Sometime in May, after nearly three weeks of sitting on pins and needles, I finally got my Blue Shield insurance card in the mail. I had paid my premium before the April 15 deadline, but considering that a) the insurance companies were dealing with millions of new customers thanks to the Affordable Care Act and b) that I don’t have much trust in health insurance companies these days, finally receiving confirmation of my coverage was a relief. What added to my anxiety was having gone through web site hell on the last week of signups for Covered California, trying to complete an application process I started way back in December (I’ll explain further later). My insurance card was final proof that my application and payment had gone through.
The ACA is giving millions of Americans access to health coverage that they had been denied for decades. Many will be able to see a doctor for the first time in years, or ever. Others with chronic conditions will see their premiums go from exorbitant to just bearable. And many more low-income Americans are now covered under expanded Medicaid. This is all great news. For myself, I finally have insurance for the first time in nearly ten years.
But like many single payer, Medicare for All, advocates, I believe the ACA still falls short. We already know the major reasons why: the law doesn’t cover everyone, it doesn’t adequately control medical costs and it keeps the flawed, for-profit system intact. However, there are just day-to-day practical reasons as to why a single payer system is far preferable.
First: I no longer want to have to deal with a health insurance company when I’m well, and least of all when I’m sick. If I have a problem with a medical bill, I don’t want to have to wait on the phone for who-knows-how-long for a customer service representative, or fight with the insurer over whether a procedure will be covered and at what cost. It’s bad enough having to wrangle with your cable provider. Do we really want to have more stress when we’re dealing with a medical crisis? Also, I’ve got better things to do in my life than wasting precious time tangling with a health insurer – like spending a day with my family, watching a movie, writing a novel, etc. I’d rather let the government handle my medical bills. Let’s have public employees be paid a good salary to bargain with healthcare providers. And we can get on with our lives.
Second: I don’t want to have to deal with a balky web site and deadlines to get health coverage. December 15. December 24. March 31. April 15. These were the various moving deadlines for people to get covered under the ACA. Each time the HealthCare.gov web site crashed under the weight of pent up demand, the Obama administration extended the deadline for people to enroll in a health plan and subsequently pay the first month’s premium. I, myself, had started my application on CoveredCA before Dec. 15, the first deadline to enroll and get coverage by Jan. 1. I had been unemployed at the time, and knew I would be eligible for expanded Medicaid (MediCal in California). It wasn’t until March that I actually heard back from the state to enroll in MediCal (I had read in the newspaper that there were delays in the MediCal program, no doubt due to the millions of newly eligible enrollees). But by the time I had heard back about my application, I had already gotten a new job with a political campaign. The job didn’t come with health coverage, so I still had to go on the state exchange and buy an individual plan. I also had to update my application on the CoveredCA web site to reflect the change in income. Unfortunately, I was doing this about a week before the March 31 deadline that marked the end of the enrollment period. That’s when the CoveredCA site was starting to slow down considerably and present its own problems. When I tried to finish my application update, the site wouldn’t take my PIN number. So I changed the PIN number, but the site wouldn’t take the new one either. I thought a new password might fix the problem. It didn’t. Even the new passwords CoveredCA customer service gave me didn’t work. At this point, it was the weekend before the March 31 deadline. Desperate, I sought out an enrollment counselor. I was the first in line to meet with the counselor – a kindly retired physician – at the local mall’s CoveredCA kiosk. To my frustration, the counselor had to enroll me by navigating the same web site! The site crashed so many times, that even though I waited for two hours, the counselor still hadn’t gotten through. He told me to just go home and he would call me when he finally got my updated application through. It wasn’t until the next day that he called me to tell me he finally forwarded my application and now I could pick a health plan. I had started the enrollment process before Dec. 15, but didn’t finish until March 30. In between all that time, I had gotten into a car accident and injured my right thumb. Because I was still uninsured and waiting to get coverage, I delayed seeing a primary care physician, and when I finally did, I had to pay out of pocket. In a single payer system, I would be covered immediately, and would never have to go through the trouble of navigating a flawed enrollment process. There are doubtless many people who, either out of procrastination or frustration, never enrolled or finished enrolling. They will have to wait until the enrollment period reopens on Nov. 15. But by expanding Medicare to everyone, no one would have to ever again deal with deadlines and enrollment periods. You’d have the peace of mind of knowing you’re always covered.
Third: Trying to find a doctor shouldn’t resemble an Easter egg hunt. Lately, while trying to find an orthopedist to look at my injured thumb, I’ve discovered there’s a drawback to the CoveredCA program – a large number of providers will not see patients with insurance acquired through CoveredCA. The problem is especially vexing when people seek out specialists. Some Californians have unpleasantly discovered that the physician they had seen for a long time could no longer see them after they bought new policies on the exchange. As with Medicaid, lower reimbursement rates are the reason some physicians and hospitals around the country won’t accept plans acquired through the ACA. Extremely narrow provider networks have become the result. Most of the affected policyholders had purchased plans from Anthem Blue Cross or Blue Shield, the two largest insurers on the CoveredCA exchange. Needless to say, many CoveredCA customers feel duped. Some wonder if their new plans are useless. CoveredCA says it’s working on the problem, and last month, Anthem Blue Cross just widened its network. But, still waiting on Blue Shield. In the meantime, who knows if or how long it will take me to find an orthopedist. I may end up having to pay out of pocket for an out-of-network provider. However, it doesn’t have to be this way. A single payer system would allow for a full choice of providers, while the awesome negotiating power of the government would be able to keep costs down. We shouldn’t have to pay more, but get less.
Fourth: I want continuity of coverage. That campaign job I had gotten in March ended abruptly early this month, and now I find myself unemployed again. I have a decision to make: do I keep paying the nearly $300 monthly premium with the money I earned with the job, holding out hope that I’ll find another job soon, or do I drop the insurance and reapply for MediCal? I have a chronic condition, and I don’t know how long again it would take to get onto MediCal. Fortunately, my primary care physician does take MediCal, but for many Medicaid recipients, finding a doctor is still difficult. In a still shaky economy where it’s hard to find a job, let alone one that pays well and is secure, more people will find themselves cycling in and out of the private system. This is what’s known as healthcare “churning.” “Churning” is disruptive and unnecessary. We need to establish a single payer system that would guarantee the same amount, quality and continuity of coverage to everyone, regardless of whether or not you are employed, and regardless of your income level. No more catastrophic coverage. No more “bronze,” “silver,” “gold” or “platinum” plans. No premiums. No costly deductibles. No networks. No more treating public health coverage like a welfare program, vulnerable to political games from spiteful politicians. Under a single payer system, everyone would be treated equally. That’s how it is in other industrialized nations, and that’s how it ought to be in America.
The ACA is a first step, but it’s is not a panacea. The law still keeps in place the flawed for-profit healthcare system. So we can’t rest on our laurels. We can’t just declare victory and go home. Let’s improve on the ACA by implementing single payer, improved Medicare for all.
Sylvia@californiaonecare.org