The insurance industry is a powerful lobby. Indeed, one of the most powerful. Every politician in this country should be supporting anything that takes some of its power away. The ACA does that. How?

1. Under the ACA insurance companies can no longer raise your premiums because you get sick or use too much of your health insurance. Some states (again, both conservative and liberal states) already have passed laws to keep this from happening. But under the ACA it will be illegal no matter where you live.

You pay for your insurance. Yet, if you use it you can lose it. People can support this notion with auto insurance. Sure, if you’re an unsafe driver your premiums SHOULD go up. Many insurance companies offer “accident forgiveness” whereby even at fault accidents are “forgiven” or not charged against you if you don’t have another in a certain period of time. No one thinks this is a bad idea. It keeps us all safe. You’re a bad driver, you pay high insurance premiums. This is something you can do something about.

Insurance companies also cancel your homeowners insurance if you have too many claims. We had a lightening strike on our house which damaged many things in the home especially electronics (and other odd, random things like the garage door opener and the AC fan). The “replacement value” is not what they pay. So many of our electronics were paid “depreciated” value and I had to pay technicians to give me a diagnostic report. I did not want to go out and buy a new computer for one that had been fried. Prior to the lightening strike, it was in perfectly good working order. So I had a great computer that worked well and to replace it, I had to pay $2000.00 after it had been valued at $400 and I had paid someone $100 to diagnose it. So I paid $1700 because lightening hit my house. And that was on one item. We had at least 5 expensive electronics that needed to be replaced, our electric door openers, our AC fan, random plugs and our dishwasher (a strange assortment of things). All in all we paid close to $10,000 to replace things and received a few thousand in insurance proceeds.

Okay, I understand depreciated value. Otherwise people would be running around getting stuff destroyed to get a new one. I get that. It sucked, but I got it. Two years and 10 months later one of the pipes burst under the upstairs shower. I had to replace the pipe and replace most of the downstairs ceiling due to water damage. And I filed a claim and guess what happened? They canceled me. Too many claims in a 3 year period. It was 2 years and 10 months and I ate most of the cost for the first incident. So even though that was really hard and made me very angry, I was like, “Okay, whatever.” Jerks.

And with both car insurance and home owners insurance people inflate expenses and damages. So I get a lot of their strictness with that.

But getting sick? Or being born with a debilitating condition?




First of all, as discussed in ACA III post, the model that this country uses is to focus on treating illness and not preventing it. So if they don’t want to pay for visits and tests and shots and vaccines that will PREVENT illness, how in the world can they raise your premiums when you do get ill? This makes no sense.

But they bank on (and reasonably so) that most people never put 2 and 2 together like this.

Well, the ACA DOES put 2 and 2 together and it not only encourages preventative care but it does not allow the insurance companies to raise your rates if you get sick.

There should not be a single person who is against this. It’s simply unfair but it’s really unfair to hard working people who get sick. There is SO MUCH to contend with when you get sick and loss of income is usually one of those things. So to be sick, lose your income (or portions of it if you’re on disability) and then have your premiums go up? That’s terrible.

Everyone should be against this practice and the ACA puts an end to it.

2. Insurance companies will no longer be able to institute a lifetime cap on your medical expenses. Unbeknownst to many, right now the insurance company you pay premiums to can say, “Oh sorry, you’ve used up too much money. Too bad, so sad for you.” This is where bankruptcy comes into play a lot of the time. Many insurance plans say you are capped at $x. Anything above that and you’re on your own.

Even if the cap is very high, such as a million dollars, you can easily reach it if you have cancer, a heart condition (needing bypass surgery), or if you have a young child who needs continuing medical care long into adulthood. A premature baby fighting for his or her life can spend months in the neonatal ICU. Any parent will gladly do whatever they can to care for the child and get him or her to a healthy state so they can take the baby home and care for it as if it were not premature. Many times premature babies have developmental problems. Many times premature babies need their parents with them many hours a day. So one parent may need to quit their job or take a leave of absence for a very long time. They lose an income, they may need to hire more help to care for the children at home…and they worry about their baby.

Then one day these parents, already under strain and pressure, receive notification that their child is reaching their lifetime allotted expenses. How can that be? THE CHILD IS ONLY A FEW MONTHS OLD!!!! They can try to switch insurance companies but if it’s not Open Enrollment period, they may run out anyway. The next insurance company may give the parents difficulty because of the pre-existing condition. However, to their credit, this is not usually the case.

But you are an overwhelmed parent with a sick child and now you have to worry about changing health insurance providers? Terribly unfair.

Under the ACA there is no lifetime cap. You can care for your loved one with peace of mind that no one is going to march in and say, “Oh you know what? You’re too sick for us! CANCELLED!”

As someone who watched the person I loved most in this world dying day by day, I know the agony of becoming obsessed with the financial issues and health insurance concerns and it’s not what you want to be thinking about.

When you are in hospice care, the insurance company pays hospice and then hospice pays for most of the expenses RELATED TO YOUR TERMINAL ILLNESSq. Hospice pays for most of your medications and a lot of your equipment needs such as oxygen, hospital bed etc. But they don’t pay for things not directly related to your terminal illness or tests or drugs that are too expensive. There is a strange dance you have to do when you are on hospice care (don’t get me wrong, hospice is wonderful but the insurance issues are a bit strange).

We had insurance and yet I couldn’t have it both ways. Michael needed a very expensive ointment due to his skin condition. He had psoriasis and had gotten so thin that we were afraid his bones would break through his skin and result in bedsores. The psoriasis made this more of a possibility.

We tried many different treatments to no avail. The doctor recommended a certain ointment which cost (no exaggeration) $500 a tube. (Don’t get me started on the drug companies. They are a whole other part of the problem but I won’t go into that here).

So hospice wouldn’t pay for A FIVE HUNDRED DOLLAR TUBE OF OINTMENT because it wasn’t related to his illness and the insurance company wouldn’t pay for it because they were paying hospice who were supposed to be picking up the costs of medication.

So I paid for it. This might seem like a small amount of money compared to how much money his cancer treatment cost, but the phone calls I had to make and the explanations I had to get and then trying to get a prescription and find the ointment. What a run around at a time when I should have been with my husband and cherishing every moment with him. Even the hospice nurses were shaking their heads. They could not believe how much it cost. We got around the “insurance rules” a few times but with the prices of this medication, we could not. I spent so much time slamming my own head into the wall over this psoriasis medication.

The good news is that thanks to my hospice workers, my caregivers (that I couldn’t afford) and me, we prevented bed sores. It was an incredibly difficult task. The caregivers who lived in and worked Monday through Friday from 8 to 8 and the hospice workers who came every day or every other day and me who fluttered over him about 16 hours a day kept him kept the bedsores at bay.

What if I could no afford caregivers? What if I could not afford the ointment (and about 12 other salves we used) and what if I wasn’t there 16 hours a day constantly checking his skin? His skin condition pre-cancer that was so bad and then he lost so much weight and his bones were so close to coming through the skin, that a breakout would have been catastrophic. I don’t think we would have gotten it under control once it broke. And that could have led to infection and a lot of misery.

This might seem like a small or stupid thing but the skin thing was such a concern for me and ridiculous limitations on people who are ON HOSPICE led to so much time wasted and ridiculous run-arounds. And I feel I was very fortunate to have caregivers and hospice workers and the luxury of being able to spend time on the phone and then get the ointment and pay for it. Many families do not have that kind of luxury. And yet it would be better for all of us if I didn’t have to do all that, just get the damn ointment.

But I did not have to worry about being canceled. I think the cap on our insurance was $2 million. But he had a short-term illness. If he had cancer that was “more” treatable or had a longer prognosis, we would have reached our cap easily. It is a terrible terrible terrible thing to think that if your loved one survives LONGER, you are in deep do-do. Of course you want this person to live as long as possible and to have him or her around as long as you can, but when you watch the mounting costs, you realize the awful awful fact that if this person continues to live beyond your financial means, you’re in deep trouble. That is a horrible horrible thought to have and to have to live with. And people live with it every day. NO ONE SHOULD EVER HAVE TO THINK, “If my beloved lives longer than a few more months, I CAN’T AFFORD IT.” No. Not when you’re deep in grief over losing this person. But I can tell you that when you have a terminal or serious illness in your family, you lay awake at night worried about your life if or when you lose this person you love so much, but also see the dollar signs that haunt you and say, “Not only are you going to lose this person you love so much, but you will have no money left and you are going to be bankrupt.” You should not have to worry about that. Under the ACA you don’t have to worry about the dollar signs.

Well under the ACA, insurance companies cannot cap your lifetime insurance payments. You don’t have to worry about it. And peace of mind is something that every family who has a loved one battling a devastating illness or a child born with a condition that requires much medical treatment needs. And anyone who is against that should be ashamed.

3. And it’s not just private insurers. Currently there is a “hole” in the Medicare prescription plan where you reach a certain limit (about $3000) and have to pay out of pocket expenses (about $5000) before you get your coverage back. To some this might seem like a lot of money ($3000) but if you are suffering from certain ailments or a variety, you can rack up 3k in prescription medications very quickly. And then where do you come up with the 5k? Where does a person, most likely on a fixed income, suddenly come up with 5k to pay for prescriptions? WHERE?

Typically most elderly who are on Medicare run out about halfway through the year. Then they have to cover themselves. Many elderly simply stop taking medications they truly need. The ACA fixes this injustice.

If you are against this, there is something wrong with you and I hope you never get sick.

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