Real Lives

What ‘Health Insurance Reform’ and ‘Obamacare’ is really about from TPM Reader JL

I had wanted to email on this subject right after the launch but I’ve been crazy busy and just now getting a chance. I’m only one data point and probably not even a very instructive one but did want to share my story …

About ten years ago when I launched my own business I arranged to do enough part-time work for my old employer to stay on their healthplan (on my nickel). A few years later I developed kidney cancer.

I had the offending kidney removed (at which time I was introduced to the expression “the cut is the cure”) and the prognosis is extremely good. At that point of course, in spite of a great prognosis I was in pre-existing conditions land. With two young kids I deliberately kept the part-time arrangement going long after I had any interest and long after frankly it made much sense for them. But the time for me and cost to them was very modest, so it kept going.

Finally, though a couple years ago, the part-time thing finally ran its course. The good news is the company was willing to just keep me on the healthplan indefinitely (again on my nickel). That was great but a bit over a year ago I found out that I have Psoriatic Arthritis (PsA) (same thing Phil Mickelson has). Thanks to having one kidney, I was not a candidate for most of the drugs used to treat PsA. Within a matter of months it was clear I needed to take TNF blockers. These are extremely costly “biologics.” I knew there was a potential problem with insurance but the risk of untreated PsA is severe, permanent joint damage, so I forged ahead.

Well, within a few days of authorizing me for Enbrel, I got booted off of the healthplan and put onto COBRA. The COBRA will run out on this spring. There is absolutely no way I can get insurance outside of the exchanges, and I’ve got 11 years before I’m eligible for Medicare. As you can imagine I was EXTREMELY interested in the launch of Obamacare. I went into the Massachusetts exchange the morning of October 1st. It definitely had some problems but I was at least able to do what I wanted, which was to look at options that would allow me to keep my current providers and determine the cost. Although it took a bit of doing to get there, I was absolutely thrilled with the end result. I’ll be able to get very good coverage, keep my doctors, and spend a lot less money. I haven’t bothered to go back and actually enroll because I’ve got some time. But it sure put my mind at ease.

Again, probably not all that instructive but wanted to share the story.

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