed my first two paychecks entirely. They were something like $582/month, for an okay policy (with $1500 deductible and out of pocket max of $3000, or something like that).
After surgery, I opted for one self-pay followup visit with the orthopedic surgeon, but I did not take the recommended course of rehab, as I could not afford the COBRA after my boyfriend's layoff in late July. Instead, I worked on range of motion and strength on my own, with various aids. My recovery might have taken a little longer than professionally guided rehab, but I believe I've recovered full range of motion and nearly all of the strength I previously enjoyed.
So, since July 31, 2013 I've been going "naked," that is, without health insurance at all. This doesn't feel particularly good as a female, aged 48, with a strong family history of heart disease and cancer, and with parents who died of those diseases around age 60.
So on October 1, 2013 I was one of hundreds of thousands of people who tried signing up for healthcare exchange coverage through the Affordable Care Act (ACA). Initially, it wasn't particularly easy going. Getting onto the site was a challenge in itself; getting all the way through the questions was nearly impossible. And even with saving the data, logging back in later and attempting completion was fruitless.
In mid November, I discovered my previous account was likely one of many with corrupted data. So I created a new account. I provided necessary documentation of identity and income, and was able to compare different plans. I'd found that, luckily, being slightly above poverty level was going to cause the credit to kick in, so I could sign up for a plan at full coverage, or an even better plan for a small payment.
I finally selected a plan in late January 2014, after a couple more episodes of difficulty with my login. Since my preference is to resolve issues via livechat or online, rather than by phone, my solutions were a bit delayed. Whenever I picked up the phone to talk with a representative, my problems were resolved in relatively short order.
I received my first bill for the premium on Thursday, February 13, 2014. The bill was for $142.00, the expected amount. I sent my payment in the mail on Friday, February 14, 2014. I've selected a platinum plan, one that has a $500 deductible and $1000 out of pocket maximum limit.
As soon as March 1st rolls around, I'll be getting in to see a medical professional, and see about getting a few routine test/s and exams scheduled. I should get a colonoscopy, a cardiac calcium study, a mammogram, and a Pap smear, also lab lipid testing. The anesthesiologist strongly recommended I get a sleep study, based on his experience with my surgery and recovery. And I need to discuss a possible change of medication for two common chronic conditions, which are usually well controlled with medicine.
So yes, there will be deferred routine testing to catch up on. I'll be more expensive this year than is usual for me. But my new plan with great coverage is 1/4 the cost of my COBRA.
75% less! Not including the difference in deductible and out of pocket max!
That difference in cost makes the difference between me being able to afford health insurance, and not being able to afford health insurance. And that makes the difference between me being able to seek preventative health care, and getting no health care at all.
I estimate the ACA will likely result in lengthening my life by at least 10 years, maybe more. When I move, I'm considering a different state for my residence (Iowa), which has expanded Medicaid and which also has more extensive coverage requirements than Nebraska. That could result in life-extending or life-saving surgery for me, which could result in another 20-30 years of relatively healthy lifespan.
So while the ACA is not universal single-payer coverage, which I would prefer, it's still a heck of a lot better than what was available to me previously. And while it's not what it could be in this state, I still owe a thank-you to President Obama. I now understand the value of not allowing the perfect to become the enemy of the good.