Three Personal Benefits of the Affordable Care Act

affordable care actI am a poster person for the Affordable Care Act. Well, not a literal poster person, although I could be. I was willing to pay for insurance, but it wasn’t available to me. I was willing to be a private pay patient, but reputable health care clinics weren’t willing to accept me. I humbled myself and went the low-income clinic route because they take almost anyone. That experience alone fueled me to persevere in getting signed up for the Affordable Care Act. I was determined to get decent health insurance or not have any health care at all.

The Affordable Care Act is not perfect, but it’s better than what we had, which was nothing for a significant number of us. There are three glaring reasons why the Affordable Care Act is necessary and needed.

Accessibility

Most people in the United States think that if you obey the laws, play by the rules, and work hard and are willing to pay the price, you can have anything you want. We know that is only true when things like education, employment, healthcare, housing, citizenship, and other basic human rights, are accessible to everyone. The reality is those basic rights and services are not accessible to everyone. Healthcare was not accessible to me.

Let me clarify something. When we moved to Texas, I was not able to purchase any private health insurance because of pre-existing conditions. I was eligible for the Texas Risk Pool which offered health insurance, at increased rates, to those unable to qualify for regular policies. The cost of my monthly premium was more than twice what most people paid for a mortgage or rent! I still had co-payments and out-of-pockets charges for which I was responsible. No wonder my blood pressure was high!

There was no risk-pool option for me when we moved to California and I wasn’t able to qualify for any coverage. That’s when I started the process of trying to find some kind of clinic so I could just get the basic medication I needed. I wasn’t even thinking about addressing the health issues I was starting to treat before we left Texas. I was just trying to hold out until the Affordable Care Act kicked in.

When I was finally seen at a community clinic (there is more to even that mini-plot), I also had to get enrolled in the county and state programs that pay for the services at those clinics. That was the beginning of my whole “indigent” experience. I have been indigent and never experienced anything like this. Once I jumped through all those hoops, I could no longer receive services at the clinic that did see me and filled my prescriptions. I was assigned to another community clinic, further away. I never saw a doctor. I never got a diagnosis. I never got a clear treatment plan. I never got my questions answered.

That leads me to the second glaring reason for the Affordable Care Act.

Quality

I would have been satisfied receiving health care at Cares Community Clinic. I had a primary care physician I liked. She thought the issues I’d begun treating in Texas were worth pursuing here and we had a follow-up plan in place, once approval came through. When the approval came through and I was directed to another clinic I decided I would at least see about getting physical therapy for my shoulder. After all, PT is fairly straight forward and there are standard practices and exercises. I’ve had two previous shoulder surgeries so I knew what to expect.

I never saw a doctor. I never got a diagnosis. The physical therapy for my shoulder was riding a stationary bike and getting ice. When I suggested that maybe this wasn’t the best use of resources [my] time, I was told that I would not be allowed to be seen again unless I completed the six weeks of twice-weekly physical therapy.

While this was going on, it was decided by someone on my health care team, which did not include a doctor, that I needed to have more lab tests to determine if I was indeed on the correct medication. I was only taking medication for blood pressure which is not determined by blood work. They wanted to do an entire rheumatoid arthritis/lupus work up because “my shoulder problems indicated the need.”

The threat that time when I refused “to comply” was that they would not renew my prescriptions. The doctor at Cares had only prescribed three months of refills because she wanted to do an entire work up that included some other issues and wanted to leave the medication options open.

That was when I decided I was done. I was not going back … ever. I also decided that if we ever could not afford our healthcare premiums, I was not going to have healthcare. The quality of care I experienced was so substandard – and this was before the Affordable Care Act was available – I was better off with nothing. I had no confidence in the clinic or it’s health care providers for even basic healthcare. I was afraid that if I ever had to have surgery or a procedure while in their care, they would kill (that’s a whole other sub-plot).

Hope

When you don’t have access to quality healthcare and you’re doing everything you can do to have a healthy lifestyle, you find your hope being leached away. You wonder what it’s going to be like to find a tumor and not get treatment. Or gradually lose the use of your dominant arm because it won’t move or function like it should. You gradually withdraw or find yourself limiting your activities because you’re so worn down coping with chronic pain.

I’m educated, white, and savvy and I found myself losing hope trying to work a healthcare system that was broken, inefficient, and ineffective. Part of the problem was I knew what it was like to have accessible, quality healthcare. I have had excellent doctors and treatments and options. I know what it’s like to have chronic pain from injuries and what it takes to forge your way back to health and maintain that healing. I also know that things just happen and none of us are immune from disease or injury, that accidents and horrible things happen, or something from our gene pool decides to rear its surprising head. At those times, we need all the hope we can muster to push through and emerge on the other side. A big part of that hope is that we have access to a competent medical team we trust and who will work with us every step of the way.

Healthcare is still our largest monthly expense, but I am ever so grateful I now have access to affordable, quality healthcare, thanks to the Affordable Care Act. I know many do not have financial resources and must rely on medicaid … if it is available to them. There are still places, and Texas is one, that have not expanded their medicaid programs to include their own people. Many are still falling through the healthcare cracks.

It’s time we grab healthcare by the horns and figure it out. Disease and injuries are not going to miraculously stop afflicting humanity. We know prevention and early detection lead to less expensive treatments and better prognoses. I know. A year ago my shoulder most likely could have been repaired with arthroscopic surgery. Today I am looking a a total shoulder replacement.

I can’t help but think that had I had access to quality healthcare a year ago, the financial outcome for both the insurance company and myself, the treatment and rehabilitation, as well as other intangibles like the quality of life, might be very different. I’m just thankful I didn’t have anything life-threatening. I might not be alive today.

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