Thursday, May 28, 2015

Getting personal

Today I am going to write about something very personal, but very close to my heart. Last night while caring for the elderly lady I sit with, I watched a new show called "The Briefcase". The show is based on giving two families $101K that they can either keep, give part of away or give all away to a family in as much or more need than them. When making this decision, neither family knows that the other family also has a briefcase, so they are making this decision with the assumption that they will not receive any money in return. One of the families had a husband with health needs and no health insurance. The wife of the other family worked as a nurse, and said several times that she felt for people who didn't have health insurance, but as I heard her say these words, I felt like she just didn't get it. I'm not belittling this woman or her family who also had financial and medical needs, but more or less acknowledging that she is like so many in this country who don't really understand what it's like to be uninsured or underinsured and have regular medical bills.

Healthcare has been a hot topic in our country the past few years. Many have been up in arms over Obamacare, the cost and the fact that they are being required to have health insurance. I am not going to pretend like Obamacare is perfect and I have had plenty of frustrations with the marketplace, but I am so thankful that it exists. Let me let you in on a little secret, for most of our marriage, Elias and I have been underinsured.

What does this mean? It means that we would receive employer based health insurance that was not comprehensive, so it covered very little. We would go to the pharmacy each month for his meds and be told that we didn't have coverage because there was no generic brand for his medications and the bill would total anywhere from half of our monthly income, to twice or more than our monthly income. These costs came every month. In our first year of marriage, we had times where we had to decide whether or not to get his meds that month. No one, should EVER have to decide whether or not their loved one could receive their daily medications. Some of his pharmaceutical companies had assistance programs, but you didn't qualify if you were underinsured. There were times I prayed that we would qualify for medicaid and if our medical expenses were counted, we would have, but we didn't qualify and couldn't afford private insurance.

There came a time in our marriage where we were out of options. Neither one of us had comprehensive employer based health insurance, we couldn't afford private insurance and our last lifeline, the NY state reimbursement plan that reimbursed us up to 7% of our income (which helped, but wasn't ideal when you don't have the initial funds to pay and they take 3-12+ months to reimburse you) was giving us 30 days to obtain comprehensive health insurance with no prescription drug coverage cap. I was in tears.

Then Obamacare began. The healthy NY program was in place which offered private health insurance at a slightly more affordable rate, it was still a lot of for us, but so much better than anything else we could ever afford. And, because of Obamacare the previously held $3000 prescription drug coverage cap that prevented us from using this option before, that we would have maxed out in one month, was removed. We then could afford appointments, prescriptions and we qualified for various co-pay cards to further remove the financial burden.

This is why we had to fundraise for adoption and were unable to put money away over our 5 years of marriage. I know not everyone agreed with that decision, but it was our only option other than wait an underdetermined amount of time where we could eventually save enough money to become parents.

Now as a family of 4, two of whom have additional medical expenses, we qualify for quality, affordable health insurance because we live off of a limited income. We have no employer based health insurance, but we now have options that we didn't have before. I know that Obamacare has not been great for everyone or even affordable for everyone. It is far from perfect and I truly hope that it improves throughout the years instead of declining, and we may someday face that challenge as well. However, I want to help those who have been frustrated by health insurance costs and issues for the first time in their lives, to understand what those of us who have lived this way for years have gone through. We are not the only family that has benefited from these changes and the past 2 years have been the only 2 years out of our nearly 7 year marriage that we haven't faced constant health insurance related stress. Okay, I'll step off my soapbox now, but if I opened one set of eyes, I have done my job :). Also, this post is not to invoke pity, just to educate.

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