For all but nine months of my adult life, I have been one of the millions of U.S. residents who purchase health coverage directly from insurance companies, known as the individual health insurance market.
I did not have an employer that offered health insurance, nor did I qualify for any public programs. Because of this, I know what happens when pre-existing conditions like lifelong asthma become obstacles to getting coverage as an adult. I understand how insurance companies punish patients who commit the cardinal sin of actually using their coverage. I also know that “expanded choice” and “access” do not mean better health outcomes.
In the debate about health insurance, most of the discussion has focused on access and affordability. This was key to selling the Affordable Care Act (ACA), aka Obamacare. In their defense of the terrible, horrible, no good, very bad replacement called the American Health Care Act (AHCA), the GOP talking points also emphasize these crucial components. But if the House bill becomes law (the Senate has yet to unveil its version), 14 million Americans currently covered would lose access to health insurance in 2018 alone, according to the the Congressional Budget Office, many because it will be too costly.
Lost in the political noise is the real-world impact of an unfettered health insurance market for individuals. Today, as in 2009 when the ACA was passed, the majority of Americans receive their insurance through their employer. Prior to the ACA, those who weren’t seniors or very poor—who were eligible for Medicare or Medicaid—were at the mercy of private insurance companies.
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And, I can assure you, there was no mercy.
Thanks to my father’s 28-year career as a United States Army soldier, I was born into government-subsidized health care. As we moved around the country and Europe, I was diagnosed with asthma and allergies. I fractured my foot, got braces, and endured many typical childhood maladies. My mother never worried about money when she took me to the emergency room during an asthma attack. There was no panic about the cost of the X-rays that diagnosed my pneumonia. Co-pays or medical bills were never topics in my home. This is the beauty of socialized medicine.
As a military dependent, I could continue to receive medical care while I was in college at any military base until I graduated, though I used the free student health services for convenience. Near the end of my freshman year, declining the opportunities to lose my virginity was becoming so … frustrating that I started looking for a gynecologist. My mother suggested Planned Parenthood.
Little did I know that, for the next 17 years, Planned Parenthood would be my only access to health care.
Planned Parenthood has been a favorite target of the GOP for decades. In the AHCA version passed by the House, Section 103 denies federal funds for “certain family planning providers” for a period of one year. They specifically note Planned Parenthood as an “example” of one such provider. For me, this is a clear indication that they have no desire to improve access and affordability because without Planned Parenthood—one of the nation’s largest health-care providers—there will be neither for millions of Americans like me.
By the time I graduated from college, I had developed a positive relationship with my local Planned Parenthood provider and saw no reason to go elsewhere. I continued to go there for my annual exam and left with a year’s supply of birth control and more condoms than I would ever need (they were obviously much more hopeful about my sex life). I would also get a prescription for my asthma medicine when needed, which would cost me little more than $15 to fill at my local pharmacy. Planned Parenthood filled all of my health-care needs, including referrals.
I worked in the music business for several years after graduation. None of the small- or medium-sized companies I worked for provided health insurance. Since I had Planned Parenthood with its affordable sliding payment scale and remained healthy, this wasn’t a big deal. The costs of my yearly visit would range from zero to $50, depending on my income at the time. It was a better deal than any insurance plan.
Wanting to be more of a grown-up, I decided to be responsible and get health insurance. It was the mid-’90s, and the Clinton administration had made health insurance reform a priority. At the time, some employers were not hiring out of fear that they would be forced to provide insurance for employees. This uncertainty allowed me to maintain a very lucrative “career” as an administrative temp but no insurance.
I became adept at completing health insurance applications. I indicated that I had asthma since I was 4 years old and allergies, both controlled with medication. I dutifully noted that Planned Parenthood had diagnosed me with fibroids but they were not under treatment; this would be a crucial revelation more than a decade later.
Over the course of six months, I filled out more than a dozen applications. I was denied by all.
Why was a healthy, active woman with no pregnancies who only went to the doctor once a year denied? I had made the mistake of having asthma. I appealed but was denied. In at least two cases, I was offered a plan that wouldn’t cover my chronic condition for premiums at three times the base price. I was 26 years old—and not a high-risk patient.
I would learn that the “in the last two years” (and sometimes three) was the magic phrase. Prior to the ACA, there were dozens of pre-existing “declinable medical conditions” that insurance companies used to deny people coverage. While it was OK to have been diagnosed for asthma, it was not okay to be on medication or receive treatment. I couldn’t lie, of course, because I would have to list all previous doctors so the insurance company could request medical records.
So I stopped going to the doctor.
I still went for my annual checkup at Planned Parenthood, but skipped getting the prescription for my asthma medicine so it wouldn’t leave a record. Instead, I relied on a network of friends and family in health care who would send me the almost-expired samples provided to the doctors with whom they worked.
After two years, I applied again, answering honestly that I had not visited a doctor (outside of my annual Planned Parenthood visit) or been prescribed medication for any of my chronic ailments during that time. I was approved.
For less than $100 a month, I had access to doctors, specialists, and medicine through a large HMO. It was perfect timing because my ad-hoc self-care had landed me in bad shape. I couldn’t be outside on windy days, and walking down one flight of stairs would require a rescue inhaler. When I called for an appointment with the asthma specialty clinic, the intake nurse wanted to hospitalize me that day.
I wasn’t hospitalized, but I was put on a very aggressive treatment. I was prescribed a new long-acting medication that changed my life. Allergy testing revealed that I had several food allergies, which exacerbated my asthma. I remain on the protocol they developed to this day.
Not long after, I was offered my first job with full benefits, with my employer paying 100 percent of the policy costs (no paycheck deductions!). I went to my first non-Planned Parenthood gynecologist during this time, who identified more fibroids, which still didn’t require intervention.
Since I was paying nothing for this health plan, I decided to cancel my private insurance. Why pay when I didn’t have to?
Nine months later, my company—and my job—went bust along with the rest of the dot-com bubble. I applied to reinstate my health insurance with the same HMO. I was denied because I was still using the asthma maintenance program created for me using the very same insurance. Nevertheless, health insurance companies value profit over common sense, forcing me to seek other ways to get care.
I was lucky that my chronic pre-existing conditions were manageable, which kept me from another dangerous decline in my health. I was lucky that I lived in Los Angeles, where a new large community clinic opened in my neighborhood. And, of course, I had Planned Parenthood.
It would be another ten years before I would be able to get health insurance again.
I was on a three-year plan to start a family when I finally found affordable health insurance. My priority was to establish a relationship with an OB-GYN. On my first visit, an ultrasound revealed several large tumors in my uterus. Many appointments and an MRI later, my doctor discovered several large fibroids. He said the only way I would ever get pregnant was to have surgery.
Those fibroids I was first alerted to all those years before during a Planned Parenthood visit had finally become serious. Six months after signing up for insurance, I was on the operating table where 22 noncancerous tumors were removed.
Several months later, my doctor’s office called saying that they still hadn’t received payment from my insurance company. It seemed that it was accusing me of lying on my application about a pre-existing condition and threatening to cancel my insurance and not pay the bill.
Unfortunately for the company, I did no such thing. I noted I had my annual checkup at my provider, Planned Parenthood, and that they had indeed indicated I had fibroids more than a decade before. The insurer paid the bill.
At the end of the year, it stopped offering the very affordable plan that allowed me to get the care. Instead, I was forced into a different plan with less coverage.
Should the AHCA passed by the House become law, millions of Americans will, once again, face the health insurance turmoil that existed before the Affordable Care Act. There is little expectation that the Senate bill that is being hidden from public view will do much to prevent that nightmare, and it’s impossible to know if Planned Parenthood is in the Senate’s crosshairs.
For now, our only hope is that there will be enough public backlash that no senator with even a modicum of human decency will agree to a proposal of anything less than the health-care options we currently have. To do otherwise would be cruel and unusual punishment.
Have talked to your senator today?