Wednesday, March 23, 2016
The Irony of "Affordable Healthcare"
Upon discussing my tax situation on Facebook, one of my friends agreed that the system is totally fucked up and rigged to keep people in poverty. Another friend said, “I don't think the government is fucked up, most of it makes perfect sense when you work through the details.” To which I replied, “yeah if you’re fucking rich it makes perfect sense, otherwise not so much.”
Whenever people tell me the system “works” or “makes sense” I have to wonder whether they are speaking from experience - like, did it really “work” for them? If so, well, good for them. I wish I could say the same. Or, are they just voicing an opinion based on political philosophy ungrounded in reality? At least when I advocate anarchosocialism, I admit my ideal is unrealistic.
I will say that the ACA did in fact work great for my husband, who had a life-threatening hernia that he acquired on the job, not covered by Workers’ Comp because he was an independent contractor. He could not obtain surgery due to making less than poverty-level income in Florida, a state that did not expand Medicaid. After he finally found an employee position that paid just barely enough to qualify for insurance, Obamacare literally saved his life. The surgeon said if he’d waited any longer it would have been fatal. The insurance covered everything, although not without a huge fight. The hospital billed the insurance company $39,900 for an uncomplicated hernia repair which should have cost $6000, and then the insurance company denied the claim and tried to make my husband pay the $39,900. It cost me nearly $1000 in lost time at work while I played “lawyer” and had to take the case to the State Insurance Commissioner. We ultimately won the fight and, more importantly, he lived, so this would be an example of when the system “works” although the details certainly did not make perfect sense.
As for myself, I’ve previously described my own experiences and how “the system” in general has not worked for me personally: Why I am Not Thrilled with Government. That was written before the bankruptcy limbo and tax fiasco. But more specifically, I would now like to describe what I find incredibly ironic about my current situation with regard to disability, medicine and health insurance.
At first, I was excited to finally be able to get real insurance to have “just in case,” because before the ACA nobody would cover me. The only insurance I could get was an accident policy which cost $59/month and would pay $5000 towards emergencies.
While living in California I was diagnosed with CFIDS, an “incurable illness” according to mainstream medicine. I tried to keep working part-time but got worse and went on CA State Disability, (the only time the system has ever worked for me!). When State Disability ran out, the doctors said, “You will never work again, we need to put you on SSDI. Don’t worry, you will certainly be approved.” My SSDI was in the preliminary stages of approval in CA when I moved to Florida at my dad’s suggestion to be near family and because, “you won’t be able to afford living on SSDI in CA.” This was probably true, as I have several friends on Disability in CA who are really struggling to survive. Upon moving to FL, my SSDI was denied despite having a great lawyer because even though SSDI is a federal program, the states get to decide who is approved and for what reasons. So friends, if you are disabled while living in a state like CA which offers good social services but has correspondingly high rent, all you need to do is move to a state like FL and your disability will magically disappear!
I had lost my previous insurance along with my job, not that allopathic medicine could do jack shit for my condition anyway. All the doctors were able to do was give me more and more antibiotics for the recurrent infections which in retrospect was ultimately a bad idea, leading to resistant bacteria and massive candida overgrowth. Having no other alternative, despite my initial skepticism I turned to holistic and herbal medicine which, to my surprise, was effective. In fact, my health improved even more after I stopped seeing mainstream physicians [as a patient] altogether about 10 years later, although I continued to associate with them on a professional basis until 2014. Thanks to holistic medicine I have recovered sufficiently to be able to work almost full-time and make a decent living. However, now I am facing unaffordable taxes and mandatory health insurance through the “Affordable” (?!) Care Act which I cannot afford and hope to never use, reserving it for major emergencies like broken limbs or being kicked in the head by a horse.
Furthermore, this insurance that I am being forced to buy, at the tune of about $180/month with the $4500 deductible, does not cover the herbs and supplements that actually make me healthy enough to work! I looked into HSA (Health Savings Accounts) because I seemed to recall that in the past HSA could be used for vitamins and supplements, but the current rules say, “you will need to submit a Letter of Medical Necessity, signed by your doctor, to verify this expense is a medically-necessary treatment for a known medical condition.” Obviously, it is highly unlikely that a mainstream physician would sign such a letter, given that the FDA does not recognize herbs and supplements as legitimate treatment for any disease. The only local doctor I know who would do this for me is an M.D. turned-holistic physician who is not on my plan and who, in fact, had her insurance privileges revoked due to curing an advanced-stage ovarian cancer patient using Issels therapy, which while legal in Germany where she studied, is not an approved therapy here in the U.S.
After doing my taxes, which included a $500 fee related to underpayment of premiums, I panicked, wondering how on earth am I going to pay my outrageous new taxes, now that I am above the poverty line for the first time in years?! But, I’m pretty good at math. So after a couple of sleepless nights doing math in my head, and then on the computer, I calculated how many additional hours I would have to work to pay my taxes in 2016 - keeping in mind, of course, that any “extra” money made will also be taxed, and that I’m an “independent contractor,” i.e. “de facto employee without benefits” and my income is variable. I came up with what seemed like a reasonable estimate, took a deep breath and said, “whew! Ok, it won’t be easy, but I can do this.” I then went to healthcare.gov, updated my income figure, and was surprised to see that my premium and out-of-pocket maximum had nearly doubled, and my deductible had jumped from $0 to $4500. Upon further investigation, I learned that the ACA bases your deductible on your income.
I suddenly realized that my insurance will now be completely useless for the purpose I would want to use it: riding my horse. I’ve been riding for 50 years, since age 2, been bucked off, bailed off, kicked, stepped on, even had my horse fall on top of me and knock me out cold for a moment, none of which ever sent me to the hospital, but there’s “a first time for everything” and I can’t afford to pay $4500 on the chance of breaking a limb, especially at my age. Not having anticipated that my ACA insurance deductible would go up to $4500, I had previously cancelled my $59/month accident policy, believing that I was now fully covered under the ACA, and I couldn’t afford both. So I guess I won’t be able to ride after all, and I’m paying these premiums for nothing.
I had the nagging feeling that I was overlooking something and woke up in the middle of the night with a terrible realization. When calculating the additional hours I would have to work to make enough “extra” money to pay my taxes, I had failed to take into account my new insurance premiums! Now I would have to actually work even more hours to be able to pay that as well. But, if I make more money, my premiums will increase correspondingly. If I were to work the number of hours necessary to make enough money to actually pay everything, I would definitely need insurance because I’d end up in the hospital. It’s simply not doable.
Holistic medicine has improved my condition from being too weak to take a shower, to being able to carry a 5-gallon bucket of water (50 pounds) in each hand while walking through deep mud, throw hay bales around, dig ditches, shovel concrete, and many other farm-related activities that many “healthy” people my age cannot do. It has enabled me to teach yoga and pilates and to work (at home) nearly full-time, or maybe even full-time if I totally neglect my house and everything else, but it didn’t turn me into Superwoman. No matter how I try to manipulate the numbers, there is no way I can earn enough money to win this game.
Again, I am convinced the system is rigged to prevent us from clawing our way up out of poverty. People on SSDI are especially in a catch 22 because SSDI doesn’t give you enough to actually live on, but if you manage to work and get close to making enough money to survive, you may lose your disability payments, despite the fact that you aren’t well enough to work a regular full-time job.