Will You Be Able to Afford Your New Health Insurance?

Last November I wrote about my displeasure with the changes coming in 2013 to medical flexible spending accounts (FSA), the result of more provisions of the Patient Protection and Affordable Care Act (PPACA), a.k.a. Obamacare being implemented.  But those aren't the only changes looming on the horizon.  2014 and 2018 are also years when more big changes are coming.

Increased Out-of-pocket Medical Expenses

I was quite taken aback when I found out the ceiling on health plan out-of-pocket expenses will rise to $6,000 for individuals and $12,000 for families starting in 2014.

First, let's answer the question: So what are out-of-pocket medical expenses?  They include things like deductibles, co-insurance, premiums and co-pays; they are the "cost-sharing" provisions in your health insurance plan.

I logged into our health insurance plan's website to see what our out-of-pocket maximums are for this year and discovered they are no where near the new 2014 $6,000/$12,000 limits.  Then I got worried.  What if my husband's employer decided to raise the out-of-pocket maximums to the new limits in 2014?  How much would we have to pay out-of-pocket before our health insurance benefits actually kicked in?  And how are we going to be able to afford to pay these higher out-of-pocket medical costs?

Harder to Deduct Medical Expenses

Adding insult to injury is that fact that this year, deducting itemized medical expenses on your Federal taxes is going to be much harder.  Before, you could deduct any expenses that where higher than 7.5% of your adjusted gross income.  Starting in 2013, that percentage rises to 10%.

So we are facing higher out-of-pocket medical expenses and a reduced ability to deduct them on our taxes.

New Trend: High Deductible Health Plans

So how did our legislators decide on these new out-of-pocket medical expense guidelines?  They were set based on rates associated with high deductible health plans.

According to Kaiser Health News, high-deductible plans are becoming the new trend in health care coverage. They say that Fortune 500 companies like General Electric, Chrysler, Wells Fargo, American Express, JPMorgan and Whole Foods are all switching the health plans they offer their employees to this model.

Historically, most people who got a high deductible health insurance were healthy.  They didn't think they'd need to use their health insurance, so they choose this option "just in case" something might happen.  Hence these plans were sometimes called catastrophic coverage plans.

Employers like these plans because it means they can contribute less to their employees' health care costs.  In the changing world of health plans, these kinds of plans are now being viewed as "consumer-driven" which adds to their appeal.  Here's how this thinking goes:

If the employee has to pay with their money first to get medical care, then they will:

1. take better care of themselves to avoid needing medical care 
2. be more concerned about medical costs and 
3. opt out of unnecessary tests and procedures when they do go to the doctor

Are These Changes a Recipe for Disaster?

O.K., so I have some questions and concerns.

How is the average patient supposed to "shop" for low-cost, quality medical care when this kind of information is currently not available?  And how are patients supposed to know what medical tests and procedures are needed and which ones aren't?

What will we have to do?  Take our laptops with us to medical appointments and use Dr. Google to figure out if what we are being told is the standard of care?  Or worse, delay care so we can research the alternatives before making a decision?

I think this high deductible health care model is so unfriendly to those of us with chronic illness!  How we all *wish* it were as easy as just "taking better care of ourselves."  We need to see our medical providers just to maintain what reduced quality of life and level of function we do have.

Plus is lower cost medical care really the answer for people living with chronic illness?  Many of us started with general practitioners when we first became ill and quickly learned that we needed specialists in order to get accurate diagnoses and treatments.  Specialists will cost more to see, but in the long run, they are often the only ones who possess the knowledge, expertise and skills needed to keep us stable and functioning to the best of our abilities.

How I View These Newest "Reforms"

So we are all going to be mandated to pay for medical insurance.  Then we are going to have to pay high out-of-pocket costs to access the health care system before that medical insurance kicks in and starts actually paying the bills.  Which means some people will have a whole new problem--will they be able to afford to use their new health insurance?

I think offer health plans that erect financial obstacles to obtaining necessary medical care is ridiculous.  How does this make any sense?  I think these new guidelines and trends will mean that people will forgo medical appointments when they don't have the money to pay out-of-pocket expenses.  And when people put off seeing a doctor because they can't afford it, this increases the number of health complications, trips to the emergency room and hospitalizations.

So is health care reform really helping us or just making things more difficult and complicated?  I have serious doubts that this will make health care more accessible or affordable.  I'd love to hear what you think.

Health Activist Soapbox: Health Care Reform Needs Reform! #NHBPM

I'm of the opinion that we rarely get things right on the first attempt.  I think it isn't until we give it a go for several rounds that we finally get closer to what we want, need or envision.

So when I think  about the Patient Protection and Affordable Care Act (PPACA), a.k.a. Obamacare, what pops into my mind is, "First draft, needs a revision."

I already know I don't like the changes the PPACA makes to:

• medical flexible spending accounts
• the medical expense deduction on Federal income taxes
• the tax on the manufactures and importers of medical devices

You might think I'm just complaining, but mark my words.  I predict that once this massive 906 page law is fully in effect, we are all going to encounter an unpleasant surprise or two when it comes to our health care.

As far as I am concerned, this isn't a done deal.  Sure, lots of people are celebrating this as a historic win, but I see this as a work-in-progress and a new advocacy issue, especially since I've been told that the needs of those of us with chronic illness weren't really taken into consideration during the writing of this new law.  With what little I know, I can already see that the PPACA needs changes, revisions and rewrites, and sooner than later.

There is a lot of ground to cover here, but right now I just want to talk about the changes to medical FSAs.  So here is my opinion on the changes that take effect January 1, 2013 and why I think you need to be concerned too if you are covered by an employer-sponsored cafeteria benefit plan.

Medical Flexible Spending Accounts (FSA)

What is an FSA? A benefit program where before-tax money is deducted from an employee's paycheck and placed into an account.  The account is used by the employee and their family to pay out-of-pocket medical expenses.

Why haven't I heard of FSAs before?  According to the Employers Council on Flexible Compensation, only 25% of eligible working Americans take advantage of this benefit.

How does the PPACA change FSAs?  Before, the employee could decide how much to put into their FSA account every year.  Beginning January 1, 2013, contributions to medical FSAs will be limited to $2,500 for an employee and their family.

Why is this a problem? This change will hurt those who have a lot of out-of-pocket medical expenses, like those living with chronic illness, autism or children with special needs.

Why should I care? Out-of-pocket expenses included things like deductibles, co-insurance and co-pays. If you have health insurance, you will be paying these fees as part of cost-sharing provisions in the PPACA.

What you might not know is that the PPACA puts the ceiling on health plan out-of-pocket expenses to $6,000 for individuals and $12,000 for families starting in 2014.  These limits were set based on rates associated with high deductible health plans and, of course, can be raised in subsequent years due to inflation.

Now I just looked and the current deductibles for our employer-sponsored health insurance plan are no where near this high.  Which has got me worried that my husband's employer could decide to raise deductibles to meet their growing costs under the PPACA.  Sure enough, we are in open enrollment right now and our deductible has gone up, not a lot, but still every little bit means less money for other expenses.

O.K., back to why I think you should care...

In previous years, you could put $12,000 into your FSA and you'd be covered.  By doing so, you saved yourself anywhere between 25 to 40 cents on every dollar spent since you were using pre-tax money.  Beginning in 2013, the worse case scenario is you paying out $9,500 of your hard-earned after-tax dollars to pay for health care expenses.  By my calculations, in this scenario you'll be paying an extra $2, 375 to $3,800 in taxes just by paying your medical bills.

What do FSA experts say about this? My husband's employer uses a company called WageWorks to manage its FSA program.  Jody Dietel, the compliance officer for WageWorks, said in a recent interview that, "...it’s not really a health care friendly policy—it was a revenue grab.”

In other words, this is one way working Americans and their families are funding the PPACA.

Are We Going to Pay More for Healthcare?

I guess that is the $25,000 question, isn't it?  Even the respected Kaiser Family Foundation says,

No one knows for sure. Even supporters of the law acknowledge its steps to control health costs, such as incentives to coordinate care better, may take a while to show significant savings. Opponents say the law’s additional coverage requirements will make health insurance more expensive for individuals and for the government.

Like I said, I think we're all in for some health care surprises.


Related Articles

• After The Election: A Consumer's Guide To The Health Law  
• Obamacare Strikes Again: New Limits on Spending Accounts  
• Deducting Medical Expenses in 2013 Will Be Harder  
• How Obamacare's Medical Device Tax Will Stifle Advancements in Health Care  

Who to Contact When You Need to File a Healthcare Related Grievance

As I discussed on Wednesday in my post Lessons Learned as a Patient in the UCLA Health System, sometimes you just need to file a complaint or grievance when things don't go the way they ought to when it comes to your healthcare.

Since I'm going through this process now myself, I decided to put together a resource list to share with you here on my blog.  I hope my research on this topic will make starting the process a little easier for you. Plus I was pleasantly surprised when I discovered that many of these agencies are set up to take complaints online, which saves you the hassle of printing and preparing forms and heading to the post office to get them in the mail.

So here they are, my suggested list of organizations to contact in the United States when you have grievance against your physician, nurse, hospital and/or health plan:

Hospital and Health Facility Complaints:

Most hospitals and healthcare facilities have in-house patient services departments that may be able to help you.  Start by asking a member of your healthcare team about who is available to assist you, like your nurse, social worker or the receptionist.  You can also call the hospital operator and ask for the name and number of the department that handles patient complaints.

Call your health insurance company.

1. They may have a nurse case management program that can advocate on your behalf.  Their nurses will talk with you, contact your medical providers and working with you to manage your health care.  This may be a free benefit to you depending on your health plan.
2. You can ask to file a complaint against any network or preferred hospital or facility and your insurance company's provider relations department will investigate.  Just know that they may not inform you of the results of their investigation.

The Joint Commission, formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), is a non-profit organization that accredits hospitals and health institutions nationwide.  Their Office of Quality Monitoring will review complaints filed against accredited institutions.

Contact your state's Department of Health.  This is the agency in your state that is either responsible for, or can connect you to, the division that licenses health care facilities.  You can browse a complete list of each states' Department of Health here courtesy of the Centers for Disease Control website.

In addition, your state may have a Health Care Association or Society that might want to hear about your concerns.  While not present in every state, you can see a list for some of the organizations here courtesy of the Joint Commission website.

Physician Complaints:

Call your health insurance company.

1. They may have a nurse case management program that can advocate on your behalf.  Their nurses will talk with you, contact your doctor and work with you both to manage your health care.  This may be a free benefit to you depending on your health plan.
2. You can ask to file a complaint against any network or preferred physician (or other health care providers.)  Their provider relations department will investigate your complaint.  Just know that they may not inform you of the results of their investigation.

Contact your state's Medical Society or Association.  These are membership societies so you'll first want to verify that your doctor is a member.  Then check to see if they are set up to receive complaints directly or if they provide referrals to the organizations in your state who are.  Find a complete list of medical societies here courtesy of the American Medical Association.

Your doctor needs to be licensed to practice medicine and your state's Medical Licensing Board is the entity that handles consumer complaints about doctors.  Look for the complete list here courtesy of the American Medical Association.

NOTE: Your state may also have licensing boards for other allied health professionals, like chiropractors  pharmacists, psychologists, social workers and physical and occupational therapists.

Nurse Complaints:

Nurses also need to be licensed to practice nursing, so if your complaint is about a nurse practitioner, registered nurse, licensed practical nurse or certified nursing assistant, contact the State Nursing Board.  You can view a complete list here courtesy of the National Council of State Boards of Nursing.

Health Plan Complaints:

Health plans are required by law to have a process to receive and respond to member complaints and grievances. So don't hesitate to call your health insurance plan, tell them you are dissatisfied with their services, determination of benefits or the health care treatment received through their plan and want to file a complaint or grievance.  You can also refer to your member handbook or your health plan's website to learn how to use their grievance process.

If you are covered under an employer-sponsored health plan, consider talking to your Human Resources Department or contacting the U.S. Department of Labor’s Employee Benefits Advisors.

To contact your state's Department of Insurance, which regulates health insurance, head to the USA.gov website, click on your state and browse for the category State Insurance Regulators.

For complaints about your Medicare supplemental health plan or prescription drug plan, go here to the Medicare website to learn more about filing a complaint.

For complaints about Medicare, you can either speak with your State Health Insurance Program (SHIP) or the Medicare Beneficiary Ombudsman.

For information about filing a complaint about your state Medicaid program, contact your local County Office of Public Assistance.

Complaints About Medications:

Here is a complete list by state of Consumer Complaint Coordinators at the Food and Drug Administration (FDA) that you can call directly to report drug adverse reactions and other issues with FDA-regulated products.

---

This is not a complete list and I welcome your input in revising and expanding this resource.  In addition, I'd like to hear about your experiences in contacting any of the entities mentioned above, both good and bad.  So please feel free to add information and your input by submitting a comment below.

Lessons I Learned From Being a Patient in the UCLA Health System

It's been over six weeks since the end of my Hepatitis C treatment and I've spent some time reflecting on my recent experience as a patient in the UCLA Health System.  Today I'm sharing with you some of the lessons I learned over the last seven months.  I hope some of these observations might be useful to you when you find your health care doesn't meet your expectations.

Sometimes the Health Care System Fails Us

The California Medical Association says:

As a health care consumer, there may be times when you are unhappy with your physician, hospital, or health plan and need to make a complaint. Some problems can be resolved informally simply by talking to the parties involved, but others will require that you follow an official set of "grievance procedures.” 

I'm amused by the easy way this statement attempts to put this issue into perspective.  I'm sure most healthy people might find a measure of comfort in this plainly stated fact, but for me, a more accurate statement would be:

As a person living with multiple chronic illnesses, you will often be frustrated and unhappy with how your physicians, hospital and/or health plan fail to provide you with the appropriate, cost-effective and person-centered medical care that you both need and deserve.

I believe how my Hepatitis C treatment unfolded is yet another example of how the health care system is not organized enough to treat me, a patient with multiple chronic illness.

Sometimes We Really Need Help

Second, can I be honest with you and acknowledge that there are times when I am so beaten down and worn out from my health problems and my medical treatments that I just can't be my best advocate?  Because this is exactly what happened to me!

Can I also say that I am so frustrated when I find myself in this position way more often than I would like, just because I am a sick chick?  I loathe putting my fate in the hands of others, especially when I have been let down more times than I care to count.  But once I got past the feelings of anger and vulnerability, I knew I just had to bite the bullet and ask for help.

Sometimes Conflicts Arise with Our Health Care Providers

I thought I had a good doctor-patient relationship with my hepatologist, a belief was based on the handful of 15 minutes appointment I had with him over the past 4 and 1/2 years.  I wasn't expecting treatment to be easy, but I thought my doctor would be there for me.  So image my surprise when, on two different occasions during my treatment, I realized I needed someone to help me resolve emerging conflicts between myself, my doctor and his hepatology treatment team.

As I admitted above, during treatment I was too overwhelmed by a boatload of side-effects to be able to figure out and resolve these new communication problems by myself. The only thing I knew with absolute certainty was that my needs as a patient were not being met and I was afraid my treatment success would be jeopardized if I couldn't get things straightened out.

Sometimes Even Patient Advocates Fail Us

So at the time it seems logical to contact the UCLA Patient Affairs Department and ask them to help me:

"The Patient Liaisons of the UCLA Health System...assist patients and their family members with various concerns that relate to their overall experience at UCLA. Such issues may include, but are not limited to, quality of care, staff interactions, access to care and general assistance and information." 

Unfortunately I didn't receive the assistance I needed from Patient Affairs.  So on July 24th, during a telephone conversation with the manager of the department, I ask to file a formal grievance.

This is what I thought would happen next:

"When you or a family member contacts the patient affairs office, the chair of the clinical team responsible for that unit reviews your records. The hospital will then provide a written response to you or schedule a conference." 

--Virgie Mosley, manager of Patient Affairs for the UCLA Health System, quoted by the Los Angeles Times

I was told that a formal grievance could take up to 30 days.  It's been 71 days now and I still haven't gotten a response from UCLA.

Sometime We Just Need to File a Grievance

When you are chronically ill, your health dictates that you need to pick and chose your battles.  But sometimes taking a stand is critical to winning the health care reform war.  So I decided last week it was time to pursue official grievance procedures, because I want to be an agent for positive health care change and an advocate from persons living with chronic illness, especially those with Hepatitis C infection.

As the patients using the health care system the most, I think it is our responsibility to thoughtfully bring our most pressing concerns to the attention of entities like health care licensing and accrediting bodies.  Because if we fail to speak up and share our concerns, we squander opportunities for the health care system to learn from mistakes, identify gaps in service and correct problems.

While this rarely will make things better for us in the short term, I truly believe it will make things better for all of us in the long run.

We need to keep our eyes on the prize.  We all want a health care system that knows how to competently and compassionately treat persons living with chronic illness.  To get there, we need to make our grievances known to the member of the health care system that have the power to recommend and implement changes.

Resources

I'll be back Friday with a resource list of organizations in the United States that you can contact when you need to file a grievance.


Related articles 

• Key to Healthcare Costs Is to Better Treat Chronically Ill - U.S. News and World Report 
• Hospital and nursing home complaints have an ear - Los Angeles Times

Health Care Reform: Will It Limit My FSA?

Image via Wikipedia

I was wrong and I am big enough to admit it.

A while back, I wrote a blog post saying that health care reform wouldn't affect me. Well, I have recently learned otherwise. Turns out, health care reform is going to have a negative impact on our family's ability to contribute to and use our Flexible Spending Account (FSA), a benefit currently offered by Robert's employer. In addition, there is speculation in the media that employers may stop offering FSAs to their employees as they begin to implement the provisions in the health care reform law.

Surprisingly, we haven't used a FSA until this year, so I definitely see the irony in this situation.

In previous years, I committed myself to saving all our medical receipts and trying to deduct part of our out-of-pocket medical expenses on our income taxes. And let me tell you, as a person living with chronic illness, I racked up the out-of-pocket medical expenses. Using this method, I could only deduct expenses that were over 7.5% of our adjusted gross income (AGI). (Since I am not an accountant, I let Turbo Tax figure this out for me.)

With the FSA, we now use pre-tax dollars from Robert's paycheck towards things like medical and dental visit co-pays and deductibles, prescription co-pays, over-the-counter medications, durable medical equipment and supplies for my CPAP machine.

I am learning that the benefits of a FSA include:

• peace of mind knowing that we have a nest egg of money available to pay our out-of-pocket medical expenses, even when money is tight
  
• having all the FSA money upfront at the beginning of the benefit year to help us meet our insurance plan deductibles (which keep going up and up)
• not having to put a doctor's appointment off or worry about filling a prescription because we don't have the money for the co-pay
  
• coverage for over-the-counter medications, like newer allergy and heartburn medications which no longer require a prescription
  
• not having to worry about accumulating receipts totaling 7.5% of our adjusted gross income in order to qualify for a tax credit for medical expenses
  

Sounds good, huh?

Unfortunately, the recent health care reform legislation is going to negatively impact FSAs in two ways: 1) decrease how much money can be contributed to them and 2) restrict the use of FSA money to purchase over-the-counter medications. As explained by the website Save Flexible Spending Plans:

Health Care Reform Limits Flexible Spending Accounts

The recently passed health care legislation caps annual contributions to flexible spending accounts (FSAs) at $2,500 beginning in 2013 in order to fund a small portion of (health care) reform. The new law also restricts FSAs by cutting over-the-counter medicines from the approved uses for FSA monies for individuals purchasing items without a prescription.

While the efforts of FSA supporters successfully prevented this benefit from being eliminated (entirely), the fight to preserve FSAs is likely to continue in the coming years.

Beyond the use of FSAs as a valuable budgeting and cost-saving tool, the benefit enables users to take responsibility for their health care regime and treatment. The benefit is particularly valuable for individuals and families battling chronic conditions who require ongoing care and medical supplies.(That would be me!)

President Obama and Congress should protect FSAs from additional restrictions and allow the program to continue to serve as a safety net and solution for millions of Americans to cover their out-of-pocket health care expenses.

What Can You Do?

Please visit Save Flexible Spending Plans to learn the facts about FSAs and how they especially help persons living with chronic illnesses. Then visit the Action Center tab to send an e-mail to your elected officials to tell them how you feel about the upcoming changes to how FSAs will work. Be sure to mention how a FSA helps you or your family member better manage the out-of-pocket expenses of their chronic illnesses.

The more I educate myself, the more I realize what a powerful tool a FSA is. I am literally kicking myself for not taking advantage of it until now. If you take the time to explore the Save Flexible Spending Plans website, I guarantee you'll be signing up for a FSA the next time open enrollment time comes along.

Please help me preserve and expand this benefit for all Americans, especially those of us living with and managing chronic illnesses.


Sponsored Message:

For over a decade USAEyes, The Council for Refractive Surgery Quality Assurance, has helped patients learn important issues about Lasik and similar vision correction surgery. Let USAEyes, a nonprofit Lasik patient advocacy organization, help you avoid problems with your vision correction surgery, like the ones created by the recent Lasik Vision clinic closures. Click here to read more: USAEyes

Let's Stop Selling Health Insurance...

Image by SavaTheAggie via Flickr

I'm really not an expert on health care reform, but something clicked when I starting writing about it on Monday and I find myself with more to say.

This post is inspired by the graphic you see at the top, the image of the house on fire. The caption reads: PRE-EXISTING CONDITION--"Hello? My house is on fire and I'd like to buy a fire insurance policy. 911? Nah, the government says insurance companies must cover all pre-existing conditions now. It's not like I should have to pay for it."

This illustrates the problem with calling health care coverage "health insurance."

Insurance implies that there is a risk from which you need to be protected. So, you take out insurance to hedge your bets and guard against the bad thing from happening. That's why homeowners' buy fire insurance, motorists buy car insurance and people worried about providing for their families in the event of their death get life insurance. The insurance companies aren't stupid. They hire people to figure out the risks of offering such coverage to you with an eye on the costs and the goal of making a profit. So obviously, no one is going to sell you insurance if your house is already on fire, you just got into a car accident or your spouse just died.

I guess some people view health care the same way. For those who consider themselves healthy, "health insurance" is something they have "just in case" they get sick. So I can see someone with this point of view on health insurance putting together a poster like the one at the top of this post.

Then there are people like me. I admit that I really don't need "health insurance." I already have health problems, so insuring my health, i.e. gambling that I am going to stay healthy and not need medical care, is literally like closing the barn door after all the animals have escaped. What I need is ongoing access to health care. Without it, I have no support for all the things I need to do to manage my multiple chronic health problems.

If your house burns down, you have choices. You can walk away. You can rebuild. You can tear down what remains and leave an empty lot. You can sell what is left.

People are not like houses.

When we become ill or injured, we need medical care. The whole profession of medicine exists because of our societal commitment to the treatment of the sick and infirm. We do not abandon people when they are ill, like animals do when a member of the herd becomes sick or injured. We stand by them, help them and do what we can to help.

So why do we denied people with pre-existing medical conditions the ongoing access to the means to manage their health problems and ease their suffering? Why do we forget that some of people who utilize the health care system the most are people who live off disability checks and therefore not in a position to pay more to access health care?

Clearly there are multiple problems. There are also disturbing reports in the news that health insurers are already looking at ways to skirt the new provisions to end the denial of health insurance coverage to those with pre-existing conditions. This is why, in a nutshell, I think the emphasis on "health insurance" in the health care reform bill is not the smartest choice of words or concepts.

I know I am probably not qualified to solve these problems, but may I humbly suggest perhaps one small step towards fixing this problem?

Let's start by acknowledging that we all need to go to the doctor, even those of us who consider ourselves healthy. Let's agree that health care services need to be part of everyone's lives, from birth to death, in sickness and in health, to prevent and treat illness and disease. Let's stop selling "health insurance" and start asking everyone to pay for access to the health care system. Then let's talk about making it so that everyone can afford access to health care. Let's agree that health care for all is a goal our enlightened and compassionate society strives towards and is willing to pay for, together, as one united nation of people.

That said, I'm not sure what our health care solution should look like. Philosophically, we seem to be torn between "united we stand" and "pull yourself up by your boot straps" when it comes to solving our social problems. I feel if we could just get over the first hurdle and agree that health care for all is our goal and that we all need to be in this together, we can figure out our own uniquely American solution to this problem.

Agree? Disagree? I want to hear what you have to say so leave me a comment.

Linky Love: On Health Care Reform

Image via Wikipedia

I'm no expert when it comes to commenting on health care reform, but I traveled the blogosphere and found some experts in the subject. Fortunately for me, many of them just participated in the recent edition of the Grand Rounds blog carnival posted at the blog See First. This blog carnival features both doctor and health care/patient bloggers, which makes for an interesting mix of perspectives and opinions. You can read all the submissions by clicking here: Grand Rounds: Health Care Reform Edition.

My favorite post comes from health and patient blogger Laurie Edwards at A Chronic Dose. Laurie has been dealing with chronic illness since the day she was born and talks about how having pre-existing conditions has effect her relationship with health insurance. I have to say, she and I are on the same page in many ways, and her post echoes many of the same sentiments as my post from yesterday: No More Pre-Existing Medical Conditions Exclusions. Click here to read Laurie's take: Where's the Patient in Health Care Reform?

Today's post is short and sweet as I want to get back to reading all the great posts from yesterday's edition of Grand Rounds. I'll be back tomorrow with more of my own thoughts on health care reform, this time inspired by the caption on a picture. Intrigued? Come back tomorrow and check it out...


Sponsored Message: Looking for affordable health insurance? Look no further that Anthem Tonik. Offered by Anthem Blue Cross and Blue Shield, Tonik provides coverage in California, Colorado, Connecticut, Georgia, Nevada and New Hampshire. Tonik might be better known to college students or recent graduates, but Tonik plans are available to anyone under age 65. With three levels of coverage--Thrill Seeker (Tonik 5000),the Part-time Daredevil (Tonik 3000) and the Calculated Risk-taker (Tonik 1500)--there is bound to be a plan that fits your lifestyle and your budget. But don't just take my word for it, check out Tonik yourself and apply online by clicking here: Anthem Tonik. Anthem Tonik, a great option!

No More Pre-Existing Medical Conditions Exclusions

Image via Wikipedia

In response to my blog post from yesterday, Health Care Reform Won't Affect Me, a friend reminded me that a big part of the heath care reform bill dealt with pre-existing medical conditions. And all you need to do is look at my blog header for a pretty complete list of my pre-existing medical conditions. Can it be, for once in my life, I temporarily forgot about them? I guess being on Medicare can do that...

Truth is, in my recent past, choices in my working life centered around my mission to always be covered by health insurance.

But let's start at the beginning. I consider myself absolutely lucky that when I received my cancer diagnosis at age 22 I was still covered under both of my parents' health insurance policies. That's right, I had double coverage. I also consider myself fortunate that I continued to be covered under their insurance past my 23rd birthday because my cancer diagnosis, with its 33% chance of survival, qualified me as a disabled dependent. I remained on my parents' insurance until I secured my first full-time job as a social worker with full medical benefits after I completed my undergraduate and graduate degrees at age 27.

Once I became employed, all my career choices included health insurance as a rule-out criteria, i.e. no health insurance benefits meant I would not consider the job. That criteria changed a bit after I got married in 1998. As long as one of us had access to health insurance through an employer, the other was free to pursue work that didn't offer it. We came a bit close to catastrophe in the early '00s when we were on COBRA benefits and neither one of us were working jobs that offered health benefits. But somehow everything worked out in our favor and we both landed in jobs that offered both of us medical benefits once again.

The bottom line is that once I finished my cancer treatment, I accepted the fact that I could never qualify for an individual health insurance policy. I resigned myself to the fact that as long as I was single, I needed to work for an employer with a medium to large workforce. Being married opened the door to expanded possibilities, because now my husband helped share the burden of obtaining health insurance. But even with a little wiggle room, health insurance always colored our job decisions.

Certainly becoming disabled skewed my quest for health insurance in my favor. Never did I think I would be on Medicare at this point in my life. No, my plan was to work, build up a career, gain experience and go back to school to earn a PhD and teach social work. I would qualify for MediCare when I reached 65 (or is it 67 by then?) and was enjoying a semi-retired life with some work, some travel and some more time with my spouse.

Ah, but life is what happens to you while you're busy making other plans.

Let me acknowledge how truly lucky I have been when it comes to being continuously covered by health insurance. I do not take it for granted. I need to add it to my list of lucky breaks, which also include finding good parking spaces and great places to live. I realize not everyone in my situation finds themselves in such good fortune, which is why I honestly and truly hope that the new health care reform bill provision ensuring health insurance coverage for children and adults with pre-existing conditions takes effect as intended.

If I am ever able to work once again, I would relish the opportunity to walk down my career path without being held back from certain opportunities because of considerations around health insurance. What a world that would be!

Health Care Reform Won't Affect Me

Image by leoncillo sabino via Flickr

I am not making this up. I actually went to the Washington Post website, entered in a bit of information about my current health coverage and was told that health care reform will not affect me. I admit I feel a bit disappointed.

After all, this is the legislation that inspired Vice President Biden's on-microphone gaffe, "This is a big f***ing deal."

To be fair, when Congress writes a bill purported to be as big as the novel War and Peace (which, by the way, had 1225 pages in the original edition and 1475 pages in the most recent reprint), it obviously is going to take some time to read all the provisions and even longer to figure out how to implement them. One sound bite I heard was that most of the provisions won't take effect until 2014. I know from experience that a lot can happen in four years.

Still, if health care reform is going to cost the US $1 trillion dollars (that's 12 zeros), I'd like to think that I am going to get some benefit from it. Then I realized that, as long as I am disable and receiving Medicare, I won't get any direct benefits from this legislation. More than that, I realized that anyone on Medicare, Medicaid or covered by employer-sponsored medical insurance won't get anything tangible. That includes the disabled, elderly, welfare recipients and those working adults and families receiving medical benefit from an employer.

This legislation supposedly helps people get medical insurance. It is supposed to provide subsidies to those who can not afford insurance. Has anyone mentioned yet how they are going to determine who gets subsidized and who doesn't? How much new paperwork and bureaucracy will be created to help make this determination? If it is anything like the process for qualifying for other public benefits, like disability or welfare, this is going to be a nightmare.

What does making health insurance mandatory mean for those who now must purchase insurance? I wonder if it just opens the door to medical care only to have it slammed shut again when the newly insured are overwhelmed by out-of-pocket expenses (co-pays, deductibles, co-insurance and out-of-network reduced coverage) they can not afford. So will the newly insured use their plan if they can not afford the associated out-of-pocket expenses?

Which brings me to the question, does medical insurance = health care?

Plus how many people are going to actively avoid getting insurance. After all, car insurance is mandatory for all drivers here in California and yet there are still uninsured drivers. Will there by a self-pay option that allows people to opt out of getting medical insurance?

For me, the biggest unanswered question is whether making for-profit health insurance coverage mandatory really the way to go here. I still think that health care needs to be non-profit, patient-centered and evidence-based. I believe that the money generated in health care system needs to be reinvested into things like medical research, practitioner continuing education, patient supportive services like social work and upgrades to medical equipment.

I fear that this heath care reform doesn't get to the heart of the matter. After all, having health insurance doesn't insure that people will be healthy. Personally, I'd rather see Congress invest $1 trillion dollars into improvements in agriculture and food production to make fresh, minimally-processed, healthy and nutritious foodstuffs affordable and available to everyone. With so many health care costs tied to what gets put onto the American dinner plate, it seems to me ensuring that everyone eats more healthfully would be a better way to spend my tax dollars than supporting the for-profit health insurance industry.

Which makes me wonder, did we just do this ass-backwards?

Yes, I am disappointed that health care reform won't affect me and seems to do nothing to make the health care system more accessible, effective, affordable, patient-friendly or efficient.

O.K., I've share my two cents, now it is time to tell me what you think. How can you let me know your opinion? By leaving me a comment of course!

Related articles by Zemanta

• 'No Cussing' Crusader Takes on the Vice President (abcnews.go.com)
• Biden "Big f*cking deal!" Gaffe Inspires Internet Entrepreneurs to Cash in (mashable.com)
• WTF Did Biden Just Say? A brief history of bad language in Washington. (slate.com)