As business owners, when our broker recommended four years ago that my husband and I get off the group PPO and switch to marketplace PPO insurance — which saved our company $400 a month due to our age — it seemed like a good idea.
At Year One, there was no difference in the quality of insurance. At Year Two, our premiums escalated equal to the cost of our company’s group plan — but otherwise the insurance was satisfactory.
In 2016, following a horse-related back injury, finding anyone new who would take my insurance was a nightmare. First, I had to switch to a family physician who was taking the revised marketplace plans. Thus began the HMO-required referral process, resulting in a six-week delay and three failed referrals because all three specialists had recently quit accepting my brand of insurance. How could I blame them?
Page 2 of the referral form stated — and I paraphrase — “if you are a beneficiary of the ACA, be advised that you have 90 days to keep your premiums current. At the end of 90 days, if your account is not current, we will be forced to retrieve any monies paid to your physician on your behalf.”
As former President Barack Obama had promised, I did get to see my doctors if I paid cash, as they no longer accepted my insurance. However, cash couldn’t get me in the door to a back specialist. I got off Obamacare and back in my group midyear. I had a new doctor a week later.
Though I believe health care should be made available to all, it comes with responsibilities on the part of the recipients. The first is to keep our premiums paid. Secondly, we are stewards of our own health.
My husband and I believe staying active is key to staying healthy. We are both avid horse people. He opened his engineering firm in 1990. I retired from a career as a veterinary technician five years ago.
My passion is competitive trail riding. For that reason alone, I have to keep this body in shape — and at times I need to get in to see a doctor for a tuneup. Though access to basic insurance — a marketplace — is now seen as a right, based on my experience, I’ve learned that access to broader availability of care — group coverage — is a privilege not available to everyone.
I’m also aware that if I suffer another accident, I can be seen immediately at an emergency room. I will pay dearly for that visit, though someone in the next bed may pay little or nothing, as most hospitals can’t turn away patients for inability to pay. I don’t mind sharing the load via higher premiums, but I need to know that I can be seen when I have a need — through proper channels and in a timely fashion.
I readily acknowledge this is a very complex issue. I feel that there were indeed some positives to the original ACA, such as our daughter being able to stay on our insurance plan after college, until she was gainfully employed. The bottom line is this: What good is insurance at any price level if no one accepts it?