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ObamacareWe’ve been into the ACA now for some months and reports are coming in from any number of sectors. After all the dire warnings that economic disaster would ensue, millions of people would lose jobs and coverage, the facts tend to tell a quite different story.

The Congressional Budget Office CBO continues on a regularly basis to project that the costs associated with the law are dropping with each assessment. Further, uninsured rates are dropping significantly in those states that adopted the ACA and Medicaid expansion. Insurance carriers are expanding their services, and entering new markets.

Evidence is still scant, but there are reports that states are seeing more competition and some evidence at least that premium costs to consumers will reduce or at least not rise at nearly the rates they did before the law went into effect. Trips to emergency rooms has dropped significantly for participating states versus those who stubbornly refuse to help their most disadvantaged.

Those are the general facts. I’d be the first to tell you that anecdotal stories have little value in terms of proving a point, since truth is seldom an all or nothing proposition. It’s usually an “on balance” sort of thing for such things  that involve millions of people. Some people undoubtedly have suffered under the Act, but we have always asked more of our more wealthy citizens, and there are almost no verifiable stories of people grossly hurt by the law, although there are no end to horror stories that upon investigation turn out to be bogus.

My story is offered as one that, as far as I have learned from a dozen or so others, is not atypical of the average person.

Years ago, back in the mid-90’s, I was associated with the Sister’s of St. Joseph who ran St. Joseph’s Hospital in Flint, Michigan. As a potential novice, I began volunteering there. As part of that activity I had a general checkup. It was noted that my blood pressure was elevated and I was given a cuff and told to monitor my blood pressure several times a day for a week. The results suggested all was okay.

Fast forward several years, to 2000. I am newly married and my husband insists that I get some coverage. At 50, health is going to be more of a concern. I apply. I routinely inform them that I was last checked at the aforementioned hospital with the only concern being my blood pressure. The carrier was unable to obtain any records. I was denied coverage. That became my “pre-existing condition.”

So I was one of those unable to secure insurance.

Along comes the ACA.

I, like thousands of others, entered the Marketplace soon after the site opened. I too ran into trouble. I was not “verified” as to who I was. I was given a coded number and told to call Experion who would complete that process. When first called, Experion told me I had called too soon, and to wait a few days. Days turned into weeks, and I decided to wait a couple of months to let things get sorted out.

When I returned in December, things had not improved. Experion did not have my coded number. I called the exchanges to speak to a live person. They started my application over again. In about 30 minutes we were done. I was informed that I “might” qualify for Medicaid, so I could proceed no further until that was resolved. I was told this would be submitted automatically but that I could call them and speed up the process by giving them the information over the phone.

I called New Mexico Medicaid. In an automated message, I was given a laundry list of required information. It included prices for any cars, what was still owed, mortgage if any, stocks, savings accounts, utilities,  as well as the normal “income” requirements. We were most sure I could not qualify and hated getting all this crap together for nothing.

I had kept a newspaper which gave the names and numbers for some “facilitators” operating in our area. I called and made an appointment. My goal was to cut the tape, avoid the Medicaid issue and return to the Marketplace. Instead, my facilitator seemed to have little information regarding the ACA, but told me that the NM Medicaid had no business asking me for any of the information beyond what my income was.

She filed an application securing only our SS income and sent the application in. A couple of weeks before the closing of the open enrollment, I got a letter from NM Medicaid, along with two cards. The letter made little sense being full of acronyms which were not defined, but suggested that BOTH my husband and I had been approved for something, and denied something, none of which we could figure out.

My husband called, and sure enough, the cards were our new Medicaid cards and we both were covered. My husband politely declined, being entirely happy with his VA coverage locally and at Fort Bliss VA facility. I, after my usual “avoidance” as I awful-ized all the dire medical diagnoses I could imagine, made an appointment with my new doctor and proceeded to begin a series of referrals and tests to “bring my health records from non-existence to a reasonable state”.

That process began in late June and was in mid process in mid-August when I got a letter from NM Medicaid. Again, a letter that made little sense but suggested something was up. I called. I had been cancelled. They had “just learned” that my husband had started to receive SS. WRONG. My husband in one fashion or another (disability for PTSD to regular SS) had been receiving benefits since the late 90’s. Oh, so then I must have just started receiving SS. WRONG. I’d been receiving SS for two years. Both yearly totals had been included on my regular application.

The bottom line: I did not qualify for NM Medicaid, a thing we had both felt fairly certain of before we applied.

NM Medicaid indicated that my coverage would CONTINUE until Aug 31. Why that was so, is inexplicable. I was also informed that I had been graciously granted “family planning services” so my future pregnancies or contraceptive care was meant to offset my loss of general coverage. At 64 I was really happy to hear that.

Since I was taking several medications and scheduled for several more tests, I was in a bit of a pickle. Sure I could pay the bills myself, but they would be rather significant (the routine blood analysis and urinalysis alone was $1100).

I called the Marketplace in a serious funk, sure that they would tell me I had to wait until the open enrollment resumed in November, leaving my uninsured once again for the intervening months.

The Marketplace people were simply appalled at NM Medicaid’s error. All the information was indeed there on my still-filed application. They assured me that my circumstances allowed them to “reopen” my file as a “failed” Medicaid deferment, and I re-entered the Marketplace. They completed everything over the phone, gave me time to look at several plans with the promise that I could go to many others if I was not satisfied with those.

I chose my plan, and they scheduled it to start on September 1, so I would have no loss in coverage. I was given the phone number of my new insurance company. They apologized again and again for the error that was not theirs.

I called my new insurance carrier. They found me in their system immediately, and pointed me to their web site. I was able to pay my premium online well before the bill came in the mail.

I got all their material and my new health cards seamlessly.

I had to go to my doctor to get help with prescriptions that Walgreens was screwing up. I told them about my new insurance and that I was not sure that I could continue with her under my new plan. The women there took the information and got in touch with my carrier, worked it all out, and I was able to keep my doctor. Again it was all seamless. My previous carrier paid for everything up to August 31, and my new one took over on September 1.

While the ACA was a mess in terms of sign up at the beginning, they did everything else wonderfully as far as I am concerned. I am pleased with both my insurance coverage and my doctor and her care. My meds are amazingly affordable as are my copays.

I have the peace of mind that can only come from being checked and found in pretty good shape. My blood pressure is a bit high, and I have meds for that. I am at the entry level for type II diabetes, take a med for that, don’t monitor my blood sugar, but avoid “obvious” sugar. My eyes are fine, so was my mammography, gynecological exam, and bone density scans. I feel great, I’ve lost a few pounds, and I’m seeking to eat a better diet.

If it were not for the ACA, I’d still be rolling the dice. I am most grateful. Bureaucracy will always cost us time and trouble. That is not a good reason to grouse about a law that provides decent health care to millions who did not have it. My experience was annoying and frustrating to be sure, but very little of that had to do with the law. Most of the fault lies with the people who work at NM Medicaid in my case.

I am happy with my health care. I thank my President. My heart goes out to all those millions who still go without care because their Republican-controlled states refused to help them just to prove that hatred in their case is more powerful than doing their duty by their citizens.

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