Monday, July 23, 2012

Why the 28th of June was a good day

Photo by Mark Wilson/Getty Images via Slate

I'm always a bit hesitant to bring up my own political views on this blog, but they are an important part of my personal experience. Thus I will write about them from time to time. I acknowledge that these are merely my opinions, and I respect your right to disagree with me. All I request is that any discussion this sparks be thoughtful and respectful.

On the 28th of June, the United States Supreme Court ruled 5-4 to uphold the Patient Protection and Affordable Care Act (PPACA), commonly known as "Obamacare," sparking a flurry of responses from commentators, politicians, and other citizens of social media and Internet spheres ranging from despair and anger to joy and elation. I was quietly pleased, but I know many others weren't. Perhaps your views on politics and the role of government diverge from me. Perhaps you already have a job that provides wonderful health insurance. Perhaps you have a major that will guarantee one of those jobs.  Perhaps you are older than twenty-six and health insurance falls at the very bottom of your financial priorities. Perhaps you have no pre-existing health conditions. Perhaps you just honestly despise every piece of legislation proposed by or endorsed by Obama. Really, the reasons for not sharing my reaction are nearly endless, and most of them are fully justifiable.

However, as the events of the last few weeks have unfolded in my life, I have gone from pleased to extraordinarily grateful for the ruling to uphold PPACA. Honestly, this legislation has changed my life for the better in many ways, and without it the events of the last week would have been potentially crippling for the future Nate and I are planning to share. And this is why I felt the need to write this piece. 

But before I delve into my personal experience, I'd like to take a moment to look at what PPACA does. This series of articles by the Christian Science Monitor does an excellent job of explaining what PPACA means for the ordinary citizen in plain English. I'll try my best to hit some of the major points here. Basically, PPACA requires that all citizens must hold some form of health insurance. If someone does not have employer-provided health insurance, they must purchase health insurance from a newly-created health exchange that sells policies to individuals. Those who choose not purchase health insurance must pay a penalty (deemed a tax by the SC). However, in order to prevent undue hardship on those with low incomes (a large portion of the uninsured), federal subsidies will be available to those with incomes that are less than four times the federal poverty level. These subsidies will cap the cost of health insurance for these individuals at a certain percentage of their income (for example, individuals making less than $44,000 per year will not pay more than ten percent of their income towards health insurance).

Simultaneously, PPACA is reshaping the healthcare industry in several other key ways. Young adults may remain on their parents insurance until the age of 26. Insurers may no longer charge women more for health insurance than men. Insurers may not refuse to provide insurance to individuals with pre-existing medical conditions. This last provision is part of the reason why the insurance mandate is necessary- the influx of new healthy customers buying health insurance will offset the risk brought by the influx of new customers with pre-existing conditions.

Back to my life. As most of you know, Nate had a nasty Crohn's flare-up last week, a flare-up severe enough to cause some complications and land him the ER three times and finally in the hospital for a couple days. And suddenly, the benefits of PPACA became extremely clear in my personal life. Nate, being younger than 26, is still on his parents' health insurance plan as allowed by PPACA. The hospital bills, while still expensive, are much more manageable, and we should be able to pay them without falling deeply into debt. His medications are covered by the insurance plans he is currently on, which also means that we can afford them.

Without PPACA, Nate would not currently be allowed to be on his parent's healthcare plan. Fortunately, he does have a job with medical benefits. However, Crohn's disease is considered a pre-existing condition. As such, without PPACA, Nate could easily be denied affordable health insurance or health insurance coverage at all. And without health insurance, the hospital bills from this last week would be astronomically expensive and extremely difficult for us to repay. Compounding this, without health insurance, Nate's current treatment regimen for Crohn's would also be out of our financial reach (with insurance it still costs nearly as much as current rent expenses). And without this treatment, his medical situation would be much worse-- likely leading to more hospital bills-- leading to more debt....I think you can see where this cycle goes.

PPACA also provides benefits for my the rest of my family and I. As a female, before PPACA, I would be charged more for my health insurance than a male in my same situation would be because the state of Arizona is one of 37 states that has not banned gender rating by health insurance plan. (This does not include maternity benefits or costs associated with pregnancy-- this is only for the same basic coverage.) My sister, who is moving to California, would escape this if she stayed in that state (California has banned gender rating). My mother has a rare genetic disorder that, like Crohn's disease, could be considered a pre-existing medical condition. Without PPACA, if my father ever lost his job, she might not be able to find new health insurance.

At this point I must apologize to all healthy males over the age of 26 who now must buy health insurance or pay a penalty-- I am benefitting from the mandate which has imposed this cost on you. So are all the women in this country. And everyone who had a pre-existing medical condition. And everyone under the age of 26. For young people like Nate and I, this legislation makes the difference between lives that are sometimes marked by significant medical expenses to lives beneath a crushing amount of continually accruing debt. It means we can afford the treatment and medications he needs. It means that we don't have to think twice when he needs to receive medical attention. It means that we don't become a drain on the medical system when we can't pay the hospital bills like so many other uninsured people with serious medical conditions.

I suppose this might be selfish of me, but I like living in a country that has passed this sort of legislation. I like living in a country that is moving just a little bit closer to following the United Nations Declaration of Human Rights. I like living in a country that is beginning to end discrimination based on health and gender. Given my experience with loved ones with serious medical conditions and with medical problems in my own life and in the lives of those around me, I see the very real need for health insurance. You never really know what's going to happen (as someone who's been hit by a car more times that she would like to recount, I can fully attest to this). Good health is a blessing that is not guaranteed. I am immensely glad that in this country there is now a way for health insurance to be affordable for everyone and that the Supreme Court has upheld this legislation. So at least from my view, the 28th of June was a good day. 

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