Sunday, March 2, 2014

UPDATED: Why the Affordable Care Act Is Important to This Christian

I aged out of ChampVA. My mom is a disabled American veteran. Vietnam era. She was exposed to Agent Orange. She worked with the artillery.

I was still in college when I aged out. I was without insurance because the student health insurance wasn't much coverage for what it cost. At that time I was diagnosed only with allergies, exercise-induced asthma, ADHD, and mitral valve prolapse. 

In 2003 BCBS of Alabama did a special open enrollment plan for people who didn't qualify for insurance through work. We thought I was insured.

In 2004, my first set ear tubes went in. Okay. 

In 2005, I graduated from college with honors. Surprised us all!

In 2006, I started grad school. Ended up with an ear infection and hearing loss. The tubes had popped out and decided to just sit there. I had to have expedited surgery to get new tubes in. Oh yeah, that was the year I developed a new drug allergy. Giant welts all over. So now I have had two surgeries, not counting oral surgery or wisdom tooth surgery.

I began 2007 with appendicitis. January 25 to be precise. Three days after my last ever peanut butter and banana sandwich. My body repayed me with a peanut allergy. Haha. Stupid salmonella tainted peanut butter. We thought that I was done, but then I kept having pain. Three months in and out at the ER. A few of those saw an emanciated, dehydrated, nauseated young lady who couldn't really function. Then I finally learned my gall bladder hit failure stage and needed to be taken out. Later that year, I tried to start another semester of grad school but had to take a medical withdrawal because I had developed tonsillitis which got so bad it went to my vocal cords. And after two rounds of antibiotics, the swelling still hadn't gone down. They had to take them out sooner than later because I couldn't breathe. Developed a bladder infection (ouch) on too of that. The doctor took out the tonsils AND adenoids. He was shocked that I had huge adenoids. Said 27-year-olds don't usually have that much adenoids tissue left. So let's just say that 2007 was a big insurance year for me. At that time, I might have had a $7500 out-of-pocket, which of course I hit that year and then didn't have OOP obligation after that.

That was also the year a letter came saying prostate exams are now covered. Great. Now what about the women?

2008 didn't see a much better year though. I broke my foot Christmas Eve of 2007. Spent the greater part of the holidays mad at Santa for that one. Got the flu even though I had the flu shot. Tarmiflu made it worse for me. Contracted chicken pox that April heading into final exams. Most of them had to be delayed. Two weeks of that only to be told it was just a mild case. Oh yeah, the dermatologist said it was just acne. Right.... Acne causes a person to have a 100.6 degree fever that the doctors ignored and pops up on the top of my foot or in my mouth. The eye gel they give you for it. Painful. Later that year, developed what looked like heat rash at first. Then when it didn't go away, the dermatologist found I had a 100.6 fever again and called it folliculitis. Turned out that is was what I suspected. Measles. What young adult contracts both chicken pox and measles in the same year! Seriously.

Sometime around 2009 is when insurance rates went up really beyond belief. Less eventful until the H1N1 came around. I got my flu shot. The next week began getting ill. Found out two girls in one of my classes had H1N1. Couldn't go to class the next week because I had to spend time in the ER being spinal tapped and checked for possible meningitis. Doctor never thought to ask about exposure to H1N1 or we could have saved the trouble of the hospital nearly killing me. OOPS! But during that illness I was also exposed to probable mold in the main building where I had classes. I developed sick building syndrome as it was only that one building on campus where I would become violently ill. Ultimately, we ended up with me back in the ER after the Sunday morning I went to church only to have to leave early and arrive at home vomiting. That did get rid of the metallic taste in my mouth though. In December I was admitted to the hospital through the ER. Developed a very dangerous kidney stone that require surgery. It was huge and jagged and could have torn up a whole lot more if it had been allowed to pass on its own. 

In 2010, the ACA had finally passed. And guess what began? For me, personally, no longer did I have to worry about being dropped if I got sick and needed surgery again. No more lifetime caps either. I was in my early 30s. Too young to run out of insurance. I found out I had an immune deficiency which played a role in a lot of the problems I was having though. The only downside was that I still couldn't get new insurance. 

I did learn in 2011 that my iron levels were fatally low. I needed an iron infusion. Fortunately, I haven't hit that low again yet. That December I was confirmed to have autism. Insurance doesn't cover therapies and most therapists don't work with adults with autism in Birmingham. 

In 2012, the abuse at church began after the autism diagnosis came back. And Romney insulted half of America calling us lazy moochers if we didn't pay taxes. Who doesn't pay taxes: children, college students on financial aid, disabled people who cannot work full-time if at all, veterans who earned their benefits, elderly who are retired for the most part. And of those, there are four groups plus military on SNAP. Romney kept threatening repeal of the ACA. And I said no way. Went to bed on the night after elections after praying, "God let YOUR will be done. And may the person who best reflects a Matthew 25 heart win." I had a nightmare that Romney won and my mom and I got booted out of the house because of a high dollar medical bill after insurance dropped me. I woke up anxious. Obama won! I didn't vote for Obama in 2008 because McCain was the one who promised to pass the ACA. 

I will say this though. Whether I pay full or reduced rates doesn't matter (I only got a $114/month break and still pay over $200/month, so don't fuss at me). What matters now is that I have secured an insurance plan that is now worth every penny going into it. I chose gold because after spending a month comparing my old plan with the plan BCBS was going to switch me to and the gold plan, gold yielded over $7000/year in savings with $5000 of that in the OOP value alone. 

To be more precise, here are my figures:

Old non-compliant plan:
$298/month
$2500 deductible
$300 medicine deductible
$10,000 OOP
2 doctors (minimum) each month x $50 = $100
2 medicines (minimum) each month x $80 = $160
If I had hit the OOP, this would be equal to:
$3,576 in premiums + $2500 + $300 + $10,000 + $1200 + $1,920 = $19,496 minimum per year

Even the silver plan that was offered looked a little better:
$264/month (-$34/month)
$2500 deductible 
$6350 OOP (maximum allowed by law) (-$3,650)
2 doctors/month = $120 (+$20)
2 medicines/month at $100 each = $200 (+$40)
For grand total of $4,058 in savings but $720 in deficits resulting in $3,338 in savings.

The gold plan I chose:
$321.75/month (+23.75/month)
$500 deductible (-$2000)
$5000 OOP (-$5000)
2 doctors/month = $100
2 medicines/month at $60 each = $120 (-$40)
For grand total of $285 in deficits and $7,480 in savings resulting in $7,195 in savings.

Assistance makes it $912 less from April to December and yields an $8,107 savings. 

This is minimum. Most of the services I have gotten this year have been $0 OOP after $50 copay. And I now have speech therapy covered AND get to start occupational therapy! And dental coverage!

What will happen with the savings, the ACA has given me because of the protections it now offers me?

1. Pay off old medical debt.
2. Needed home repairs.
3. Autism therapy not covered by insurance.
4. Vacation celebration. 
5. Conferences.
6. Donate to a church and charity.
7. Technology upgrades.
8. Loom bands for my Cra-Z-Looms so I can keep making autism bands to raise money for charity. 
9. Art supplies so I can paint. I want to sell art for charity.
10. Swimming pool, therapy/service dog, etc. 

Now if congress will just stop trying to impede the progress of the ACA already. They failed 40 times. And if they will just pass the ABLE Act. 

What does this have to do with a journey through theology?

Everything and nothing. 

Matthew 25:31-46

Okay, this took some thought, but I want to add some things to this.

First of all, for those who may not understand all the intricacies of the ACA or how or why it came about, let me share some thoughts.

Insurance companies were in need of an overhaul. The healthcare system in America because healthcare became more about the business of medicine rather than the practice of medicine. 

When this happened, many doctors could no longer afford to take on uninsured patients. As such, only the rich could afford doctors. Or the ones who had full time jobs with benefits (personally, I feel ALL full time employees should have health insurance as part of the package as it one of the benefits that I had come to know as being the bonus of working full time versus only working part time).

But even still, many patients were finding that when they needed insurance the most, it didn't cover what they needed and was nothing more than a catastrophic plan. Great in an emergency, not so great everyday.

But what is insurance? Insurance is protection of the future of your family finances. Don't believe me?

Look at what I experienced in 2007. Appendicitis, gall bladder removal, tonsillectomy/adenoidectomy, and a broken foot. Not counting any sinus infections, throat infections or allergy spells and asthma attacks. If I didn't have any kind of insurance at all that year, my mom and I would be homeless. The charges from the appendectomy just from the hospital alone was around $45,000. 

Let me explain something else. If you do not have $50,000 cash on hand for an emergency, then you need insurance. If you see a doctor more than 4 times a year for anything, then you need a minimum silver level plan.

Argument: But I now have less coverage. Defense: No you don't. You have TEN essential benefits. And depending on your plan, you may have even more than that. Argument: But I don't need maternity care or mammograms. Defense: Women don't need prostate exams. Argument: But my premiums went up. Defense: Yes, and no. Yes, they seem to have gone up, but with the end of the discrimination against customers who have pre-existing conditions comes a leveling of costs. Your costs now are what my costs were and still are. Argument: But I have all these expenses. Defense: Is there ANYTHING nonessential going on in your budget that you can eliminate? Say a Starbucks each week, a movie each month, eating out each day, less expensive clothing, etc. Don't steal from God, and definitely pay your BILLS, but just re-examine your priorities. 

Now I will say something else. Here are my thoughts for how it can be improved. 

Instead of a marketplace, I would redirect the purpose of the Healthcare.gov site to more of what the FAFSA for students seeking financial aid does. The applicant files the form, provides codes for schools the applicant is interested in, then the results are not only sent to the student but also to the schools. The schools then draw up a financial aid package based on that information. The student then accepts or rejects the offer. I would redesign the purpose of Healthcare.gov to follow the FAFSA and put more power back in the hands of the consumers and the insurance companies. 

Instead of stipulating that ALL policies have pediatric coverage or maternity coverage, I would make those opt in features and allow consumers to substitute in dental and vision coverage. Or better yet, I would add adult dental and adult vision care to be covered by all plans. 

I would make sure that all insurance plans carry an autism services rider. For all ages. My mom is now going to be tested to see if she has autism. And I have autism. And autism doesn't go away just because a child turns 21 even though that is what the churches and the schools seem to think. 

I would make the highest cost anyone can pay for a particular level of policy the lowest cost for that level in the nation. In other words, if a gold plan in California or New York costs $250, and that is the cheapest, then a person in Alabama would only pay $250 for a gold plan rather than $300. After all, why is one person paying more for the exact same level of coverage than someone else.

I would expand Medicaid in all states, no exceptions. 

I would cap the price a family pays in monthly premiums at $800 for four people and $1000 for five or more. Then I would lower the OOP for a family to $10,000 and the OOP for a single person to $5000. 

I would not allow any exceptions for the birth control coverage as part of a woman's preventive care. And just as BCBS does, limit abortion coverage to situations where the woman's life is endangered.

And instead of tax penalties, I would stipulate that doctors may not give discounts to people who do not have insurance (discounts are a benefit of insurance) and that an additional fee be assessed for every time a person shows up at the ER or the doctor's office without insurance. The fee might start at $25 and go up each time after to a maximum of $500 assessed at one time. 

The reason for there being a penalty for not having insurance? 

Because from the time you are born to the time you die, you will need healthcare at some point in your life. Because when you are uninsured and use the ER and them don't pay your whole bill because you cannot afford it, they pass the cost onto the insurance companies who pass it on to consumers in the form of higher premiums. 

And really, it is no different than being required to have car insurance save for the fact that you can get out of the requirement for car insurance by simply not buying or driving a car. But if cancer is going to happen, it will choose whom it wants when it wants.

No person living in America should ever be without healthcare and if it takes insurance to get affordable healthcare, then no person in America should ever be without health insurance either. 

Now that is that.

UPDATE:

So today, we decided as a family to cancel the plan through the marketplace because I will not need it as it looks as though since we won my fight, I will have other means in addition to the original BCBS plan. Still though, $7,195 in savings is AWESOME! And I am a big supporter of the Affordable Care Act.

What I am not a fan of is that there are people on Facebook that claim to be Republicans and "conservatives" that are harassing and bullying people on the Healthcare.gov Facebook page. Many of these people have been blocked and then they turn around and create these FAKE Facebook pages that cannot be blocked just so they can continue to harass and bully people. The page has taken a tragic turn for being helpful and supportive in the marketplace process to being unsafe for anyone who is in favor of the ACA. 

Look at this example:






And I am not the only one who has been targeted but this was an outright attempt to target me because the post was never made on a page but in a group. And when I went through my mom's account I saw the majority of the people doing the harassing were ones I had blocked for that very reason. 

So Tabatha thinks it is appropriate for her to create a fake page because people blocked her for harassment? And she uses it to harass them again? And yes, I was one of the targets of her harassment. Yep.... This definitely is an admission to illegal activity.

The reason I am sharing these screen shots on this post is to provide solid evidence of one of the reasons why not only the Republican Party is losing ground, but these people are also professing to be "Christians" yet are in blatant violation of the Facebook TOS:



Dear Christians and dear republicans, you will not win anyone over with this kind of malicious sermonizing behavior. 


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