The ACA (Obamacare) and me

Diabetes Advocacy Self Advocacy
1

I surely hope the ACA helps a lot of people -- and helps them a lot.

It looks like it will result in me having to give up the insulin pump, and CGM. Two devices that have changed my T2 life, and made me normal w.r.t. blood sugars.

I expect to have complications, and suffer a painful early death as a result.

Here's the deal: At my small company (18 people) the health care option I've chosen to cover me and my family (4 total) costs $789/mo. Fortunately, this plan continues through 2014 because we "got in under the wire" and renewed before some deadline that allowed us to "keep the health insurance we like", and keep our doctors.

I went on the "Covered California" site to see what I'm facing next fall in open enrollment. The closest plan is the Gold.

With a premium over $1,400/mo. Deductible is 4x my current plan. So is OOP max.

I worked all the numbers, and there is no way we can afford this. This plan will hardly pay for anything of my annual expenses, because of the huge deductible increase.

To add insult to injury, none of my doctors are in-network for any of the carriers offering Gold plans.

Finally, I make too much money to qualify for any subsidy. Basically, my out of pocket -- including the premiums -- will go from around $13,000 a year to $30,000 a year.

I can't afford that, of course.

So, goodbye omnipod. Goodbye G4. Probably goodbye insulin altogether.

2

I know another family that's losing their health insurance because they're a small company. Obama has apologized to the 5% (though it's probably more) that will lose their coverage rather than benefit. Like it makes a difference to the people whose out of pocket will go from $13,000 to $30,000 a year.

Personally, I think he should pay those people's out of pocket from his salary--for lying, not thinking this through, and overall being a moron. Our universal healthcare will deprive doctors and ordinary citizens alike. The best way to do this would've been to take capitalism out of it, but that would be even more socialized than what he'd already planned. Too bad.

I'm terribly sorry about all of this. I hope you find a way to keep your supplies somehow.

3

I couldn't afford that kind of price increase either. And I would feel lost without a pump and CGM! The ACA is flawed, especially in cases like yours. Let's hope that changes can be made going forward that will address this inequity. The ACA is a huge program and other huge program introductions, such as Social Security and Medicare, significant improvements were made in the years following their implementation.

During the health care debate that led to the ACA, I supported first, a Medicare for all system, and second, a public option choice. The ACA is neither of those. I believe that access to health care is a right, not a privilege.

The ACA, in concept, was conceived by the conservative think-tank, the Heritage Foundation, as a response to the failed Clinton administration health care proposal in the '90's. Remember the demonized "HillaryCare?" The ACA is not socialized medicine, far from it. If we had a Medicare for all system (still not socialized medicine!), stories like yours would be different. The US political system surely disappoints sometimes.

I wish you luck. Do not give up hope! You will certainly get your insulin covered. Perhaps you could use 2014 to pack away as many "extra" infusion sets and sensors as possible to cushion the loss of affordable supplies.

4

The reason the plans don't work is because the medical industry itself, the AMA/ AADE, etc. who set standards have been negligent in failing to recognize the clear benefits of testing regularly and tighter control with the sort of fine tuning and adjustments that are possible with pumps and CGMs. I don't engage that much w/ my doctors that I would care about being in or out of network and would go in network to save money (atlhough none of this applies as we have a PPO plan we are able to keep as we both work for enormous companies...the Dilbert stuff can be extremely stressful but the benefits are very useful).

I am not seeing how Obama is personally responsible for the flaws in the plan. Getting everyone insured is an important first step in reining in health care costs. People with diabetes need to lobby more aggressively, or maybe file class-action suits, to push the number of strips "needed" to a reasonable level, prove that tight control is not as dangerous as the medical community believes and that insurers, whether privately funded or governmentally based, need to provide coverage for these items. Testing should be a right.

5

"I am not seeing how Obama is personally responsible for the flaws in the plan."

Obviously, the buck stops with the "man in charge" and he did sign it, and "they" tagged his name to it. But really this stuff has to get through Congress. If there is something about this folks don't like it is all to easy point the finger at Obama when it was a Republican lead congress that conjured up and voted for a lot of this stuff.

Anyhow, I agree with you and just wanted to add that extra bit.

Also - I'm self-employed and had some crappy coverage for the past few years because I figured I was generally healthy and didn't need anything more than coverage for the hit by a bus scenario and a few doctor visits a year at most.

July of this year that all changed quite a lot.

So now I'm saddled with all of the expenses, etc and my current insurance only has generic prescription plan, etc So I am out of pocket on everything.

In my book - the ACA has been huge. I got 90% covered for 360 and change per month w/ 500 deductible and 1650 max oop.

When I total everything up the ACA helped me (aka forced the insurance companies to provide a plan) save $100+ bucks per month on all my Beetus stuff and covers me quite well for all the unknowns.

Without it I was staring down the denied or a jacked up premium that is more expensive than just paying out of pocket for everything due to preexisting condition.

Of course, I'm a single fella with very few other expenses.

And California puts a 10% tax on the sunshine so it is understandable that the premiums are though the roof as well.

6

Is it possible that your employer will still offer insurance after this year? Small employers may be eligible for a tax credit for this.

I haven't been able to access our state website to enroll, it has been down all week and wasn't really working before that. From what I've seen, it is not all that promising though, it looks like we will have high deductibles on the reasonable premium policies or high premiums on the reasonable deductibles. I have not been able to ascertain what if any subsidy we will get since that has been broken too.

7

oh no :(

I hope that you can figure out a way to keep your pump and cgm and not pay exorbitant prices for whatever health insurance you end up with. One thing you can try is forming an LLC within your family for some sort of business. Then pay yourself a salary and apply for one of the non obamacare insurances which will allow you to keep out of network docs and which may be a lot cheaper. I think if you have your doctor write letters of medical necessity for your pump, cgm and test strips you may have a chance of keeping these, don't give up. I doubt they are going to take you off insulin since you have already been on that, that would be crazy. I do agree Obama made a lot of mistakes in this plan, the first one being that all the plans are hmo and you have no choice of what doctors you go to and I think no compensation for out of network etc.

8

I am so sorry. Unfortunately there are millions of other people in similar situations… I just hope that the more it becomes evident what a mess has been made with all of this the sooner the cleanup can begin

9

This is the choice of your company, not the AFC. They can offer you the old insurance if they want to as long as it meets the guidelines.

If you out of pocket costs are $30,000 that makes no sense at all because the out of pocket caps are some where in the $1500 range on Gold plans.

I looked into this extensively. I signed up for a Platinum plan. I get no subsidies.
it will cost me $488 per month and covers all diabetes supplies inc sensors and pumps at 90%. and insulin is $5 per bottle.Test strips are also 90% covered.I am paying $545 now for just 80% coverage.

I looked at several different companies and they are all very similar. Platinum is 90% gold is 80%. I even put in a family of 4 and I could not get anything near what you quoted.

My family of 4 is quoted at $966/ month. But I need coverage just for me right now.

It may be worth going back and finding out what went wrong or changing your options when you apply.