By Michael Poole
Politics aside, the new health care bill has deeply affected our family. Seriously!
At 59, my wife and I do not qualify for Medicare until 2019. Our deep concerns about “what if” significantly shifted due to the Affordable Care Act. Here’s the story.
After 24 years in full-time congregational ministry, I recently transitioned to “interim/supply” ministry. It’s a very specific and needed ministry that congregations often cannot or will not pay for. The career change means sporadic work and comes with little or no benefits.
Currently, we have health care coverage through my wife’s employer, but no guarantees. One hiccup in an executive boardroom, one accident or serious medical condition, could mean losing job and coverage. We, like millions of others, have been teetering on the edge of disaster for the past 10 months. No kidding.
Prior to the Affordable Care Act, loss of employer-sponsored coverage would have forced us to seek private insurance. Even if we could pay outrageous premiums, that coverage would likely be cancelled if we actually got sick — cancer, heart disease, etc. I mean, what if we actually needed health care?
Before the new world of the ACA, everything we’ve worked for would be at risk — house, modest retirement savings and perhaps even medical treatment. Unfortunately, that’s exactly what has happened to millions of hard-working Americans.
This week, I went to the now infamous website — www.healthcare.gov. To my surprise, the experience was much better than a few weeks ago. I found it both navigable and responsive.
Of course, I had to game the system a bit because I’m ineligible due to coverage through my wife’s employer.
I was heartened to see just how many different plans and providers are available in my home state, Virginia. I also noticed numerous reminders that “estimates” of coverage plans depend on how I had responded to a few qualifying questions — questions like income range, number of people being covered and category of coverage desired — catastrophic only, silver, gold or platinum. I think that was all. One other question is tobacco use. Go check it out.
As for missing qualifying questions? No questions regarding family history, pre-existing conditions, current health, race or gender issues, and no age questions! It was amazingly simple.
Once I knew the various plans available in Virginia and their provider costs, the question became “How much would I actually be required to pay?” In other words, what, if any, assistance would be available? I couldn’t go any further because, as I said, I was fudging the system.
The Kaiser Foundation estimator was helpful. It’s a different website, but, according to healthcare.gov, it’s designed to give credible estimates. I discovered that even in worst-case scenarios, my wife and I would be okay; that is, it looks like our net premiums for standard silver plans (70 percent coverage) would cost around $350 a month. If we earned less in the coming year than expected, then our assistance would go up while at the same time “out of pocket” expenses, like co-pays and deductibles, would go down.
Most important for us, we would have a cap on “out of pocket” expenses at about $12,500 per year. Now, we might not spend a dime in addition to the premiums, but the worst case would be $12,500. Not cheap but doable without tearing our lives apart. And best of all: coverage cannot be canceled, even if we need it! That’s right — even if we need it. No cancellations, no rate hikes.
Politics aside, it’s a new world.
As for those good, honorable and hard-working friends of mine with upper middle-class incomes, I hope your incomes double and your premiums halve. I don’t think the latter will happen and I am truly sorry.
For others whose insurance companies are pulling the plug on their plans because they do not meet Affordable Care Act minimums, you know what? Those plans you and your employer faithfully paid into for decades, including annual premium increases of 15-20 percent: Weren’t you going to get nixed anyway — perhaps exactly when you needed insurance most? And, when you turned 65, weren’t you going to be dropped at the door of Medicare?
At our house, we are breathing much easier today. While government overreach happens on a daily basis, in this matter, government is doing what ought to be done — protecting and providing basic human services.
Why should America do less than many other free nations? Thanks to the Affordable Care Act, unexpected health problems, accidents or unemployment over the next six years may not rob my wife and me of our house and modest savings. And maybe, just maybe, we will not die clutching the empty bag of a cancelled policy.
Politics aside, the world has changed. No kidding!