I have many personal stories about healthcare deferred, issues postponed, obvious problems sidelined until they (hopefully) resolve themselves, but the problem with my right ear couldn’t be ignored.
It started one afternoon in May. My ear felt full, so I used a q-tip in an attempt to (carefully) clean it out, took a shower, then took a nap. When I woke up, my ear was completely clogged.
“What did I do?” I wondered as I hopped up and down on one foot to try and “pop” the ear, like one does after swimming. The ear didn’t pop. I spent the next several days using a product called Debrox — an over-the-counter ear wax treatment that you drip into your ear. Debrox softens earwax so that it can drain out of your ear (gross, but usually effective).
The Debrox didn’t work. My right ear felt like it was permanently stuffed with cotton. I went to my doctor and, after declaring there was too much wax to see my eardrum, she gave a very dedicated nurse the task of flushing out both ears (a brutal, yet satisfying procedure). My ears were clear and the eardrums visible, so she sent me home.
The ear did not get better. Also, now it hurt.
I used Debrox off and on for the next week before calling my doctor and asking for a referral to an ear/nose/throat (ENT) specialist. She supplied me with the name of someone locally and I immediately made the appointment, saw a fantastic doctor, and got my ear fixed!
That last sentence is a lie.
I didn’t call the ENT specialist because my health insurance plan has a very high deductible. A deductible is the amount of money you must pay as a cost sharing requirement to your insurance provider before receiving most benefits. My deductible is about $9000 and after I pay this money, I’m still required to pay a percentage of my medical bills until I reach an out-of-pocket of $16,300.
Since I avoid going to the doctor unless absolutely necessary, I’ve met exactly $0 of my deductible for 2020.
I did some quick, shot-in-the-dark math (as one does do if one lives in America and needs to see a doctor). I figured that the specialist consultation would cost me between $250 and $500 and any subsequent visits would cost at least $200 or $300 each.
The small bottle of Debrox seemed to mock me, but it was my cheapest option at about $11.99. I used it for another week, to no avail. I finally gave up because it’s not pleasant squeezing that stuff into your ear day after day.
I resigned myself to partial deafness, at least in the short term, and promised my worried family that I’d go to the ENT if my hearing got worse.
A few days after stopping the Debrox, my ear began intermittently popping. It seems the $11.99 treatment worked — it just took a long time. After a month of walking around with cotton-ear, the pressure eased and I could hear normally again.
Bullet dodged. This time.
I complained about my ear to my dear friend Babs and confessed my reluctance to spend the money for a consultation. Though my sudden-onset deafness was a problem I’d obviously needed to address, she fully understood.
“I hate trying to stay healthy in this country,” Babs said.
Babs had a damn good point.
Babs and I are 59 and 49, respectively. Like many Americans who are underinsured, we’re used to deferring or limiting healthcare because of the cost.
The inadequacy of America’s healthcare system is such a familiar song, particularly if you’re Gen X, that sometimes I don’t realize I’m singing it anymore. I’ve mostly stopped complaining. I pay my (supplemented) monthly insurance premiums of $276 for a plan with inadequate coverage that actually costs $915 per month and try to feel grateful that my premium is subsidized.
That extra $639 per month is paid by the federal government through the Affordable Care Act (A.C.A.), otherwise known as Obamacare. I pay an additional $30 per month to cover my daughter’s health insurance under a New York State health program called Child Health Plus, financed in the state by a provider surcharge. Child Health Plus covers everything for that $30/month — no premiums, no deductibles, and no coinsurance.
While I’m (very) relieved that my daughter is covered for the next few years (she becomes ineligible for Child Health Plus when she turns 20), my insurance situation is precarious.
I will lose my $639/month subsidy if the A.C.A. is eliminated, making me responsible for the entire $915/month premium plus the additional $16,300 out-of-pocket maximum (this includes my deductible). By the way, even if I pay the $16,300 it zeros out every. single. year. even though illnesses or the need for treatment don’t tend to go away when the calendar year is over.
In a nutshell, if I get sick, really sick, injured, or really injured with my current healthcare plan, I’ll need to pay nearly $30,000 before I see any benefits. Another worry — premiums increase each year. I already received a letter from my current insurance provider that my premium is going up in 2021, but the plan itself isn’t changing.
“When people talk about how heartless Trump’s determination to get rid of the A.C.A. is, they leave out specifics,” Babs said to me during our most recent chat about healthcare.
It’s not just Trump. It’s his entire administration. Hell, it’s the entire Republican Party. The very idea of universal healthcare seems to give them all night sweats. They hate it so much that states lead by republicans refused to expand Medicaid even though, according to Paul Krugman of the New York times, the federal government would’ve paid for most of it.
I don’t know why Republicans don’t like the idea of universal healthcare for all Americans. Maybe it’s the whiff of socialism. Maybe this is how the republicans figure they’ll cull the herd. Maybe, if you’re a fiscal conservative, spending taxpayer money on anything that actually helps taxpayers is terrifying because DEFICIT!
Fun fact: Trump’s golf outings are projected to cost American taxpayers over $300 million, but I guess wasteful spending is subjective.
So, what are the specific issues involved with losing the A.C.A. right now?
Well, the most obvious issue will be that A.C.A. subsidies will disappear, leaving about 11.4 million people who get their healthcare through the marketplace stuck paying the entire monthly premium. Remember, for a mere $1000 per month, I get…pretty much no health benefits until I pay my $16,300 out-of-pocket maximum. An additional 9.2 million people may lose the coverage they’re getting through the expanded Medicaid program.
Medicaid funds about 40% of the treatment costs for access to opioid addiction treatment. This would vanish if the A.C.A. were repealed, along with access to the treatment providers that sprung up once states expanded their Medicaid programs.
One of the flagship requirements of the A.C.A. is that it protects Americans with pre-existing conditions from being denied insurance coverage. A recent New York Times article notes that nearly half of Americans have pre-existing medical conditions. Without A.C.A. protections, it may be impossible to get affordable coverage (if we’re not denied coverage outright). Per the Times piece:
“Under the A.C.A., no one can be denied coverage under any circumstance, and insurance companies cannot retroactively cancel a policy unless they find evidence of fraud. The Kaiser Family Foundation estimated that 52 million people have conditions serious enough that insurers would outright deny them coverage if the A.C.A. were not in effect”
There’s more we’ll lose. Much more. Read that New York Times piece then go jog around the block and eat some fruit. At this point, it’s your best option for longevity.
I took an impromptu poll among my closest friends to see what medical care they’ve postponed because of cost, lack of access, or both.
I’ll start. In addition letting my ear issue resolve itself (it’s a Debrox miracle!), I haven’t been to the eye doctor in over two years and I desperately need to get my eyes checked again. I can tell that my prescription needs to be adjusted, but…the cost…
I haven’t seen my therapist since sometime in 2019 because it’s $95 per session (that’s the insurance adjusted price) and it was just too much of an out of pocket expense for me to keep going. I lost a child to cancer three years ago. Trust me when I say I need therapy.
Last month, one of my friends hurt her back and couldn’t walk for a week. She didn’t go to the doctor because of money. “ I never go unless it’s dire,” she told me. Losing the ability to walk for a week is pretty dire, but I know what she meant.
Another friend is on Medicaid, but she needed to get a second opinion from a cancer specialist. She ended up paying out of pocket for that second opinion even though money, to put it mildly, is very tight. This was life or death, after all.
A third friend’s husband lost his job due to COVID-19 shutdowns and she immediately canceled all her medical appointments and procedures, including her husband’s consultation with a knee surgeon. She can’t pay for COBRA. It’s roughly $4000 per month, so she’s without health insurance (and being very, very careful) until August.
Those are some hard specifics, yet they only tell part of the story. They don’t speak to the constant stress we experience about healthcare. What if one of us gets the virus? What if one of us gets something else? What if we’re injured in a car accident or diagnosed with something chronic that requires expensive medication?
It is, frankly, exhausting trying to stay healthy in this country.
Meanwhile, back in the shadowy pit of desperation that is Trump’s mind, the A.C.A. looms as The Whale that must be destroyed. He’s wants to get rid of it during a pandemic, when millions of people have lost their jobs (and, thus, their health insurance coverage), while the virus roars through America, essentially unchecked because Trump and his goons really don’t give a shit if we die.
The A.C.A. was a way to prop up a failing health insurance system that was starting to collapse under the weight of its own dysfunction. It sucks, but at least it’s something! At least it enables me to have an (expensive) catastrophic backup plan for when I inevitably get sick.
And I will get sick. This probability increases every single year because aging is a pre-existing condition.
I am exhausted. I am tired of struggling and I am tired of watching everyone I care about struggle. I’m scared too, because things are about to get much worse as we head into fall and hit flu season. There are millions of us out here, hanging on by a damn thread, and the virus is barreling towards us while Trump spews toxic bullshit at his hate rallies, plays golf, and incites civil unrest. The election, at this point, is my only hope. November can’t get here soon enough.