Open enrollment is among us, if you need to buy your health insurance from your state’s marketplace pursuant to the Affordable Care Act, also known as the ACA or Obamacare. Today, I went to healthcare.gov to choose which plan I wanted for 2020. As some of you may know, I am currently fighting cancer, and incur a lot of health care expenses. I have one of the top of the line gold plans for 2019, and have been very happy with it. I was thrilled to see that not only is the same plan available for 2020, but the premiums went down by about $100 a month for me. I can’t promise the same results for you, but by all means, if you need health insurance check out what is available through your state’s marketplace on healthcare.gov. You have until December 15, 2019 to enroll.
My experience buying health insurance through the marketplace has recently been a pleasant surprise, especially considering that one of the main policy goals of the Republican Party has been to repeal Obamacare. Well, technically, the GOP has called for the repeal and replacement of Obamacare. But if you recall the Spring and Summer of 2017, you may remember that when the GOP had both houses of Congress and the Presidency, there seemed to be wide-spread agreement on the repeal part, but not a single Republican could propose a replacement. This was a scary concept for someone like me, who worked as a solo practitioner at the time, and had a pre-existing condition. If the Republicans could repeal Obamacare, but would not replace it, where was that going to leave me? Luckily, the rest of the country and I watched as Republican Senator John McCain strolled to the floor of the Senate, and famously turned his thumb down, going against his party and saving Obamacare from repeal.
Of course, that was not the end of my anxiety. One thing that is clear about President Trump is his obsession with trying to undo everything he can that President Obama accomplished. If his party could not deliver on the promise to repeal Obamacare, then Trump was going to do everything in his power to sabotage it from the inside.
He started by withholding subsidies to the insurance companies for participating in the market place. This created a great deal of panic and uncertainty. It resulted in higher premium prices and fewer choices for those who went through the marketplace. For myself, I noticed that there were only two insurance companies offering plans in my state. When I purchased the plan I thought was the better choice, I suddenly found that many of the doctors I had gotten used to seeing did not accept this insurance. Not only was my choice limited, but getting the insurance company to approve of the care I needed, such as major surgery, suddenly became a challenge. I spent a lot of time learning about peer to peer reviews and asking my doctors to call the insurance company doctors to convince them why the treatment, such as cutting recurrent cancer out of my body, was necessary.
But this was not Trump’s only strategy. He also stopped enforcing the penalty for not complying with the mandate. That is, in order for Obamacare to work, low risk healthy Americans had to purchase health insurance in order to offset the additional costs to insurance companies for being compelled to offer plans to people like me, without considering my pre-existing condition and at the same premium. Without the penalty for not buying health insurance, which was enforced by the IRS, healthy people may choose to forgo buying health insurance, thus increasing the percentage of high risk customers, which in turn would increase premiums. And that is what I experienced. Not only was my choice of plans more limited, the plans that were available were more expensive and had a high deductible.
Trump tried to drive more people out of the marketplace, by approving more short-term insurance plans. These type of plans had less coverage than the plans available on the marketplace, and were far cheaper. A small number of these plans were available before Trump won the election. I needed to utilize this option for a few months in 2016 through the first month of 2017. The premiums were super cheap. But, that was based on the customer not needing to use the plan for major health problems. This was fine for me, until the beginning of 2017 when I started showing some serious symptoms. My cancer had been in remission for several years, and thus was not considered a pre-existing condition for the purposes of this plan. Nonetheless, the insurance company fought with me tooth and nail to cover the treatment I began to need in early 2017. Indeed, the insurance company refused to pay over $36,000 worth of treatment, until I finally reported the company to my state’s insurance commission. Amazingly, after months of denials and fighting, once the insurance commission got involved the insurance company changed its tune, and my expenses once again covered. Still, from my experience with this short-term plan, I will avoid them as much as humanly possible in the future.
But even with Trump’s efforts to sabotage Obamacare, something amazing happened. The health insurance market stabilized after one year. When open enrollment came around in 2018, there were suddenly over twenty plans available to me through the marketplace. With the guidance from my healthcare providers, I was able to choose a plan that was widely accepted by the doctors I already patronized, and that offered a good amount of coverage at a reasonable price. Despite Trump’s efforts to destroy Obamacare, the system was working well for me.
That trend continued this year. Indeed, it has been reported that in many states, there are more plans available this year, and at lower premiums. For now, Trump’s efforts to destroy Obamacare without formally repealing it seems to be failing. Yes, there are lawsuits out there challenging the law as unconstitutional. There are lawsuits challenging the requirement to cover pre-existing conditions. Given my personal situation, these are developments I worry about and watch closely. But for now, Obamacare is working for me.
So I urge you, if you need health insurance, check out your state’s marketplace. Yes, you will need to input a lot of information, including information about your income. But you just might find yourself pleasantly surprised, as I was this year.
By: William J. Kovatch, Jr.
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