Three Weeks and Counting

Can you feel the excitement in the air? Yes, it’s fall. Yes, it’s football season. Yes, wrestling is back in the Olympics. But that’s not what I’m talking about. I’m talking about the launch of the state and federal health insurance exchanges–the cornerstone of the Affordable Care Act–on October 1.

I don’t know about you, but I can barely sit still I’m so excited!

Ok, I admit that I am a health policy addict and I’m looking for a 12-step program. But seriously, these exchanges have the potential to revolutionize how we get health care in this country, provide an important burst of energy to the development of small businesses and entrepreneurship, and impact the health of a large chunk of the population.

These are grand goals, I know. So let’s swoop down from the 50,000-foot view that most of us have received from the media to the ground level. Let’s talk about two women, Sharon and Karen.

Sharon is a good friend of mine, a Realtor in her 50s. As such, she’s self-employed and has to purchase her own health insurance. Sharon is very healthy today–but she had a severe cardiovascular complication after her son’s birth 26 years ago. Thus, her health insurance costs more than $1,000 a month and, even then, comes with a high deductible and minimal benefits.

But in October, Sharon can sign up for a plan that pays 70 percent of her medical costs for a premium of about $250 a month. The plan has a rich set of benefits, including coverage for all emergency care, outpatient and inpatient services, mental health services, and tests, among others. It also includes all preventive care at no cost (think “free”mammograms, well-woman visits, and colonoscopies). You can get a sense of what such a plan will cost you here.

Not bad, huh?

How much do we need coverage like this for people like Sharon, people whose employers don’t provide health insurance and who aren’t eligible for government coverage like Medicaid and Medicare? Consider the woman a friend just told me about. We’ll call her Karen. And yes, she is a very real person.

Karen moved from Virginia to Washington, DC to take a new job. Unfortunately, the job didn’t come with any health insurance. Karen, who is not gay, was living with a female friend, who is also not gay. Her friend, however, has health insurance. So Karen and her friend are now getting married (gay marriage is legal in Washington, DC) so Karen can get covered on her friend’s insurance policy. When Karen and her friend consulted an attorney about this, he told them they were hardly the first such couple he’d seen. In fact, he said, he was counseling a lot of couples–both gay and straight–who decided to marry for one reason and one reason only: to get health insurance.

I think about these two women, and I think about the vitriol around the ACA and the insistence that we don’t need it, that Americans could afford health insurance if they only wanted to or if the “free market” were allowed to work. I think about these two women and I feel sick. But then I remember that in three short weeks the exchanges open—and suddenly I feel. . .well . . . hopeful.


Send me your questions about the Affordable Care Act and healthcare reform and I’ll answer them in this space.

4 Responses to “Three Weeks and Counting”

  1. Claire Santos, MS, RN

    Wow! Great piece! I never thought of the new way to commit fraud in order to gain health insurance benefits, but it speaks volumes about survival mechanisms. Here we go into the Great ACA Unknown!

  2. Roger Gosden

    Deb. That’s a very poignant story. While I was working in British medical schools and hospitals I was very critical of the National Health Service, and even in hindsight the criticism was justified, but it took living in the USA to be grateful for the safety net that the NHS provided for all citizens, regardless of circumstances.


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