Affordable Health Care Feels Like A Privilege I Haven’t Earned

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Is the Affordable Care Act perfect? Of course not. But for women who have been systematically discriminated against for decades by health insurance companies, it’s a victory, says Laurel Hermanson.

A couple of weeks ago I visited the doctor twice, once for lab work and then for a follow-up with my doctor. Both times, I slapped my insurance card on the desk so fast the receptionists looked at me funny. I do this with equal parts pride and humility, always with a bit of apprehension. I fear that one day someone will call me out as a fraud, declining my little plastic rectangle of security because I didn’t earn it and therefore don’t deserve it.

I took health insurance for granted most of my life, because I always had it and believed I always would. After college, I switched from my parents’ insurance to my employer’s. There was no “managed care” then. I simply went to the doctor, and my insurance—for which I paid nothing—covered the visit, minus a small copay.

When my husband and I moved to Portland in 1998, neither of us had a job with benefits, so we applied for private insurance. He was accepted; I was declined. I suffered from migraines and allergies, and prescription coverage was the deal-breaker. That was the first time I worried about pre-existing conditions. I never imagined that being a woman might be considered a pre-existing condition, too.

As of January 2014, the Affordable Care Act will make it illegal for insurance companies to discriminate based on pre-existing conditions.

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My husband got a full-time job. Since I worked freelance, I was included on his insurance plan as a dependent. As our premiums rose over the next 10 years, so did the amount we paid out-of-pocket. I learned a lot about insurance companies and managed care then.

My premiums were higher than my husband’s. I didn’t know why, yet I was determined to get the most out of the twice-monthly pre-tax dollars taken from my husband’s paychecks. I studied each new plan. I knew exactly what was covered at what rate, and I fought for every dollar. If a claim was improperly denied, I called as many times as necessary to convince someone there was a mistake. I managed the shit out of our managed care.

Because of “gender rating,” a common insurance industry practice, carriers legally charge women more than men for the same coverage—even for policies that exclude maternity care. Women of child-bearing age are seen as high-risk customers. Women who purchase individual insurance are hardest hit.

Since laws against sex-based workplace discrimination prohibit employers from passing the cost of higher premiums to women in group plans, small businesses like my husband’s bear the brunt of gender rating in the group market. Not surprisingly, these companies have limited options. At best, they offer plans with high deductibles, some excluding maternity coverage for female employees, or including it as an expensive option. At worst, they offer no coverage at all. And one can’t help but wonder if this affects hiring practices.

As of January 2014, the Affordable Care Act will prohibit insurance companies from charging women higher premiums in both individual and small group markets.

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I once mentioned to my husband that I wanted to get a job so I could be around other people. He wasn’t enthusiastic. We had an elderly dog who was having seizures. Since we were trying to get pregnant and I planned to stay home, it seemed silly to start a job I would have to leave. But after six years our dog was long gone and we were still childless. I felt my independence slipping away.

And then two months later, I was pregnant. I was ecstatic, but also uneasy. I had many fears during my pregnancy, including the fact that I would, for the first time, be completely financially dependent on my husband. Still, when our daughter was born in 2005, I wasn’t worried about depending on him for health insurance.

Twenty-four percent of women are insured through their spouse’s plan, compared to just 11 percent of men. A woman with “dependent coverage” relies on several factors: her husband’s continued employment, his employer’s ongoing willingness to cover dependents, and, of course, the success of the marriage.

My husband and I separated when our daughter was 3. Our divorce took two years, during which time he was obligated to keep me on his plan and pay my monthly premiums. The day our divorce became final, I was on my own. I was an unemployed single mother living in a tiny basement apartment, but I never questioned the choices that brought me there. I was looking for a job and focusing on my daughter and my writing.

Eventually, I came to question the years I had spent working from home, and the three years I stopped working to take care of my daughter. In an economy with record unemployment, my job search proved futile. I had been out of the work force for more than 10 years. No matter what position I applied for, I was virtually unemployable.

Women are more than twice as likely as men to face insurance instability because they are covered through their spouse’s employer-sponsored insurance.

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Keeping my insurance through COBRA cost about $350 a month. I paid as long as I could, mostly from savings, a car accident settlement, and spousal support. When I could no longer afford it, I became one of millions of uninsured Americans, a group with whom I’d always sympathized but never expected to join.

I didn’t see doctors for routine checkups or when I was sick. Then I ended up in the hospital for several days with pericarditis, an inflammation of the tissue surrounding the heart. That untimely illness left me with bills totaling more than $10,000.

After my hospitalization, my regular physician, a woman I had been seeing for 13 years—at times even when she wasn’t a preferred provider in my plan—insisted I see her for a follow-up. For the privilege of chatting with her for 10 minutes, without so much as a stethoscope touching my chest, I was billed $248. I tried to dispute the bill, but the office manager never returned my calls. I kept getting bills and kept calling, until I received notice that my account had been turned over to a collection agency and my longtime doctor had fired me.

What I find most ironic is that the hospital that treated me eventually granted my request for financial assistance and wrote off the entire amount. Yet the doctor who had treated me for more than a decade took me down over $248, with no discussion.

Playing a game of chicken with a medical billing office was, in hindsight, rather stupid. But there were so many other bills. Most of my debt is on credit cards, which I pay regularly, but some is still in collections. I work freelance, but I don’t have the money to pay off everything. The shame I feel around that is even greater than when I had nothing. Every penny I earn and don’t spend on medical debt feels like a dollar’s worth of guilt.

I’ve done nothing to earn the insurance I now have. I married into it. Once again, I’m dependent on circumstances beyond my control. What if something happens to my husband? What if I get really sick and exceed my lifetime benefits?

On October 1, enrollment began in the Affordable Care Act’s Health Insurance Marketplace. And under the ACA, lifetime limits were banned in September 2010.

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The U.S. is the only country in the industrialized world that does not guarantee healthcare to all its citizens. Is the Affordable Care Act perfect? Of course not. But for the 50 million Americans who currently have no health insurance, the ACA offers options. And for women who have been systematically discriminated against for decades by health insurance companies, it’s a victory.

My fears of ending up underemployed and uninsured may now be unfounded, but years of being uninsured has changed how I approach my own healthcare. As I was writing this, I had a bad reaction to a medication, side effects my doctor had warned me could be life-threatening. Ten years ago I would have gone to the ER or even called an ambulance, but not this time. It was late and I couldn’t reach my doctor, and I convinced myself I didn’t need help right away.

My doctor called early the next morning and told me to go to urgent care. I resisted. Instead I went to ZoomCare, and they sent me straight to the ER. When the ER doctor wanted to admit me overnight, I resisted again. And then they pumped me full of drugs and I thought, “What the hell? I get to lay in bed and sleep. And I won’t have to worry about a $10,000 bill.

Later, I felt like kind of an asshole for letting myself relax and even enjoy being taken care of. Affordable health care feels like a privilege I haven’t earned. That mindset is so ingrained that I’ve put off making follow-up appointments with my regular doctors. I don’t know how long I’ll feel guilty about taking advantage of good health insurance. I don’t know how long I’ll feel guilty that I have it and millions of other Americans don’t.

I do know that Republican threats to overturn the ACA are a direct attack on women. Consider the hypocrisy of championing “family values” while pandering to hugely profitable health insurance companies that blithely discriminate against women. Consider that it took the ACA to prevent insurance carriers from denying coverage to women who’ve had a prior Caesarean section, or rescinding coverage for breast cancer patients due to errors on previously approved applications, or for simply being a woman of childbearing age.

There are roughly as many uninsured men as women. But the barriers to good health insurance are weaker for men than they are for women. And as long as health care reform is under attack, the war on women continues. I appreciate how lucky I am, but I won’t be truly comfortable with my good fortune until all women—all Americans—have the same options I have.

Role/Reboot contributor Laurel Hermanson is a freelance writer and editor in Portland, OR. Her first novel, Soft Landing, was published in 2009. She is currently working on her second novel, Mommune. She blogs about almost everything at Grace Under Pressure. Find her on Facebook and Twitter.

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