Hey y’all. I’ve seen a lot of myths, half-truths, and negative speculation about the Affordable Care Act making the rounds on the interwebs and have decided to share my experience with this scary beast popularly and lovingly referred to as “Obamacare.” I am aware of the downfalls of the ACA and by no means do I think it is a perfect solution to a very complex problem; it is obvious to me that we still have a long way to go with reforming our healthcare system in this country, but overall, from my experience, I would say that we are heading in the right direction. As a result of how the ACA has affected my family so far, I have high hopes that in the future we will see even more drastic reform to make healthcare truly affordable and available to all.
I will start by providing some background information about myself and my family for those of you curious as to what type of household the ACA is benefitting. I am an unmarried female, late twenties, full time job that pays around $30k per year. I am partnered with (but not legally married to) an early thirties male with a full time job which pays around $20k per year. Neither of us has any dependents. Everything is separate tax-wise as we are unmarried, but since we have a joint bank account, share all of our resources and have been married in every way other than legally for many years, I feel it is legitimate to take our entire financial situation into account when going into the specifics of how the ACA will affect us as a family unit.
Prior to the ACA reforms, I had what would now be considered a “gold” level individual plan through Blue Cross Blue Shield as I am employed by a small business who doesn’t offer a group insurance option. Part of my yearly salary (so included in the $30k figure) is doled out once per month in a check that is separate from my hourly pay and is specifically intended to help cover my insurance cost. I am lucky to have employers who care enough about their employees to offer this additional benefit, as many of my past employers offered no such assistance. This check amounts to around $265 per month after taxes are taken out. When my employer first offered this benefit, I had the choice to use it as additional income, OR apply it to my health insurance cost. I was uninsured at the time so I chose to start a gold level plan with BCBS, which that amount at the time covered. Over the past couple of years BCBS has raised the price of my plan each year to where it ultimately ended up at $325 per month, meaning the stipend I was receiving still covered most, but not all, of my monthly payment.
As for my partner, he hasn’t been insured for several years even though he’s been employed full time for most of that period. Unfortunately his employers in recent years have offered no benefits and there was no way we could afford to both be insured at full price (meaning no subsidies). Our only option for both of us to be insured would have been to both choose what would have amounted to “bronze” level plans, plans where the benefits barely outweigh the monthly costs for low-income individuals when you are paying full price for them. So basically, there was no point in both of us having crappy coverage that we could barely afford and couldn’t do much with. As such, we chose to pay for a good insurance plan for me since my employer offered the healthcare stipend and as a female I have some medical needs at this age that he does not. We lived on hope that nothing serious happened to him that would require a doctor, prescription medication, an emergency room visit, etc. We were lucky in that regard, and he hasn’t seen a doctor for any reason in years, including no preventative care visits. So lucky thus far, but far from an ideal situation.
Okay, fast forward to the exciting new future of healthcare in the good ol’ US of A in the year 2014, and here is our current situation. Under the Affordable Care Act stipulations, we both need to be insured to avoid paying fines at income tax time each year. Okay, yeah, that kind of stinks, but can we both afford decent insurance plans to make it worth avoiding the fines without spending any more money than we already were for just my plan? The answer is a resounding YES! (Can you tell I’m excited?) Under the ACA, based on our projected income for the next year as stated above, we are both provided with subsidies that make our monthly payments affordable for both of us to have silver level plans from Blue Cross Blue Shield. These plans provide affordable basic medical services, as well as caps on what we would be responsible for if and when either of us ever has any major medical issues.
Now, don’t get me wrong, it hasn’t all been kittens and roses, or whatever cute/nice thing you like. My experience with www.healthcare.gov was kind of a nightmare at times and had me worrying and pulling my hair out for two and half months until I was able to get everything straightened out. Here’s the jist of it: I started my application within a few hours of the website going live (I now recognize that this was a grave mistake on my part), spent about 50 online sessions clicking through the same application as there is no way to “jump” to the last page even when all of your information is filled in and saved (this probably amounted to several wasted hours of my life), went through a handful of 10-20 minute phone calls to the website support team once I hit a website glitch where it was unable to verify my identify (these phone calls all being pointless as I was put off each time and not helped at all), all of which finally led to me submitting proof of my identity via website form multiple times, scanning/uploading supporting documents, AND mailing the same documents through snail mail. None of which made any difference, of course.
So at long last the debacle culminated in an hour-long phone call with a representative from the website support team who, at my very determined, demanding demeanor (the deadline to update my plan with BCBS was the next day), FINALLY helped bypass the website error and get my identity verified and thus, my application submitted. I can’t remember his name, but I think I was in love with him for a brief moment as a massive wave of relief and a feeling of victory washed over me.
Oh, and for the record, my partner didn’t start his application until the end of December, once they had the initial website glitches worked out, and he got the whole thing done in under an hour with no phone calls required. Lucky him.
For those of you interested in the specifics of the actual insurance plans we have chosen through the marketplace and how they compare to what we had before, here is a hand-drawn not-very-professional graph with specific numbers to satiate your curiosity. Please note that the post ACA monthly premiums are factoring in the maximum subsidies that we each qualify for.
As you can see, while my insurance plan isn’t quite as good as it was before, now we both have decent coverage and reasonable caps on what our maximum yearly expenses would be if we needed any serious medical care. In addition, it is interesting to see that even though we both have similar silver level plans, his out of pocket expenses, deductible and copays are far lower than mine. I assume this is a result of the ACA taking income level into account and giving him breaks accordingly, so that essentially he has as good of a plan in terms of coverage and caps on out of pocket expenses as the gold level that I had prior to the ACA. I would also like to note that, while I downgraded to a silver level plan to keep our combined monthly premium more affordable, I could have continued with a gold plan just as good as, if not better than, the one I had before and spent $77 less per month on it with my subsidy taken into account.
So, to conclude the saga of how I got insured under the Affordable Care Act, the process was a little ridiculous but in the end it is working out beautifully for my little family and therefore I am pleased. I’m massively relieved that I no longer have to worry about suddenly being blindsided with hundreds of thousands of dollars of debt because of a medical emergency or serious health issue, that both my partner and I can see a doctor for preventive care purposes and/or medical necessity without it breaking the bank, and that even with having both of us insured we are paying a little less each month than what it was costing for just me before. All-in-all, it’s a win for us. I have also spoken with several friends with incomes in the same range as my family, and several of those people have told me that they can opt for bronze level plans that cost them literally nothing once their subsidies are applied. If you are a low-income individual or family who isn’t offered group insurance through your employer, I highly encourage you to not be put off by all the negative propaganda out there. Take an hour of your time, visit the website and see for yourself what it can do for you. You are the intended recipient of the benefits offered by the Affordable Care Act; don’t let your benefits go to waste out of fear or skepticism.
Amanda Wood is a writer and editor based in Asheville, North Carolina. She received a BA in English from the University of North Carolina at Greensboro.