in praise of obamacare [because experience]

As we are all well aware by now (unless you've been living in a media blackout), the Affordable Care Act-mandated healthcare exchanges -- the websites that will enable uninsured folks and people paying for individual plans to enroll in health insurance plans and gain access to government subsidies -- open today.

Much has been written about the political right's hysteria about the ACA, or Obamacare, and their effort to deter the eligible from using these exchanges to gain access to affordable medical services. For the past few weeks the freak-out has only gotten worse.

So I thought, on this auspicious day of an important piece of the Obamacare roll-out, I'd offer up a big "thank you!" for my own experience with Obamacare's more local predecessor, Romneycare.

When I moved to Massachusetts in 2007, I had been paying independently for health insurance since graduating from college in 2005 and becoming ineligible for my parents' workplace-sponsored healthcare coverage. I paid to extend that coverage for several months through COBRA at the price, if memory serves, over $300/month. As that cost was unsustainable, even living in my parents' household, I switched to a catastrophic-coverage plan through Michigan's Blue Cross, Blue Shield. The monthly payments weren't too bad, about $50, but the deductibles were so high that I was paying out of pocket for all of the routine, preventative care that I actually needed: primary care, medications (I'm on several ongoing prescriptions), as well as dental and eye care. Actually, before moving to Massachusetts, I had never had coverage for dental, or eye care. I was used to paying $90-180 per appointment for regular dental cleanings.

Mental health care, too, was something that my family had never had coverage for -- counseling appointments were strictly out of pocket, if we were lucky reimbursable through the flexible spending account (FSA) my parents paid into every year.

Between 2005-2007 I worked a number of part-time positions for between $7-10 per hour. My last pre-library school job was at Barnes & Noble where I worked 15-30 hours/week for minimum wage. I started there at $7.50/hour and when I quit the job to take a position at the Massachusetts Historical Society I was making around $9.00/hour.

At the MHS I earned $14.00/hour, which was more than I'd ever made in my life. But at 21 hours/week only came to roughly $15,300/year ... before taxes. In order to buy into the Simmons-sponsored student health plan, I would have had to take out additional student loans to cover the premiums.

Thankfully, as a part-time graduate student I qualified for the Massachusetts state-subsidized healthcare program. After submitting an application, providing proof of income and lack of insurance options through work, and waiting for the bureaucracy to churn away I was approved for Commonwealth Care. Hanna was also approved as well, after many years of being uninsured during periods of low- and unemployment in states without comprehensive health insurance programs.

bDuring the rest of my part-time employment/graduate student days -- until I transitioned to full-time professional employment with work-sponsored healthcare coverage -- I had Commonwealth Care to thank for access to a primary care provider, to eye- and dental care (for which I paid only co-pays for the first time in my life) and, wonder of wonders and miracle of miracles mental health coverage.

Let me repeat this for you:

For the cost of between $0-$100/month in premiums, and $0-20/visit in co-payments, scaled as our income changed, Hanna and I had access to comprehensive medical care. Thanks to Romneycare. 

Between 2007-2011, while we pieced together part-time work for living expenses and shouldered the burden of student loans to cover tuition, we had the peace of mind that our medical needs wouldn't go by the wayside due to our inability to pay.

our awesome health center
Romneycare paid for us to go for our annual physicals and our ladybit exams.

Romneycare paid for my thyroid medication and all of Hanna's prescriptions, sometimes with no co-pay.

Romneycare gave Hanna access to psychiatric and counseling services when she needed them to combat depression.

Romneycare brought us eye exams and low-cost prescription lenses.

Romneycare funded dental cleanings, x-rays, and repair work.

There's been a lot of talk about how young adults, supposedly healthy, have little incentive to engage in these health insurance marketplaces. Yet there are plenty of young adults out there who have chronic health conditions (or are working to prevent chronic health conditions toward which they would otherwise be trending). Apart from anything else, how many of us need glasses or contacts? Despite America's love affair with youthful bodies, young bodies are not always healthier bodies. And the struggles of those bodies are not always within our powers to ameliorate or eliminate without access to health care professionals.

I can't create the synthetic hormones that make up for my lack of a functioning thyroid.

I can't grind the glass to create the lenses that allow me to work and drive safely.

I can't manage my migraines without assistance from my primary care provider.

Hanna needs ongoing support to navigate her depression and anxiety.

We've both, in the past two years, needed diagnostic tests and physical therapy to prevent chronic injury.

In 2011 we both transitioned into professional positions that offered robust health plans as part of the benefits package. Today, we pay roughly $120/month (pre-tax) in premiums through our employers to continue our access to medical, mental, dental, and eye care. Most appointments come at a $15-20 co-pay; prescriptions are $5-20 per refill. We are able to utilize flex spending accounts, and thanks to a strong union, Hanna's co-payments annually top out at $135 for her wage bracket.

Last year we were reimbursed about $800 by Harvard for prescriptions and co-payments.

I haven't done the math for all our medical services, but without insurance our counseling appointments alone would cost $10,800 as billed ... about 2/3 what we pay in rent annually.

While we're lucky to have workplaces that offer these benefits, it's also reassuring to know -- in this age of uncertain employment -- that if one or the other of us needs Commonwealth Care again, it will be there to access. I've referred friends the program. And I'm glad to know that many, many others in the state of Massachusetts have been able to access care like we did, supported by our tax dollars.

(According to one subsidy calculator, if Hanna and I needed to purchase
private insurance, even at our current income we'd get $900 annually
in federal subsidies to help make that more affordable.)
This coming year, I'm going to feel a little bit better about being an American citizen in a nation where people in Michigan, Texas, Oregon, and elsewhere can access care also.

Supported by our tax dollars.

I believe this is (the beginning of) government as it could and should be.

Thank you, Obamacare, for taking a step in the right direction.

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