12/4/13 THE PLAN under the ACA

I have been the recipient of some benefits under the Patient Protection and Affordable Care Act (The ACA, also known as Obamacare). I wonder by what name I should call it now? Should I take the administration’s recent cue and revert to calling it the ACA instead of Obamacare? Should I call it the ACA when it works for me and Obamacare when it doesn’t? Or vice versa? Or should I not want to lend the administration political capital by calling it Obamacare when I am reporting things that seemed to work in my behalf? I am not that disingenuous. I will call it the ACA. I will do so unfailingly. ACA will become part of the style sheet of this blog. If you notice me violating my own style rule in the future, I hope you’ll put me in remembrance of this.

I have lambasted THE PLAN (my plan) many times over the last few years. THE PLAN is IBEW Local 480 Health & Welfare. It is located in Byram, Mississippi, a suburb of Jackson, and Joel Hill is the Plan Administrator. I have written about Joel and THE PLAN regularly, and they have borne the brunt of my wrath in this blog. I gave a nickname to Joel. I refer to him as Plan Admin, which is likely how you know him if you have been a regular visitor here.

The benefits I have so far received under the ACA is that my son is able to stay on my insurance until he is 26 (he is 24 now) and that the lifetime benefits limitation are gone. I was livid that Health and Human Services (HHS) allowed Unions and others to get waivers from compliance with the ACA which knocked me out of having my annual limitation of $100,000 removed. I have written many times that it is hard to have cancer and be taking chemo under the restrictions of a $100,000 annual limitation. Hemosapien and the staff at his clinic helped me to manage my costs every step of the way, scheduled chemo treatments so that they carried over from one year to the next, and generally offered me the most invaluable assistance. I am thankful to them for that, and thankful for the treatments that went well. I was cognizant through the chemo process that I was doing pretty well if I were able to stay focused on my wallet; that was only possible because I was responsive to the treatment.

I received a notice from THE PLAN the other day, and another one yesterday, confirming that as of January 1, 2014, the annual limitations of benefits would expire. A great burden has been lifted from me, at least temporarily. I am thankful for that. Were it not for the ACA, this limitation would have continued. I vilified HHS, rightfully so, for allowing the waivers, and fully expected to get waived again, despite the assurances of HHS that they were not going to allow the continuation of any waivers beyond December 31, 2013. So far, they have stuck to their guns. You can determine for yourselves whether I was unjustly paranoid about assurances from HHS. They do not have a very good track record for veracity.

THE PLAN assures me that it is a grandfathered plan and therefore does not meet all the requirements of the ACA, but these concern limitations on substance abuse treatments and a few others for which I am not a likely candidate to need benefits. The annual limitation of $100,000 will be gone at the end of this year, which is just a few short days away. In my case, the chemo drugs alone cost nearly a hundred grand. The ancillary costs of biopsies, expensive lab work, doctor visits, chemo infusion costs, etc., would have sent me far over my annual limitation. THE PLAN, being THE PLAN, would have paid everything that was required of it and not one cent more. This is the way insurance works. Had I had a type of cancer that required surgery followed up by immediate chemotherapy and radiation, and had I had any complications, I would have consumed my annual limitations right away, and had nothing left over for so much as a flu shot (which I can’t take anyway).

I am thankful for this respite, though I have no confidence that it will continue unabated. After visiting the Healthcare.gov website, I was shocked at the limited network that Magnolia Health Plan offers in Mississippi. I think the next battle that the administration will try to smooth over is that while people may have the right to purchase insurance regardless of their preexisting conditions, they may not be able to keep their doctors or hospitals, nor may they find any substitutes for their doctors and hospitals. This limited network problem may correct itself in a year or two, but right now it is a serious limitation. It is possible that people will be able to claim that they have health care insurance, but they still cannot obtain the health care.

It reminds me of the great Zig Ziglar, who said that when someone wants to buy a drill, the vendor needs to always remember that it’s not really the drill the buyer is wanting…it’s the holes. If the buyer could get the holes without the drill and bits, he wouldn’t fool with them for a minute. Being able to tout that one has health care insurance while simultaneously being unable to access health care providers serves no purpose. We purchase the insurance so we can receive the care. It is still a terribly awkward process. The ACA is not likely to make this better.

So, since I have admitted I have received some benefits under the ACA, am I happy with it? No. But I am happier than I was. This is a move in the right direction. I am not happy that others have had their insurance canceled, nor that the government is so callous to say that we are not responsible enough to know a good health care policy from a bad one. I have looked under the hood of the ACA in Mississippi. Is the health insurance offered here better than nothing? Yes, but not by much considering what it costs versus what you get.

Is the health insurance offered by Magnolia Health Plan suitable for healthy people? Yes, but then again, so is a bad policy of any description. Health insurance is only good when you need it and it works satisfactorily for you. This is true with any insurance. It is when the CLAIMS come in that the rubber meets the road. Short of any claims, we are all persuaded that our insurance is adequate.

Ironically, we expect miracles with our modern medicine yet we have a nostalgia that we might be able to see Gunsmoke’s Doc Adams, have him cure us with his grit and homespun wisdom alone, offering him a couple of chickens and a dozen eggs when it seems like it’s time for us to pay the bill he never seems to send. We are likely not to remember all the times when Doc Adams just shook his head over a dying gut-shot man or a woman in the throes of childbirth gone wrong and said there was nothing he could do. We are likely not to remember that at one time shamans passed as physicians and surgery was the part-time province of barbers. Now our medicine is scientific, technology based, far more effective, and far more expensive. Technicians peer into our bodies with the most remarkable devices, telling doctors more than they had ever thought it possible to know in their efforts to treat us for diseases and maladies that seem to increase with our knowledge of them.

In the end, the results are all the same, regardless of medicine’s effectiveness or expense. In the end, none of us will need health insurance. In the end, the uninsured, over-insured, under-insured, re-insured, and Cadillac-ly insured all meet the same fate. Will our insurance serve us in the interim?

I suppose, the interim is all that matters to any of us. Enjoy your interim while you can!  Many Happy Interims to you! Have a Holly-Jolly Interim. Have very merry interim, and a Happy New Interim.

We are all thankful for the miracles (however expensive) of modern medicine.

“We were thankful for the miracles of modern medicine in our time, too,” Aristotle, the ancient philosopher, not the former Greek shipping magnate, whispered in my ear. Both Aristotles have successfully navigated beyond their interims. We wish them both well!

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