Individual Insurance: Then and Now

If you’re reading about the Republican efforts to repeal/replace/reform/whatever Obamacare and think that it will never matter to you because you have insurance through work, I would just ask you to stop and think about whether you’ve ever considered leaving your job to work for yourself or to join your friend’s small but growing business that doesn’t offer insurance. Have you ever worried about whether you might get laid off, or been laid off? Ever struggled and panicked over your insurance coverage?

I work for a small company with fewer than ten employees. I like my job. I would like to keep my job.

Because there are only a few of us here who need insurance coverage, any group plan that my boss could buy to cover us would likely be ridiculously expensive and would offer crappy benefits (since there would be so few of us in our “pool” of enrollees). So instead, my boss gives us money to help us buy a plan on the individual insurance market.

Since I’ve worked in healthcare since I was a teenager, I’ve always insisted that both my significant other and I carry insurance. Which means that we’ve bought a LOT of individual plans. We’ve both always worked full-time and have earned middle-class salaries, but have mostly worked for small companies that didn’t offer group coverage.

In the old, pre-Obamacare days, if you needed individual health coverage you’d fill out a 10–20 page application that asked for every detail of your health history. These questionnaries were intense. Have you ever had allergies? Ever been diagnosed with an STD? Any joint pain in the last five years? If so, where? How were you treated? With which doctors? Have you ever been pregnant? If so, what happened to that pregnancy? And on and on.

You didn’t want to lie on those applications, because if the insurance company ever decided to go back and request your medical records (something that believe me, they did used to do) and discovered you’d omitted something on your application, they could deny all your bills or even cancel your policy.

Anyway, in those old days the initial premium quote you’d get from the website was just an estimate. After the underwriters went through your application, they’d come back with the actual premium they were going to charge you. This number was always higher than what your initial quote was. (Or else they’d deny you altogether.) Our premiums were always $20–100 more per month than our initial quotes, even though we both have always been healthy and were in our 20s and 30s.

And oftentimes, those policies you could buy would have big holes. I spent several years with a policy that had no maternity coverage, because I wasn’t planning to have a baby and didn’t want to pay the extra $250 a month. If I had gotten pregnant while I was on that policy, my options would have been “pay out of pocket” or “have an abortion.” What amazing options, huh?

Once Obamacare passed and it was time to buy a new policy again, I went onto healthcare dot gov for the first time and filled out a three-screen questionnaire. They asked how old I was and what my family income was, and then I got a quote. That quote never changed from that initial screen, and no one looked through my health history. I paid that premium for the first year and had decent coverage. My plan included maternity care (and all of the other essential health benefits). And my premium was just about the same as I’d paid for my old, crappy plan!

For the first time, buying insurance was EXACTLY LIKE buying any other consumer product. You need something, so you look at the range of options in your price range and pick the best one. I didn’t have to hem and haw over whether I needed to report that one time I saw my doctor for a stomachache five years ago, nor did I run the risk of having my insurance company go through my medical records and rescind my policy for not telling them I had a minor surgery seven years ago.

Now of course a lot of ACA plans have high deductibles or are too expensive. Those problems need to be addressed, and the law needs to be tweaked so that people are able to get the care they need at a reasonable price.

But I am speaking from lengthy personal experience here. Obamacare is better than what we had before, and Trumpcare will take us right back in time, by (among other things) allowing states to opt back into that lovely old “preexisting condition review” situation.

This is not a good law. Right now, the Senate is debating it, and I urge you to contact your Senators to give them your thoughts.