We are writing to tell you about your 2015 health plan." The letter is to my wife and me from Blue Cross Blue Shield of North Carolina. It's about our insurance policy under the Affordable Care Act. We're automatically approved for next year. But there is some fine print. Our monthly premium will increase by—I did the math—26 percent.
I mention this not to complain about the ACA, better known as Obamacare. Thank goodness for it, or we—freelance writer, self-employed consultant—would be at the mercy of an unreformed health insurance industry that would've ripped us off even worse because of our pre-existing condition: Each of us is 64 years old.
Insurance companies don't like old(er) customers. Why? They get sick. Then, you know, they need health care, which these "health insurers" try to avoid.
We're not sick—yet—but absent the ACA, I'm not sure we would've been able to find individual insurance coverage at all. And if we did, the cost would've been exorbitant.
So I'll give it up for the ACA's rule that insurance companies must sell to everyone and can't discriminate on price because of one's pre-existing illness or propensity thereto.
That said, I know from personal experience why this Rubik's cube of a law, which so fundamentally improved life for millions of Americans, is nonetheless widely reviled:
• Did I have trouble with the government website when I signed us up? I sure did.
• Did I end up with a plan that didn't cover our family doctors? Yes.
• Did it cost us a bundle? Maybe. Maybe not.
• Did it shield us from the seemingly insatiable appetite of the health-care industry for money? See the 26 percent rate hike.
• Am I switching plans? Yes.
Long story short, we came perilously close to not getting through the ACA application process a year ago because of that wretched government website—healthcare.gov—despite dozens of tries.
I say perilously because, after I did get through, aided by a customer assistant who took my information over the phone—and after he'd signed me up for a Blue Cross Blue Shield plan—BCBSNC wouldn't issue the policy because the "paperwork" from healthcare.gov lacked a crucial number: the price. At healthcare.gov, they were stumped.
The standoff went on for weeks.
Finally, when BCBSNC cut through the red tape, we were so relieved that we didn't notice that the plan I'd chosen over the phone had a "limited network," and it didn't include our family doctor or my wife's doctor.
By the way, the state Department of Insurance was no help. That's because the General Assembly passed a law prohibiting state officials from assisting with the ACA in any way.
Also, they refused the Medicaid expansion program, despite the fact that it's 100 percent federally funded, which cost our state $3 billion a year and left hundreds of thousands of our neighbors—the working poor—ineligible for ACA coverage at any price.
When these folks go to the hospital anyway, as they do, their unpaid charges are a big reason why ACA rates in North Carolina are high compared to states that did accept Medicaid—witness the 26 percent increase.
Yes, the Republicans who control North Carolina hate Obamacare that much.
New York Sen. Chuck Schumer caused a storm in Democratic Party circles recently when he criticized President Obama for pushing health-care reform in 2009–10, his first two years in office, instead of focusing initially on bringing the economy out of the Great Recession.
My own view is that Obama was right to move on health care, but the way he did it was so wrong it would've been better to delay.
We are better off with the ACA than without it, but its passage caused the Democratic Party to be decimated in the 2010 elections, which unfortunately allowed regressive Republican legislatures across the country—including in North Carolina—to dominate the redistricting process that follows each new decade's census.
The result is that the U.S. House is now and will remain for the foreseeable future under Republican control, making the passage of progressive policies next to impossible for a generation. Was it worth it to cover pre-existing conditions?
Yes, if that was the only way to get them covered.
The right way to have done health-care reform, though, was by a single-payer plan—Medicare for all—or by the public-option plan that Obama (and Hillary Clinton) campaigned on, with the federal government offering a Medicare-like program in competition with insurers like BCBSNC.
Would Congress, then under Democratic control, have passed it? We'll never know, because Obama didn't try.
There's a lot of good in the ACA, but it has two great flaws. One is that it creates separate programs for people with high incomes, middle incomes and—via Medicaid expansion—low incomes. The second is that it's based on the states to make it work.
Since 2010, most of the states haven't wanted it to work.
As to the ACA's layer-cake approach to health care by income, it relies on people knowing—or guessing—what their income will be for the year ahead. Middle incomes get subsidized rates. High incomes don't. And if you fall too low—you get no subsidy, only Medicaid. Except in states where you don't.
The reason I can't tell you yet whether we're going to pay a bundle for our 2014 insurance plan is that the totals aren't in for our income this year. If it's low enough, we'll qualify for the subsidized rate of just $453 a month. Sweet.
Too much, and we'll owe another $9,000.
If you owe me money, pay me next year.
This article appeared in print with the headline "My year with obamacare ."