Bluefield Daily Telegraph, Bluefield, WV


November 29, 2013

A second opinion on the benefits of the Affordable Care Act of 2013

— — My grad school’s health insurance plan ran out last August. Because I was older than 26, I missed the cutoff to get on my dad’s policy. My employer — who I love and respect — didn’t provide health insurance. I was on my own to find a policy, at least until Obamacare kicks in come January.

I’ve seen enough as an EMT, medical student and public health professional to know that going without insurance is not an option. I’ll never forget an AIDS patient who attempted suicide because his insurance company dropped coverage, or a family begging to stay in Ann Arbor rather than be cast out to a public hospital in Detroit. Later, as a medical student, I was assigned to a free clinic in New Jersey. I saw patient after patient out of work because of everyday illnesses run amok. Obamacare, for all its issues, takes us out of a very dark place.

Growing up, I never worried about insurance coverage. My dad is a Veteran Affairs physician with a great federal policy. What made me more worthy of care than any of the clinic patients — or their children?

Dad often said that he loves the VA because, unlike private practice, there is no haggling with insurance companies or arguing over the boss’ bottom line. He just focuses on what the patients need. I hope Obamacare leads to that kind of system for everyone. For now, I just needed to find something reasonable within the old one.

I opened my laptop and became a pioneer — the first to apply for individual coverage since my great-grandparents landed in the Bronx.

It didn’t seem that hard, at first. I began with the Priceline of private health insurance, called The application process started off so easy - age (27), sex (M), marital status (single) and zip code. That’s about what Obamacare asks for on the new health insurance exchanges.

The next page presented me with 80 plans from most of the major carriers, sorted by popularity. They had star ratings and customer reviews, just like Amazon. Very consumer friendly.

The most popular plans came with a ridiculous $10,000 deductible, and cut off coverage after the fifth office visit. These cheap “point-of-service” plans are repackaged HMO’s.

I thought about my parents a lot as I searched for plans. If I’m in a serious accident, how screwed would they be? Would I torture them with tough choices about my care, just so I can save a few bucks every month?

Even if I was a vegetable, I couldn’t live with that. I settled on a more flexible PPO with a $2,500 deductible, advertised at $120 per month.

After the friendly process of choosing a plan, I was hit by the real insurance application — a festival of checkboxes. From aneurisms to sexual dysfunction, there was a box for every ailment known to medical science. Some I swear were trick questions. Loss of consciousness? I do that every night at 11. I could either check the box and get dinged for having a “head injury” or leave it black and get called an insomniac liar.

They even asked how much I drank, and whether it was beer, wine or liquor. Now they wanted to know about every office visit and medication from the past five years - in detail. Do people actually keep track of this? I don’t even know my dentist’s first name.

By applying, I permitted the insurance company to access my records from any medical practitioner, and agreed that any “misrepresentation or intentional omission” rendered the contract “null and void.” A few days later, a young-sounding doctor called me. He took me line by line through the application. He asked about every office visit, vital sign and medication. I tried to stay positive. “I see your weight is 245?” he asked.

“Yes,” I said, “but - I lift weights!”

I hung up thinking that I should scale back my standards. Maybe a POS plan is the best I can get. After days of chasing down records and checking boxes, I felt defeated. A week passed, and I worried if they’d take me at all. Finally, I received notice that the American health care system was going to let me in. However, I was found guilty of fatness and charged an additional $60 per month. By then, I didn’t mind.

This is not how insurance is supposed to work. In theory, health insurance exists to share risk. Most people enjoy good health for a decent portion of their lives. But when (not if) a catastrophic event occurs, few have the resources to tough it out alone. The solution is a pool of money deep enough to sustain the sick, with the hope that they can eventually rejoin the “well” ranks.

Instead, for-profit companies weeded out the sick (they get sicker) and skimmed money off the top. Obamacare kept the for-profit structure but capped it at 20 percent. Nice.

So far, the coverage I bought on my own isn’t half bad. I’m not sure if I’ll stay on it or move on to the insurance exchange. I might be able to save about $50 per month in tax credits, but it’s hard to tell because the web site is overrun with people who are looking for guaranteed coverage. At least it’s a fair fight.

Gavin Stern is a reporting fellow with the Scripps Howard Foundation in Washington. He holds a Masters in Public Health from New York Medical College. Distributed by Scripps Howard News Service.

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