Running in circles and getting nowhere

Running in circles and getting nowhere

As I write this I’m standing in line at the Illinois Social Services Office in the Humboldt Park section of Chicago. I’m here because something went off track in my effort to transfer my health insurance from New Jersey. Last year at about this time, I applied for insurance through the Healthcare Marketplace. The ACA was supposed to be a great benefit to the self-employed like me. And it was – until I moved.

The marketing of my business was largely put on hold this year because of my pending move. My part-time job doesn’t include healthcare. My lack of substantial income has made me eligible for low-cost or free healthcare through Illinois Medicaid. Lucky me. Sort of. I wasn’t given any other option. I received my notification of the determination from the Healthcare Marketplace in mid-August and was waiting for the specifics from the state (like I had received from New Jersey last year). When October rolled around and I still hadn’t received anything, I called. While the kind woman on the phone said she’d file a complaint, she said the best thing I could do to expedite my coverage was to come down here.

It should be noted that while I still have healthcare coverage with Blue Cross/Blue Shield of NJ that was obtained through the marketplace, participating doctors are only in New Jersey. Doesn’t do me much good here in Illinois. The finger that was injured almost eight weeks ago when my dog saw a squirrel isn’t healing and I need to get it examined. This is why disadvantaged people are kept down. Problems aren’t as easily solved, and life has a way of spiraling downward.

img_3296.jpg
My “Mallet Finger” almost 8 weeks ago. Waiting to see a doctor.

This is an important lesson in how the disadvantaged live, what they are subjected to and who makes up this group. Of the 50 or so people sharing the line with me and the few dozen sitting waiting for the next step, I am one of only four Caucasians. Other than that it’s a pretty diverse group of shapes, sizes, genders, and generations – toddlers and pregnant women and the elderly. Everyone is being patient and quiet. No one is angry or boasting a sense of entitlement to anything.

I’ve been here for a half hour. There are eight people still in line ahead of me.

This was not what I wanted to be doing today of course. I’m trying to focus on my business plan and creating a strategy for execution. I am trying not be distracted by the sense of despair I tend to feel at this time of year. The anniversary of my husband’s death is coming up on Saturday. I’ve learned over the last few years to ride the waves, and that yes, this too shall pass. But knowing that still doesn’t make the negative feelings or the depression go away. And times like this – waiting in line at a social services office – makes me long for everything I feel I let go – my six-figure income, my four-bedroom house in the wealthy suburbs of New York City, and yeah, employer based healthcare that didn’t require I wait on line to prove my eligibility.

Finally seen by an agent, I explain my issue; she tries to give me the number I called yesterday when I was told to come here. I was assertive and was then told to sit and wait for my name to be called. I’ve now been here for almost an hour. I am wondering if all of these people will be assertive to get what they need, or have they been beaten down enough by the system that they will backdown when confronted with a challenge.

I’ve been on edge and overly sensitive over the last week or two. I ran the Bucktown 5k on Sunday and felt really sad, homesick I guess, longing for the races where I knew so many of the other runners and race staff. I thought of the Cheers theme song, “where everybody knows your name.” No one knows my name here.

And yesterday, I needed a walk in the woods, to be surrounded by tall colorful maples and oaks, to climb to the top of a mountain to uplift my soul and embrace all that I still love about autumn. But that is so far away; I am so far, too, from anywhere I want to be at this very moment. Waiting.

I don’t like waiting. I’ve always been a doer. I’d rather drive out of my way than sit in traffic. I feel so much better when I’m moving. Movement makes me feel in control or at least like something’s happening – forward motion, accomplishment, miles logged.

After my name is called I explain, again, what has brought me here. I am told that there is a 60-day backlog on applications, and that providing a copy of my pay stub (why didn’t the woman on the phone yesterday tell me to bring that?) will assure that they have all they need to process my application. So after investing two and a half hours here, I have to return home to retrieve it and bring it back, and start over. They said at 3:30 the line might not be as long.

My daughter still needs to get her Illinois driver’s license. Tomorrow I was planning to take her to DVM. LOL.

Fall on the Prairie. About an hour away. Long Grove, Illinois. October 2017.
The uninspiring terms of the AHCA

The uninspiring terms of the AHCA

The mission of this blog – and my coaching business – is to inspire better physical and mental health and a passion for life.  Not having affordable and adequate healthcare coverage could certainly undermine one’s ability to be inspired. So, just 5 days after the House voted to repeal and replace the ACA, I feel compelled to discuss healthcare.

We often make judgements based on our own perspective and fail to see how others are affected. I am not immune to that. Let’s go back to 2005, when as the CEO of a small non-profit I was tasked with finding an affordable healthcare plan for our 5 full-time employees. Not an easy task given our census. I was also aware that given the size of our organization, we were not required by law to provide healthcare insurance to our employees at all.  But many of our employees were heads of households or single, and providing insurance was part of a compensation package that would allow us to retain a good experienced, staff. Truth be told, I wouldn’t be able to stay in my position there had we not been able to offer full medical coverage.

Training for the NYC Marathon at the time, I was working out regularly, eating right, getting lots of rest and, in my opinion being “responsible” for my healthcare.  I required only preventative care, as did the other members of my family. We were all young and healthy. In spite of the contradiction of being CEO of a cancer support organization, I was of the mind set that people who took a proactive approach to their health – people who invested their time and money in regular exercise, good nutrition, and other healthy habits – should be rewarded with lower health insurance premiums. Makes sense, right? Like drivers who don’t have accidents and tickets verses those that do.

I made the decision to go with a low-premium, high-deductible plan with an HSA (Healthcare Savings Account) to which the organization would make an initial contribution to fund the high deductible for year one. The thinking was that, at least in the first year, employees would see no real increase in their healthcare expenses and in subsequent years – if they didn’t spend down their HSA – they would actually see their costs go down. And after the initial investment in funding employees’ HSAs, the organization (which I will note was a non-profit always on the verge of bankruptcy) would save a significant amount of money.

Every employee with a healthcare issue (read: “pre-existing condition”) — which was pretty much everyone but me and the finance director, had an issue with the plan. But it was a done deal. I had reviewed all the figures and it appeared to be our only option to keep the staff covered and the organization out of bankruptcy. (I’m not completely sure I wouldn’t still make the exact same decision today, except that I would involved staff in the process, be more curious about their needs and concerns, and share with them my concerns about the financial viability of the organization, and I would be completely more empathetic to the issues they faced. Read on…)

As healthy as I was, in early 2006, I began to develop sciatica. I spent through my HSA trying to remedy it, and because I had family coverage, I still had $2500 of my deductible to cover out of pocket. As a result, I took some pain meds saw a chiropractor for months, and opted out of more expensive diagnostic and treatment options. I never fully recovered until it came back worse than ever in 2011 after a fall. Thankfully I was under a much better plan with a new, larger organization, got the MRI, a Lumbar Epidural Steroid Injection (LESI) because it had gotten to the point where I could barely walk and running wasn’t even an option. That was followed by months of physical therapy.  With the exception of some minimal co-pays, it was all covered by insurance and I was healthy again! I got back to running in 2012, even completing 13 Half Marathons in 2013.

But, would I have not saved the insurance system money had I just addressed the issue in 2006 when I probably wouldn’t have needed the LESI?

 

At the beginning of 2014, I was training for the NJ Marathon and never felt stronger or healthier. Eleven weeks into the 16-week training plan I was diagnosed with stage 1 invasive breast cancer. Between the lumpectomy, numerous doctors visits, and 4 weeks of daily radiation treatments, I ran up a bill at Memorial Sloan Kettering Cancer Center of over $50,000, all but about $250 in co-pays was covered by insurance. Suddenly, the $750 monthly premium I was paying for employer-based heath coverage seemed cheap.

Moving to a new job last year, I switched healthcare plans. I’m back to a low-premium (if you consider a $996 a month COBRA payment “low”), high deductible plan ($5,000 for me and my daughter). “Preventative care” is supposed to be included. Because I am only 3 years post-op, my mammographies are considered diagnostic, not preventative. My by-yearly appointments with my oncologist aren’t covered either. $1600 in total toward my deductible. At year end, I will probably spent about $15,000 on healthcare and still not cover my deductible.

I’m sharing this with you because if you think, like I did, or like Alabama Rep. Mo Brooks,  apparently thinks, that people who “lead good lives” don’t get cancer, or have back issues, or fall or have plethora of “pre-existing conditions,” you’re wrong.

My understanding is that (the new proposal) will allow insurance companies to require people who have higher healthcare costs to contribute more to the insurance pool. That helps offset all these costs, thereby reducing the cost to those people who lead good lives, they’re healthy, they’ve done the things to keep their bodies healthy. And right now, those are the people — who’ve done things the right way — that are seeing their costs skyrocketing. – Alabama Rep. Mo Brooks; watch the full interview here.

Not only may we all see our health coverage become cost prohibitive, more and more people aren’t going to get treatment when they need it thus creating bigger – and more expensive issues – later on.  I’m not even going to go into what the AHCA bill will do for treatment of mental health issues (and if you need a reminder about what can trigger or be considered a mental health issue, read this post from last May).

The ACA certainly wasn’t perfect. As a self-employed consultant, I purchased insurance for my daughter through the Marketplace in 2015 while I kept myself on my previous company’s plan through COBRA. A policy through the ACA would have required that I only see doctors in New Jersey and I was being treated at Memorial Sloane Kettering in New York City. Thankfully I had the resources to make that decision. So, while acknowledging that the ACA wasn’t perfect, it was a step in the right direction. It saw that everyone was insure and had protections for people who actually got sick. The AHCA as it goes to the Senate, is a step backwards.

When it comes to health care, readers should be wary about claims that important changes in health-care coverage are without consequences and that people are “protected” – or that the changes will result in massive dislocation and turmoil. There are always winners and losers in a bill of this size. In this case, if the bill ever became law, much would depend on unknown policy decisions by individual states – and then how those decisions are implemented. – “Here’s what you need to know about preexisting conditions in the GOP health plan, The Washington Post; read full article here.

Obviously people currently under a doctor’s care – those of us with “preexisting conditions” – might believe we have more at stake. But this affects anyone who may get sick, may change jobs, or who may have a change in marital status. In other words, this affects all of us.  Please don’t think you’re immune. It is my hope that I have inspired you to educate yourself; to know the facts and if you don’t like what you’re seeing, I want to inspire you to speak up. Call your representatives! Ask them to look at this from the prospective of someone who is actually going to be insured by this system (they are not).   Click here, if you need their contact information.

And to get you started on your research, here are two recent articles you may find helpful:

 

IMG_3756Ramsey, New Jersey. May 2016.