The Preciousness of the ACA is Relative

Every morning I sit down at my desk and scroll through the latest health news as I wait for my first appointment to arrive. Today, my first consumer is a retired gentleman in his early 60s who is collecting social security, but is not yet eligible for Medicare. He needs some insurance to tide him over until his Medicare picks up. After a discussion about household size and income, I begin to look up plans and prices on Healthcare.gov. As it turns out, this gentleman qualifies for a large subsidy, so we begin talking about the different plan levels and what they mean in terms of premiums, deductibles, co-insurance, and co-payments. I happily explain these terms to him since, like most of my consumers, he’s not sure how it all works. The gentleman tells me he has diabetes, but it is managed with insulin and regular lab work. We review the plans, and based on his need for doctor visits, labs, and prescription medication, he thinks a silver plan with a lower deductible and lower copays is best for his medical needs. Next we discuss cost. He is outraged at the prospect of paying $190 per month for a plan with a $600 deductible and $1,200 out of pocket maximum, the lowest available cost sharing in a silver plan. I acknowledge that the added monthly expense is difficult, but remind him of what he is getting for that price: coverage for his pre-existing condition, reduced cost to see a doctor, free preventative services, and extremely low-cost care in case of a serious illness or injury. He’s not convinced. He’s healthy, except for the diabetes. I inform him that his total yearly out of pocket responsibility with this plan would be less than the cost of one night in the hospital, if uninsured. He informs me that Trump is going to fix this mess so he won’t need this Obamacare for very long. He grudgingly enrolls in a plan after I promise that he can cancel at any time.

This has been the norm in recent weeks, as promise of Affordable Care Act (ACA) repeal has become more of a reality. West Virginians, who have benefited heavily from the coverage gained through the ACA, assure me on a daily basis that the new administration is going to improve their current health care hardship. As an enrollment assister, politics is not my game. My goal is simply to educate consumers about the plans available, and ask the right questions so that they can independently assess their own needs. I like this part of my job, because I get to use the teaching skills that I learned in graduate school. I was going to be a language teacher, until a bump in the road (cancer) sidetracked things. I was 25 years old and on my parents’ insurance, in between school and work, when I got the diagnosis. My year of inpatient chemotherapy and five surgeries would have cost my family hundreds of thousands of dollars, forcing us into bankruptcy, had I been uninsured. Now, as a contracted employee of a community health center, I purchase my insurance through the West Virginia Health Insurance Marketplace. Last year I paid $404 per month for myself, as a single person, so I can completely empathize with those who complain about the cost. It takes a huge part of my paycheck, but having coverage for my scans, labs, and medications is a priority for me because I know what my finances could look like without insurance. Is this everyone’s priority? No. Last week I had a woman with a newly discovered mass in her lung who was not willing to pay any premium for health coverage. “What’s the point when you still have to spend thousands of dollars for care?” she asked. The point is that with insurance, it’s thousands and not hundreds of thousands or millions of dollars. When I relay these stories to others, I’m asked, “Well didn’t you explain it to her?” I do explain. To an extent. Explaining the ins and outs of the insurance market and U.S. health care system to consumers who don’t understand what a co-pay is, or have never been to a doctor, is not an achievable undertaking in an hour long appointment. Further, teaching about health insurance, and by extension the ACA, has become inherently political. If I describe to a consumer the scenarios that may occur if the ACA is repealed without a replacement, I am not perceived to be knowledgeable, I am perceived to be liberal. As soon as I am perceived to be a liberal, in my area, I am no longer trustworthy, and the consumer reverts to his assertion that Trump is going to fix health care.

If I were asked six years ago to pay $404 per month for health coverage, I probably would have responded much like many of my consumers- “I can’t afford that!” and I’d have foregone insurance. No one can grasp the enormity of a catastrophic illness until it happens. But to be fair, no one can grasp the peace of mind that comes with having health coverage until you’ve needed it and used it. I currently have that peace of mind, and each day that passes, my fear grows that soon I will not only be uninsurable, but unemployed. And the fear isn’t only for myself, but for all my consumers who have benefited from their coverage: the plant nursery owner who got his first physical in 20 years, the young woman who caught her cervical cancer early, the self-employed IT guy who could afford his thyroid medication again. We all stand to lose if the ACA is repealed without a replacement that is comparable in the number of Americans it covers and the comprehensiveness of the benefits offered. Frankly, we’ve come too far to move backwards, and I, for one, refuse to be placed in a high risk pool. Please, let me continue to take care of myself so that I may continue to ensure that my fellow community members get access to the care they need and deserve.