NEW YORK (MainStreet) "Infiltrating Ductal Carcinoma, Stage 2," said my doctor in late February, giving me the pathology results of a breast lump biopsy done a few days prior. That's Breast Cancer with a capital B: a medium-sized malignant tumor was growing and spreading quickly through a milk duct and into the lymph nodes, as I found out later. First thought running through my mind was, "Ummm...those can't be my results."
If this had happened any time before January 2014, it would have been a totally different story. That's because I've gone largely uninsured for the past 15 years, as an independent contractor with no employer health insurance coverage. The first thought through my mind might have instead been, "Ummm...I don't have health insurance. I'm going lose my house paying for breast cancer treatments, and I'm probably going to die anyway."
But, I bought health insurance due to the Affordable Care Act (ACA) on the Federal Marketplace at Healthcare.gov that became effective January 1, 2014.
You might say I chose to be uninsured or that I could have afforded the insurance during those last 15 years. A couple of times I bought private insurance, and in 2010 when my husband had a job for about six months, we were covered for those short periods.
One plan I bought many years ago was a catastrophic plan with a maximum benefit cap (that certainly would not have covered my cancer surgeries and treatments, which in only one month have topped over $240,000 in billings). I had the plan for more than a year and never used it once. When paying the premium became a hardship, I cancelled the plan.
Another plan I bought had a very high deductible and was a 30% coinsurance plan with a high monthly premium we really couldn't sustain any way. I used it to go to an eye doctor for an eye problem and never even met the deductible, so I was left paying thousands for diagnostic tests while not able to sustain paying the premium.
In 2010, my husband had health insurance offered by a new job and I went for a basic well-woman exam. Again, I ended up having to pay for everything in cash, including the mammogram (which showed no abnormalities then), because I never met the deductible. Later that year, he lost that job, and because the COBRA payment to continue that insurance was double the premium amount that came out of his paycheck, we cancelled it.
In all the 15 years, neither of us ever got sick or went to the emergency room.
Now that I am in my 40s, I applied on Healthcare.gov as early as possible in October. I worked my way through all the tech glitches and uncertainty and finally in December purchased a Gold Blue Cross Blue Shield plan. With our middle class income, we qualified for a subsidy that made the payments for a two-person adult plan $368 per month. If we earn more money than last year, we will gladly pay the difference in taxes.
According to the most current U.S. Health and Human Services (HHS) data released on marketplace enrollment, Obamacare met its plan by coming in just over 8 million. A small (possibly unreliable) data sample found approximately 87% of those who received subsidies were uninsured when they applied, like me. Kaiser Family Foundation tallied the enrollment numbers by state and found Florida, my state, which refused the Medicaid expansion and loudly, politically opposes the ACA, came in fourth in sign-ups among the 50 states.
No matter which way you look at it, many uninsured Americans wanted and got health insurance and the uninsured rate continues to fall, according to a recent Gallup Poll. How can you oppose that?
You might spout statistics about insured people who were kicked-off terminated plans due to the new law, or those complaining about more expensive premiums. Insurance companies have been hard at work offering new ACA-compliant plans and those people will re-enroll in a new plan. And health insurance premium price hikes have come yearly anyway. The difference in 2014, due to the ACA, is ten preventative care wellness exams and tests are free for everyone in America, including everyone who is actively opposing or trying to repeal the Affordable Care Act. For women, that includes the well-woman exam in which I pointed out the breast lump and the resulting mammography.
Also See: Why Some People Are Refusing Health Care
Never in a million years did I plan on having cancer (who does?). And I have none of the 20 or so genetic, physical and lifestyle risk factors for breast cancer listed on cancer.org. But now that I have cancer, I am getting quick and aggressive treatment, and I'm not going to die, because I have health insurance that adheres to a set of standards, which I can afford, due to the ACA.
What saved my house is the new maximum-out-of-pocket (MOOP) amount required by all new ACA plans. That dollar limit is the most you pay during a year before your health plan starts to pay 100% for covered essential health benefits such as all the different doctor visits, diagnostic tests, surgeries and chemotherapy treatments. I chose a Gold plan with a $1,600 per person deductible ($3,200 family) and a $4,200 MOOP per person ($8,400 family). I've already paid (out of my income and my cash emergency fund) up to those limits for my care, and that's why I won't lose my house paying my portion of the bills.
The ACA healthcare exchanges are directed solely at people like me who couldn't afford healthcare before by offering the subsidies and also by expanding Medicaid in those states that accepted it. Obamacare covers everyone with pre-existing conditions that was simply denied covered care before the ACA. Those people simply died or lost their savings and houses or had the type of medical debt which is the cause of 62% of bankruptcies, say organizers of Strike Debt, a grassroots organization devoted to eliminating crippling debt.
That's not going to be me...but easily could have been if the Affordable Care Act had not come along when it did.
Also See: Can Obamacare Be Mended?
My cancer surgeon, Dr. Kevin Palmer, says he is still seeing uninsured patients who haven't even heard of the Affordable Care Act and some who had planned to just pay the penalty...another with breast cancer. He says maybe the ACA didn't go far enough in its protections.
Buying a marketplace plan is not necessarily cheap, and families still have plenty of skin in the game with deductibles and maximum out-of-pocket amounts as high as $12,000 for some Bronze and Catastrophic plans for younger people. So while you'll spend $12,000 if you get in an accident or have a life-threatening disease, you won't be liable for tens of thousands of dollars. Or the amount of your house, as the costs of my treatment has already reached.
Also See: Uninsured Who Passed on Obamacare Said It Was Because of Cost
"Our side supports this law, making it work better," said Democratic National Committee spokesman Mo Elleithee on CNN's "State of the Union" in April. "Their side wants to take it away. People don't want that fight anymore, right? The one thing -- the one thing that is much more unpopular than the Affordable Care Act is repealing the Affordable Care Act."
Also See: Your Badonk and Cancer Sticks Will Cost You Under Affordable Care
Bloomberg News polled Americans on their feeling about the law and its specific provisions back in March and found 34% still calling for a repeal of the ACA, 13% saying no changes were necessary and the remaining majority, 51%, saying they'd like to see how the law works and modify it if necessary.
The most popular provisions of the law, according to the Bloomberg survey, were eliminating lifetime caps on insurance and allowing children up to the age of 26 to stay on their parents' insurance plan.
Personally, I'm a fan of those provisions and imposing the maximum-out-of-pocket limits to every plan.
Simply put, Obamacare saved my life...and my house.
How can anyone say that's a bad thing for that to be every American's story?
--Written by Naomi Mannino for MainStreet