As the United States Supreme Court prepares to rule on the constitutionality of ”Obamacare” today, I have more than a few concerns. Honestly, I am not 100% sure where I stand on the healthcare debate anymore. As a financial conservative, I want to cut costs and make healthcare more affordable. However, as a realist, I know that no matter what happens today, that is unlikely to happen. Healthcare costs have risen every year for as long as I remember. No matter what happens, health insurance companies will find a way to fatten their pockets. They’ve proven that. Will our policies even matter?
While I’m not sure what size of a role our government should play in healthcare, I am sure that certain things need to change. People who own or work for small businesses shouldn’t be financially penalized for working there. Afterall, small business is the backbone of our economy, right? Those who work in small business shouldn’t be thrown to the wolves of the open health insurance market. We have been there, and it is a house of horrors. While our story is not nearly as nightmarish as others, it is still a story of hardworking, middle-class people who have had the unenviable task of navigating the waters of the open market insurance industry. It is common story, and a story that needs to be told.
Finding our First Healthcare Policy…on the Open Market
When I was 21-years old, I found out that I was going to have to have spinal fusion. At the time, I had an individual insurance policy that my parents had purchased for me. I was very lucky for this, and it is one of the many reasons that I remain grateful to my parents. My surgery and recovery were long and painful, but I had no idea that I would be suffering from the ramifications of this surgery for many years to come. Actually, it didn’t matter at all until I married my husband, Greg, in 2005, and we started shopping for a family policy on the dreaded open market.
At first, I had trouble getting covered at all. We applied for a few policies and were denied. Eventually, we settled on a high deductible policy that insisted on excluding my back from coverage. From that point on, I would not be covered at all if I had any more problems with my back. Additionally, we were unable to secure a single policy that would cover maternity. Here we were, just married, ready to start a family, and had no way to get any sort of maternity coverage. The agent that sold us our policy advised that we should open a health savings account and save the entire amount required to pay the hospital to have a baby. After doing some research, I found out that the average cost at the time was over $8,000 for a regular vaginal delivery.
Of course, this was somewhat doable. Although we didn’t have a lot of money at the time, I was sure that we could save enough to pay for a regular delivery. But what if something went wrong? What if I had an unexpected medical emergency? If we took this advice and something did go wrong, we could end up thousands, tens of thousands, or more in debt. This was not a risk that we were willing to take. We decided to purchase the insurance policy but put our baby plans on hold in the hopes that something would change.
Finding a “Better” Policy
A few years later, because of a chance encounter, I ended up speaking with the same agent that sold us our policy. Excited, he told me about a new option on the open market for families who needed maternity coverage. The coverage was expensive and it was hard to get accepted, but he thought that it was worth a try. Why not? The worst scenario would be that they would just refuse coverage. Most importantly, by now it had been more than five years since I had received any treatment for my back. This meant that I was not required to report it on a health insurance application. (Note: When buying health insurance on the open market, it is required that you fill out an extensive medical history report for the past five years. Any discrepancy could mean cancellation of your policy and refusal to pay.)
We filled out the paperwork with high hopes that we would qualify for this new policy that included maternity coverage. Unfortunately - as Suze Orman would say - we were “Denied, denied, denied.” Amazingly, it had nothing to do with me. Their reasoning was that my husband had undergone a precautionary colonoscopy several years prior. After this test, his doctor had determined that he had Irritable Bowel Syndrome. From that point on, nothing else had been prescribed except that he should avoid dairy products and stress. We were dumbfounded. We had been so excited to finally have my back surgery off of our record and now….this.
We were back to square one. Luckily, our insurance agent suggested that we obtain a letter from Greg’s doctor stating that he was very healthy and that the colonoscopy had revealed nothing. We took his advice and, luckily, the new health insurance agreed to provide coverage on one condition: my husband’s colon wouldn’t be covered. This was getting ridiculous! Still, we finally had maternity coverage and were thrilled. However, the new plan stated that once coverage began, there was a six month waiting period that must elapse before we could get pregnant. Additionally, if we gave birth any earlier than 15 months from the start of the policy, we would also not be covered. This meant that if we waited 6 months but our baby was born early, we would also not be covered. Afraid of what could go wrong, we decided to wait a full year to get pregnant to avoid possible financial ruin. Afterall, I did have a spinal fusion at a young age; we had no idea what complications could arise or even if I would require an expensive C-section.
Having a Baby
Our new policy began, and we were excited at the prospect of trying to get pregnant after the first year. The downside of our new insurance policy was that it was very expensive. In the beginning, it was around $625 per month and each individual person had a $2000 deductible. There were many other less than ideal stipulations including confusing co-insurance deductibles. I really wasn’t certain how much having a baby would even cost when the time came, but at least I knew I had coverage.
As our first year passed, I thankfully got pregnant within days of trying. But as my excitement and anticipation rose, so did our premiums. Over the next year, they climbed from $625 per month to over $900 per month. The total of our final hospital bill totaled over $4000 for my deductible, co-insurance, and my daughter’s co-insurance. Yet, finally - at age 29 - I was able to hold my first child in my arms. After years of struggle and heartbreak, she was finally here. The truth is that she was worth everything I went through and more, but that’s not the point.
By the time our employers were able to secure a group policy for our company, we were paying almost $1000 per month in premiums alone. Luckily, before we had our second daughter, we were able to get on the aforementioned group plan. We only had to answer four generic health questions, and we were covered immediately. Additionally, our new plan is paid for via payroll deduction with pre-tax dollars. Although it is still a high deductible plan, nothing is excluded as a “pre-existing” condition in our new plan – and honestly, I love it.
What are the Answers to the Healthcare Problem?
Now that we have decent health insurance coverage, it would be easy to consider the healthcare debate as somebody else’s problem. While I am no longer the healthcare warrior I once was, that doesn’t mean that I’ve forgotten all that we’ve been through. It is absolutely ridiculous that any person should have to jump through as many hoops as I did to have a child. In the United States, the open insurance market is a giant mess. One is barely able to navigate through all of the red tape and legal insurance jargon. How did it get this way? And why should an average person like myself have to wait until the age of 29 to be able to have their first child?
Unfortunately, I don’t have the answers to this. What I do know is that something needs to be done. How long can we let people with pre-existing conditions continue to suffer and be uninsurable? Why should insurance be able to stand between a married couple and their first child? If it’s this bad now, won’t it only get worse if we do nothing?
I don’t have the answers but I would love to hear what you think. Please share by commenting below.