March 3, 2012

I am Obamacare.

Update: Obamacare fails to collapse. Time to move on, folks. (washingtonpost.com) 7 Million sign-ups, 9.5 million including previously insured have gained coverage.

At 37 years old, I am the healthiest and most fit I have ever been.

I practice yoga 4-5 days per week. I walk a minimum of 10 miles per week, up and down the hardcore hills of San Francisco. I eat a healthy, whole food diet and I drink at least eight glasses of water per day (as I have all of my life). I take my vitamins. I sleep for at least eight hours a night, I receive regular acupuncture treatments and I meditate regularly. As a result of this healthy and mindful lifestyle, I have very minimal stress and anxiety in my life. All told, I lead a very healthy and happy life.

So you perhaps can imagine my absolute shock when I received the letter from Blue Shield of California informing me that I had been rejected for health coverage due to pre-existing conditions. As a self-employed writer, my only option is to purchase a private, individual healthcare plan. This makes me among millions of other small business owners in the United States. Those of you who are accustomed to the comprehensive coverage that a corporate group plan provides (as I had been for the past 15 years), may not be aware of how high the costs are for individual plans, and of how poor their coverages are, even at high premiums. Although the plans were all pretty poor in terms of high premiums, high deductibles and high out-of-pocket costs, after months of researching, I settled for a plan that seemed like the most decent option for my budget. I was willing to pay for the best possible coverage that I could afford. I was not looking for a handout.

As this same company, Blue Shield of California, had insured me four years prior on a similar private plan, I was not at all concerned about being accepted for coverage. That made it all the more shocking when I did receive the rejection letter. For the purposes of full disclosure, I will share with you the relevant aspects of my health history:

When I was 25-years old, my doctor had ordered a diagnostic ultrasound as a result of a kidney infection that I had. During the ultrasound he inadvertently discovered a small cyst on one of my ovaries. Never having had any pain or symptoms of having this cyst, the doctor performed a routine laparoscopy to find out what it was. It turned out to be a small endometrial cyst, and it was at that time that I received the diagnosis of endometriosis, a female reproductive disorder that is shared by an estimated 176 million women the world over1, more than 6 million of those in the U.S.2

The good news was that the doctors had found the cyst before it had further developed into a full-blown and problematic case of endometriosis. The even better news was that this disorder was easily and routinely treated hormonally by being on continuous-dose birth control. Since that day, now over 10 years ago, I have continued to be successfully treated with a very inexpensive, generic form of birth control. In 10 years I have never once had a single symptom or incident associated with my endometriosis. The birth control has, for all intents and purposes, kept the endometriosis at bay.

Blue Shield of California insured me four years ago, knowing that I had endometriosis.

Fast forward 10 years. At the age of 35 I was diagnosed with a thyroid disorder, specifically hypothyroidism. My doctor advised me that thyroid disorders are extremely common and that 1 in 5 women will be diagnosed with a thyroid disorder in their lifetime. In talking with friends, I discovered that over five of the friends within my own circle also had a thyroid disorder, thus illustrating how common it in fact is. Like my endometriosis, my hypothyroidism is also easily treated with daily hormone therapy, in my case with another very inexpensive, generic drug called levothyroxine (brand name, Synthroid). For the past two years my thyroid disorder has been successfully maintained, without incident, with the daily dose of levothyroxine.

When I received my rejection letter from Blue Shield, it cited these two extremely common and non-serious pre-existing conditions as the reason why I was being denied coverage. I am still to this day flabbergasted by this. The statistics above speak for themselves. My conditions are clearly conditions that are shared by millions of others, so if I am being denied coverage, chances are millions of others are as well.

According to a government study, up to 50% of adults have at least 1 pre-existing condition.3

But what concerned me far more than myself in this scenario was, what of the millions of people who are suffering from far more serious conditions than I, conditions that need much more extensive and expensive treatment? What about the people with diabetes, cancer, HIV, etc., people whose lives depend on getting proper treatment? If these health insurance companies were rejecting me for having two very minor and easily treatable conditions, it breaks my heart to think about what is most likely happening to the millions of people who are in much more dire and critical need of healthcare. I suspect I know what is happening to those people, and chances are you do too, as we see stories on the news regularly: many of them are going bankrupt, they are losing their homes, and in many cases they are losing their lives. This is the sad state of health care in our country.

By Bernard Pollack (Flickr: LA: Highway to Healthcare, Baton Rouge), via Wikimedia Commons

Before I go on to tell you the happy outcome of my personal story, and why I feel that Obama has provided hope for this country, let me share with you some of my past experiences and perspectives. Day after day I watch in dismay as the healthcare debate wages on in this country. So many of our fellow citizens are terrified at the prospect of “Universal Healthcare,” and due to a very successful propaganda machine they have become convinced that it is evil. They are convinced that to have Universal Healthcare means to “God forbid end up like our Canadian neighbors.” First I feel compelled to tell you that I know dozens of Canadians living in the United States and they all continue to express to me their horror at the backwardness of our healthcare system. (All of my European, Latin American and Asian friends express exactly the same.) They have seen and experienced it from both sides, first hand, and when I ask them about the healthcare system in Canada (and other countries), while they admit it is not perfect and there are definitely problems, they tell me they feel it is a far more humane option than the American system; they believe that it is the humane duty of a compassionate society to provide at least basic healthcare for its citizens. On this I could not agree more.

My own views on Universal Healthcare began to form when I was 20 years old and spending my junior year living abroad in Spain. My own experiences of the Spanish healthcare system were nothing but positive and my American friends and I had many in depth and insightful debates with our Spanish friends about the pros and cons of their healthcare system versus ours. Like the Canadian system, the Spanish system is also not perfect, but from the Spanish perspective they viewed us Americans as somewhat barbaric and cruel for not providing the most basic healthcare for our citizens. As I myself continue to be, they too were appalled at the knowledge that American citizens could be bankrupt out of house and home (and in the worst cases out of their lives) at the expense of their healthcare costs. Having lived in and spent a lot of time working and traveling in both Europe and South America, I know many foreigners and I have yet to meet a single one who wishes they had our healthcare system versus theirs.

In fact it dawns on me as poignant to mention that the day I received the rejection letter from Blue Shield, I happened to be on a road trip with a good friend who is a Canadian, and who has lived and worked in the U.S. for 20 years as a healthcare executive. This guy knows the U.S. healthcare system inside and out, having worked for several major healthcare providers himself, and when I told him about my rejection letter he was furious and went on to tell me of all the problems he has seen inside U.S. healthcare and insurance companies. I will admit I am no expert on public policy, nor do I claim to be. But this friend of mine is exactly that, a U.S. healthcare executive and an expert on healthcare policy. So when he speaks on the topic, I know it is with authority. He went on to explain to me all that is wrong with our system and how it is flawed compared to the Canadian system, and the Universal Healthcare systems of virtually every other developed nation on the planet. I will not go down the rabbit hole of those specific details today, I’ll save that for the public policy experts.

My point in saying all of this above is not to say that the only solution is a free, Universal Healthcare system. That is not at all what I’m saying. I’m simply trying to stress that our current system is broken and is in desperate need of fixing, and like anything the real solution is probably somewhere in the middle. But to Obama’s credit, he is trying to fix it, and as I learned personally, I for one believe he is succeeding… little by little.

The day I received my rejection letter, I called my mother in distress, completely uncertain about what possible options I had left. I knew that Obama’s larger healthcare reforms were set to kick in in 2013 and beyond, and that those included provisions for citizens with pre-existing conditions, but that was still a year away. What would I do in the meantime? I was faced with the troubling eventuality that I may have no choice but to live without health coverage. This was a daunting proposition.

Flickr Creative Commons, by Intel Photos

Thankfully I have a mother who loves to research this sort of thing and she immediately began digging. And it is to her that I owe having found California’s Pre-Existing Condition Insurance Plan (PCIP), which is a new initiative enacted by Obama’s healthcare reform. This plan is specifically designed for people just like me; people who have, for various reasons, had to go without healthcare for the previous six months and who have subsequently been denied for healthcare due to a pre-existing condition. I couldn’t believe that this plan existed. It was exactly the safety-net that is needed for people like me who are now un-insurable due to the broken state of our healthcare system. Not only was I able to get coverage, but because I am now able to be part of a larger pool of insurees, this reduces the overall costs and allows in turn for much better coverage at lower negotiated rates. Afterall, this is exactly what Obama is aiming for with more universal coverage: larger pools of people that can provide greater leverage to negotiate rates with the insurance companies.

For those of you who may read this and falsely assume that I am somehow sucking off the system or taking advantage of a government program, I must be clear that this is not a government welfare program. We the insurees are largely paying for this plan and I will tell you that my monthly premium is $275/month (based on age and zip code) (this, incidentally, is higher than the premium of the plan from which I was rejected), and I still have a sizable deductible and co-insurance on top of that. This is no small amount of money. But as I said above, I was never looking for a handout. I was perfectly willing to pay my fair share for coverage… I was simply looking for someone who was willing to provide me that coverage.

Today I had my annual physical and the first doctor’s visit that I have been able to have in over a year; a year during which I had to run the very scary risk of being without healthcare. Today I am able to get back to complementing my already very healthy lifestyle with a preventive health and wellness routine. Today I owe a huge debt of gratitude to President Obama and all of the legislators who made this possible. And today I have hope for a nation, for millions of other uninsured and sick people who are in the same, and far worse positions than I was in.

So yes, today I am proud to say, “I am Obamacare.”

 To learn more about PCIP plans in your state, click here.

1. Source: http://endometriosis.org/
2. Source: http://www.endometriosisassn.org
3. Source: http://www.healthcare.gov/law/resources/reports/preexisting.htm


Update 10/6/2013:

Though I wrote this blog back in the spring of 2012, the content of the story is more relevant than ever in today’s political climate. I wanted to share with you the progression of my health coverage since that time:

I have now been covered by California’s Pre-Existing Condition Plan (PCIP) for well over a year, and I could not be more grateful for the coverage and for the peace of mind that has come with it. I have been able to stay on track with my preventative and maintenance health care routine and my health continues to thrive.

This past July, in preparation for the full roll-out of the Affordable Care Act, my California PCIP plan was rolled over to a federal transition plan, and from July through the present, I have been paying a slightly higher rate of $287—still a much better value and coverage level than the private Blue Shield plan that rejected me.

And as of this October 1st, I have now received the same letter of enrollment that all other uninsured and under-insured have received, advising us of the enrollment period to enter into the open marketplace provided by the Affordable Care Act; here in California it is called https://www.coveredca.com/.

Between now and December 31st, I will be doing all of the necessary research to determine which is the best plan for me, and as of January 1st, I will be thankful to be part of an even larger, and therefore more competitive, marketplace. And at the same time that I am enrolling, so too will another family member who is also self-employed and is currently paying extortionist rates through Cobra.

He too is thankful for the ability to enroll in the healthcare exchange.

For those of us who are self-employed and are responsible for our own healthcare, and even more so for those of us who carry the stigma of a pre-existing condition, we are more fortunate than ever to have the guarantee of coverage in a marketplace that, through sheer volume, will be forced to be more competitive, and humane, than ever before.

Now, let’s get back to work so we can get this show on the road.

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