The ACA isn’t working for people like me.

So, let me see if I understand this correctly.

I had a junk policy that cost me less than $200 a month. It covered nothing except for a physical and a gyn visit. If I needed a specialist test, it was not covered.  If I visited a specialist, it was not covered. The only thing that the policy was good for, presumably was an emergency situation and even that was questionable. The second purpose of my junk insurance policy was the maintenance of insurance without a break. Prior to the ACA, any illness developed during a break in insurance could be considered to be a “prior condition”. Even if you didn’t develop an illness during the break, the insurance company could use it against you.

Because I am an artist, and self-employed and in the process of building a new business, money is tight. I negotiated payment to my specialists, including my allergist, a Republican who, as a physician, has committed himself to my health care.  The same can be said for my Gastroenterologist.  In spite of these two specialists that I need to consult with at least on occasion, I am very healthy. The likelihood that I will become ill enough to require emergency care is slim…The thing is, you never know. You can not predict the sudden failure of your health. I have witnessed it first hand. I have seen people go from perfect health to feeble overnight. 

Having good doctors who will negotiate with me, doctors who care more about my health than about  how much I pay is important to me. When I was living in New Jersey, I used to visit the Immedicenter in Bloomfield, New Jersey. After I left my job, there was a mix up with my old insurance company and a bill did not get paid. There was a brief period where I was uninsured. Then, once I got insured, I went to the doctor without my insurance card. 

My doctor, whom I had been seeing for several years, refused to treat me.  Read the reviews. When they first opened up, they were great. Me, I never went back there.


They had my daughters card on hand but refused to even consider treating me without my paying both the bill that my old insurance company did not pay and the price for the visit that my new insurance company should have covered. Have you ever tried to get your insurance company to pay a bill that they should have paid?  I had a prescription filled once. In the process of moving, I had no card with me. I had to pay full price. The insurance company refused to reimburse because the store gave me a receipt with a different name on it. Mind you, it was the same address, but a different name. So…I fucking HATE insurance companies.  They will do ANYTHING to avoid paying for your treatment.

So back to today. Under the ACA, junk policies were eliminated.  Forced onto the health exchange market, I began to look for a new policy. I make too much money for medicare, which leaves me in the Bronze to Silver level and an additional outlay of $100 – $200. In the Bronze to Silver level, I now have a deductible. What does that mean? The deductibles vary, but in most cases, they are very high. The lower your premium, which is your monthly payment, the higher your deductible.

If your deductible is $4000, you are going to pay for everything until you reach that deductible.  That’s right. You pay full price for all of your doctors visits, prescriptions and tests. The cost is negotiated by the insurance company, in some cases directly with the physician. In other cases, they are specific amounts. Normally this is great, but I lose the advantage of my own negotiated payments now and on top of paying more per month for insurance that doesn’t cover my medical costs, I will be paying more in medical costs.   Luckily, you can withdraw money from your dwindling IRA account to pay these costs with no penalty.

Once you reach that deductible, you have a real insurance policy that will cover everything, usually with a co-payment or a co-insurance payment (the difference is explained here)..unless your deductible is very high. The Oscar plan that I looked at had a $6000 deductible that I am never likely to reach and no co-payment or co-insurance.  The Gold & Platinum plans are better.  They have a much higher monthly premium.  There is only one advantage to having these new plans. You will be covered when you get sick. You now have the peace of mind of knowing that your illness will be covered if you have a catastrophic illness. Or will you? As I was writing this, I ran across this story. It should send chills down your spine.

William Rivers Pitt | Worse Than the Mob: The Insurance Industry Is Organized Crime

Abandoning the concept of single-payer health care is the Original Sin of the Affordable Care Act. While I and the half of the country dealing with pre-existing conditions are grateful for the prohibition against denying coverage to people thus afflicted, that protection is next to useless when dealing with the shark tank that is the insurance industry. They have less morality than a Mafia leg-breaker, but far more power, and someone decided to keep them in charge of the process anyway.


  • pinkelephant22

    Wouldn’t it make MUCH MORE SENSE to have a cheaper catastrophic policy? You can pay for your own doctor visits & prescriptions that you’re having to pay for anyway due to the deductible. You could also take the amount you’re paying in premiums, put it in an interest bearing savings account, save money, AND it’d be a cushion for unexpected medicals costs falling outside the catastrophic coverages.