Every American has a health insurance story of some kind. Some people's stories are blessedly straightforward and uneventful. It is very possible, for instance, to be covered by a parent's health insurance until you graduate from college, get a job with great benefits when you graduate, and stay at that job until you retire. Other people's stories are straightforward for sadder reasons, as it is also possible to have a job that does not offer benefits of any kind and to simultaneously make too much money to qualify for Medicaid, but not enough to buy a private insurance plan. With all the talk recently of repealing the Affordable Care Act (ACA, aka "Obamacare"), I had been thinking of writing about my own health insurance saga for a long time. Today, when I saw in the Washington Post that 18 million people will lose their health insurance in the first year if the ACA is repealed without a replacement, I decided it was time to start writing. Here are the major milestones of my health insurance saga so far as a US citizen:
- Ages 0-18: Covered by the health insurance my dad got through his employer! Not every child is this lucky, so this was very good fortune right off the bat.
- College: Still covered by my dad's health insurance!
- Graduate school: And still covered by my dad's health insurance! Currently, under the ACA, children can stay on their parents' health insurance plans until the age of 26. Previously, rules varied. In my case, I was allowed to remain on his plan until one of the following things happened; (1) I turned 26, (2) I got married, or (3) I finished or left school. As it turns out, I did all three things within less than a year, but turning 26 was what happened first. If I had needed to, I could have purchased health insurance through my university, but it would have taken a significant chunk out of my carefully-budgeted grad school stipend.
- First job out of graduate school: I moved to Madison, WI right after successfully defending my MA thesis. I didn't technically graduate until December of that year, so had some time to frantically look for work before turning 26 that October. Hard as I tried, it took some time for me to find a job at all, and once I did, it did not offer any benefits. My parents generously offered to cover private insurance premiums for me until I could get insurance by some other means. I applied for coverage with a plan that was highly rated in Consumer Reports. They ultimately covered me, but not before one of their representatives called me to ask follow-up questions from my health questionnaire. Also, although I was not planning to become pregnant at that time, I was taken aback to notice that this plan provided no benefits for prenatal care or delivery unless you purchased a maternity rider. Given the high number of unintended pregnancies in the US, this seemed like a disaster from the standpoint of healthy mothers and babies. It also seemed like a slap in the face for people to potentially pay for this additional coverage and then not end up being able to use it.
- Marriage: Covered by Scott's health insurance plan! His plan was from his university, and it covered us through the remainder of our time in Wisconsin and during a research fellowship Scott had in Israel after that.
- First job with benefits: Shortly after our return to the US from Israel, I got my first job that offered benefits. I had a number of plans to choose from, and ultimately picked the PPO with the lowest premiums. I had a longstanding suspicion of HMO's after working in a pharmacy for a few summers during college and seeing some of our customers struggle with their HMO's rejecting medicines of different kinds, so I decided a PPO would be better. I chose the one with the lowest premiums because I figured Scott and I were young and healthy.
- Sickness strikes: Three or so years into the job mentioned above, I started to develop odd symptoms. I had trouble swallowing. Then I had body aches all the time. Then I was always exhausted, no matter how much sleep I got. Finally, my heart started racing at random times. When your heart does something unexpected, it brings on a lot of tests. I had multiple EKG's, a CT scan, and an echocardiogram. I had to wear an event monitor (basically like a portable EKG that you can use to record what your heart is doing when you feel it doing something out of the ordinary) for a couple of weeks. I had a multitude of blood tests, and when those started to provide clues, a thyroid ultrasound. All these tests are expensive, so it was lucky that I had good health insurance. It was also lucky that I had adequate sick leave and didn't end up losing my job due to the time I had to take off.
In the end, I was diagnosed with Hashimoto's disease. This was a better diagnosis than some of things doctors were considering, but it put me squarely in the dreaded pre-existing conditions
camp. No amount of participating in triathlons, eating goji berries, or meditating at sunrise
will make this disease go away. Prior to the full implementation of the ACA, private insurance
plans could have denied me coverage because of this disease.
- A plunge into the unknown: A couple years after my diagnosis, I left my job. This was in part to help Scott pursue a career opportunity, and in part because I had become increasingly unhappy at work. After leaving that job, I was able to pursue teaching, a new line of work for me. My new job did not provide me with benefits, but I was able to get health insurance under Scott's plan. Neither of our jobs at that time were "stable," but I had the courage to leave my previous job and try something new in part because, due to the ACA's prohibition on discriminating on the basis of preexisting conditions, I knew I would be able to get private health insurance if I had to.
- Kazakhstan: Our next jobs took us to Kazakhstan, where we were promised free global health insurance. Unfortunately, in our employer's world view, the US was mostly excluded from this globe; our health insurance would cover only the first 28 days of any visit to the US and only for emergency care. We knew some of our visits would last longer than 28 days, and I needed somewhat routine care anyway, so we needed to supplement this coverage somehow. We consulted with an expert, who told us that in NC (where we based ourselves during our time abroad), we couldn't sign up for ACA insurance unless we were physically present in the state for at least 6 months out of the year. We opted for COBRA coverage from Scott's previous employer. This was very expensive, and would only last for a maximum of 18 months, but for our peace of mind, we were lucky to have the option.
- Almost signed up for ACA insurance: When we returned from Kazakhstan, our 18 months of COBRA coverage was drawing to a close. We were in a race to either find a job with benefits for at least one of us, or sign up for ACA insurance. We consulted with the same expert who, upon learning that we were getting job interviews, advised us to wait as long as we could. Losing our insurance would have been a qualifying event to allow us to sign up outside the open period, so it made sense to wait until closer to the end of our COBRA coverage to see if either of us got a job.
- A new job with benefits: One of those interviews panned out for me! We were slated to lose our COBRA coverage on March 1; I started working on February 29.
Certain parts of my story--most notably moving to Kazakhstan--might be somewhat unusual. But other parts aren't. Anyone could have trouble finding a job with benefits, especially when they are young and lacking in job experience. Also, anyone, no matter how well they take care of themselves, could end up sick or injured and developing a "pre-existing condition." In some cases these sicknesses and injuries lead to people losing jobs, and therefore losing employer-provided health insurance. In other cases, they may prevent people from working in the first place. For that matter, anyone could be laid-off and lose their employer-provided health insurance that way.
I've had advantages that not everybody has had. I have educated, employed parents who kept me continuously covered on their health insurance until I turned 26. I have a graduate degree, which opens up opportunities to certain jobs that provide benefits. Scott and I have been married for ten and a half years, and we have added one another to our employer-provided health insurance during that time. In spite of that, I spent several months on a private health insurance plan before getting married, and we almost signed up for ACA insurance in 2016 before I started working at my current job.
There has been a lot of talk recently about repealing the ACA. There has been talk about replacing it, too, though I have yet to see a concrete plan for how that will happen. Trump has promised how wonderful the replacement will be. I hope he is right, not just for the sake of the 18 million people who stand to lose their health insurance right away, but also for the sake of everyone who might need it in the future. Anyone can experience bad luck, and I hope that people who do can at least have health insurance.