Affordable Care Isn't

Wow. It turns out that I applied and was accepted for health care under the Pre-Existing Condition Condition Insurance Plan just in time. Yesterday I made some phone calls to track down the insurance card I have not yet received, and discovered this website announcement by the Plan:

"Beginning February 16, 2013, the federally-run Pre-Existing Condition Insurance Plan (PCIP) is suspending acceptance of new enrollment applications until further notice. State-based PCIPs may continue accepting enrollment applications through March 2, and will then suspend acceptance of new enrollment applications until further notice. PCIP will continue providing coverage to more than 100,000 people currently enrolled nationwide."

The explanation is that the Plan has a finite amount of funding from Congress, and they have to suspend enrollment to ensure that there is enough funding to support current enrollees (about 135,000 of us) through 2013, after which the Insurance Marketplace will be available as dictated by Obama's Affordable Care Act.

How did this happen? Well, according to the Plan:

"Based on program experience and trends since the start of the program, PCIP enrollees have serious and expensive illnesses with significant and immediate health care needs."

Even though the enrollment volume has been much lower than anticipated, the government underestimated the expense that would be realized by people having to actually use the Plan.

Remember, the Plan is not free to enrollees (although it it partially subsidized by the federal government). We have a monthly fee, which is higher than what many people pay for health insurance through their employer. There is also an annual deductable, which can vary by state (mine is $2000 in Arizona). Coverage does not include dental or vision, which we pay on our own. Enrollment has not been as high as expected, because some people still cannot afford this health care option.

My concern is this... The federal government has miscalculated demand, what the public can afford, and the expense of delivering subsidized coverage. What other unfortunate surprises await us when Obamacare is fully implemented in 2014-2015?

Without a Net

In my transition from Illinois to Arizona, I have lost my health insurance.  The insurance I had in Illinois after my COBRA expired was a high risk pool sponsored by the state.  Having been declined for individual health insurance, I was eligible to apply for this safety net provided to full-time residents of Illinois.  My coverage was through Blue Cross Blue Shield, and we paid about $560 a month for it.  For Ron’s individual policy, we paid another $325 per month.  Each of us had a $2500 annual deductable.  Do a little math and you can guess that health care has been a substantial percentage of our expenses in retirement. 

Thirty-five states have high risk pools – Arizona is not one of those.  Now full-time residents of Arizona, I just sent in the cancellation notice for my Illinois insurance.  I applied for individual coverage in Arizona, and have been declined.  So now what?

The Obama administration’s Patient Protection and Affordable Care Act, AKA “Obamacare”, will be my safety net.  Although a very imperfect bill (yes, I read the whole dang thing), it will provide the option I need to secure health insurance in this long gap I am in before being eligible for Medicare.  Obamacare requires states without high risk pools to provide them to people who prove that they cannot otherwise obtain health insurance.

But…in order to be eligible for Arizona’s high risk pool, I have to be uninsured for six months.  This is a condition of entry into the plan that, frankly, I do not understand.  I prepared as well as I could for this period, by seeing my doctor and having a check-up, making sure my prescriptions are current, and having a colonoscopy.  All I need to do now is make it through six months without a major incident.  I am very scared that my situation has put me and Ron at great financial risk.

I’m writing about this for several reasons.  (1) If you have group health insurance through an employer – appreciate it.  You cannot be denied coverage, and most employers pay fifty percent or more of your actual health care costs.  (2) Your health is precious.  Any health issues become part of your history and until Obamacare is fully implemented in 2014, could result in you not being able to obtain insurance.  Finally, (3) You must consider and plan for your health insurance needs in retirement.  There are many resources available online that will clarify the situation and explain your options.

If the federal health care law is ruled as unconstitutional by the Supreme Court, I may be without my safety net for much longer than six months.  It doesn’t seem right that I can’t obtain health insurance, even though I can afford to pay for it.  Health care reform outside of Obamacare probably wouldn’t come soon enough for me.

Wish me good health!

Be Kind To Yourself

One thing I have discovered since quitting my job is that I have more time to be kind to myself. This is so important; yet when we are running from here to there and always thinking about what we SHOULD be doing, it often seems we don’t have time to take care of ourselves. With this thinking, we open the door to more stress, feelings of frustration and anger, and even poor health.

The first thing we need to learn is to forgive ourselves for not being able to do everything we think we should do. Enough with the self-flagellation for ignoring a dirty kitchen floor, running behind on the laundry, having to send a belated birthday card, etc. (And this doesn’t even address all the stresses of a job!) Sometimes you can only manage the things high on your list of priorities and scrabble intact from one day to the next. But you must occasionally put yourself at the top of the list.

Give yourself a break, and do something that makes you feel pampered. Be kinder to yourself. It will help you feel more like you are living than just surviving. Everyone has their own outlets. Here are some of mine:

• Taking an afternoon nap
• Treating myself to some flowers
• Having a manicure/pedicure or facial
• Playing! (golf, going to a museum, dominos, Wii)
• Indulging a passion (playing my ukulele, making jewelry)
• Enjoying a favorite food and drink
• Connecting with a friend
• Buying myself a present
• Sinking into a bubble bath
• Curling up with a good book

You have your own list of things you wish you had more time to do. I know you do! Carve out some time and be kind to yourself. It’s good for you, and you need it.

 

Health Care Shock

Health care reform has certainly been front and center recently among the issues being pursued by the current administration. I’m particularly interested in following progress on this reform, which I feel is much needed. Now approaching my 54th birthday, I am forced to pay more attention to the shadow cast by my past health issues as my COBRA is about to expire and I search for individual health insurance.

I consider myself to be in pretty good health – certainly better now it’s been more than 7 years since I survived colon cancer. Over the past 17 months, I have lost 25 pounds. I have been able to go from 3 prescription medications down to just 1 (for cholesterol). With regular exercise and a low carb diet, I am keeping Type II Diabetes at bay. I see my primary care doctor once a year for labs and a physical. But I have already been rejected for coverage by one major health provider based on my medical history. I’m on to applying to others, but am not terribly hopeful. I may be about to become one of the many Americans without health care coverage, unless we can come up with a creative solution. We’re smart – we’ll figure it out. But it pisses me off that this situation makes me feel that the security of my happy life is threatened.

The forms that have to be filled out to apply for medical coverage are very detailed. In addition to asking about major health issues, like cancer, diabetes or AIDS, you may be surprised to know that they ask whether you have recently or ever been “advised, counseled, tested, diagnosed, treated, hospitalized or recommended for treatment” for any of the following: alcohol use or abuse, illegal drugs, migraines or headaches, carpal tunnel syndrome, attention deficit disorder, any form of therapy or counseling, heart condition, high blood pressure, high cholesterol, allergies, sinusitis, bronchitis, hemorrhoids, ulcers, hernia, hepatitis, cysts, psoriasis, acne, breast implants, arthritis, bursitis, thyroid disorder, hearing loss, sexually transmitted disease, warts, impotence…and the list goes on and on. Oh, and are you taking any prescription drugs, do you or have you ever smoked or chewed tobacco, are you pregnant? Are you getting the picture?? (BTW, I’m thinking I should get a credit for any missing parts that have simplified my anatomy and completely eliminated risk of a handful of serious diseases.)

If you do not understand that health care reform is an imperative for our country, I will bet that at least one of the following is true for you: (1) You have always had health insurance through your employer that did not require a physical or a review of your medical history, (2) None of your close friends or relatives have become ill or died as a result of a lack of medical attention due to financial reasons, or (3) You have never really been sick or required a major medical procedure that makes you fear for your long term well being.

We need reasonably priced health care options that allow individuals to preserve their own personal security, while incenting us all to lead healthy lives. Why wouldn’t we want that for our country?