Finding Coverage and Reassurance– thanks to the Affordable Care Act

Just one of the many families for whom the ACA has made a difference

sheets-sara-headshot-2016-240x300Guest Contributor: Sara Sheets

For 15 years, neither my husband nor I have enjoyed employer-sponsored health care. He left a stable government job to start his own law practice and I became a self-employed project manager and grant writer. He is still self-employed and I work at a small nonprofit organization without benefits. We’re both doing entrepreneurial work serving our community. The Affordable Care Act has made a real difference in our lives–from ensuring that our daughter won’t be penalized for a cancer diagnosis to putting necessary medical care within our financial reach. Congress should not repeal this important law.  

Dual Incomes, No Kids–or Health Benefits on the Job

In 2003, when my husband and I were in our thirties, newly married, and healthy, we bought a high-deductible, catastrophic policy directly from an insurance company. Every visit was pay-as-you-go. That meant choosing whether or not to see our doctor based on what it would cost and paying a monthly bill for something we never utilized. It also included infuriating and time consuming exercises in seeking answers to cost questions from a doctor’s office, lab, or hospital. Each year, our premiums went up 33%, the maximum allowed by the Ohio Department of Insurance. Every single year. We could predict it.

In 2004, we began to think about starting a family. Our insurance company said that a maternity rider could be added for $400/month and it had to be in place before I got pregnant. Otherwise, if I were to conceive and then asked for coverage, I would be denied because my pregnancy was a pre-existing condition—and an expensive one. So, we had to pay $400/month for the privilege of trying to start a family.

Facing that sizeable increase in cost, we decided to look around for other options. We called hospitals asking, “How much does it cost to have a baby?”  They couldn’t answer the question. How was I going to get pre-natal care? How would I deliver a baby without insurance? Would we even be able to start a family? It seemed impossible until we found a private option offered by a local health system. For $3,000, we signed a contract for my pre-natal visits, delivery, and post-natal care. I had two healthy pregnancies and two healthy children.

New Family Additions and Health Care Expenses

We added each child to our policy but were surprised to learn that our insurance company didn’t cover vaccinations. So, we paid cash for the less expensive ones; for others we turned to the Cincinnati Health Department, which offered accessible and affordable service for all. I vividly remember standing in a block-long line anxiously awaiting the H1N1 vaccine for my children. I was so grateful for the public safety net catching us more than once.

Then, the unthinkable.  In 2008, our three-year-old was diagnosed with cancer. We remember telling the oncologist we didn’t know how our insurance policy would be ever be renewed. Every year before the ACA, you had to fill out lengthy paperwork identifying any changes in your health. Sure enough, our 3-year-old’s cancer diagnosis triggered transported our policy into the “high risk” category and the price skyrocketed. Our best choice was to purchase two policies, one for her and one for the rest of the family.  Bills and hospital statements came addressed to our little girl. It was absurd.

The Difference the ACA Has Made

Since the ACA was enacted, our lives have become much simpler. Instead of calling multiple insurance companies and filling out lengthy applications, we log on to one site, insert our demographics and are presented with several choices. We can pick an option that works best for us. We have kept our long-term doctors. Instead of paying out-of-pocket for prescriptions, we have manageable copays. Our children receive all their vaccinations from their pediatrician and the ACA covers them 100%. I get mammograms; we all see our doctors for preventive care, which the ACA covers. We no longer put off seeing a doctor because of the cost. If we were looking to have another child, the ACA ensures that I could get maternity coverage. Insurance companies can no longer discriminate against me and my uterus. Our insurance premiums have remained relatively unchanged.  Most importantly, we have found comfort knowing that our daughter will not face a lifetime of discrimination for having BAD LUCK.

We are just 4 of the 20 million Americans who will be deeply impacted if the ACA is repealed; we shudder at the thought that our daughter might lose her health care or that she will spend her entire life feeling shame for her unfortunate diagnosis and its consequences on her health coverage. We’re afraid that repeal would result in costs so high that we would be forced to change careers, close our offices and find employment simply in an attempt to chase health insurance coverage. These are real scenarios. We implore our national leaders to listen, to study the issues and become familiar with what is and what isn’t working. The ACA is working for us and I hope someone will listen and save it before it is too late.

Sara Sheets is the Executive Director of the Madisonville Community Urban Redevelopment Corporation.  

Author: Verna L. Williams

Interim Dean, Nippert Professor of Law, co-founder and co-director of Cincinnati Law's Center for Race, Gender, and Social Justice. Professor Williams joined Cincinnati Law's faculty in 2001. She teaches Constitutional Law; Gender and the Law; and Family Law. Her research examines the intersection of race and gender in law and society.

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