By: Adam T. and Lisa H., Brevard County
We are living in a time where health care influences every major life decision that you make. Changing jobs? Getting married? Our story illustrates many of the reasons that employer-based health insurance should be eliminated. Universal health care is our best option.
Lisa’s Story. Two years ago I met Adam and moved to Florida from Kentucky. Kentucky expanded Medicaid years ago and created the Kentucky Connect Medicaid program. It’s their version of the Marketplace. I had a major medical policy through Kentucky Connect which worked fine until I needed a minor surgery procedure. My plan was capped out and the surgery wasn’t covered under Kentucky Connect. I ended up with a $17,000 bill from the hospital which they turned over to a collection’s agency. The agency was out for blood and the $17,000 bill was never going away. I ended up filing Chapter 13 bankruptcy because of the debt. I’m still paying on the bankruptcy, but my monthly payment is still cheaper than what I was paying the collection agency. So, I had insurance coverage that wasn’t sufficient to meet my needs and I ended up bankrupt.
When I moved to Florida I got a job with a temp agency that didn’t offer health insurance coverage immediately. When I got a full-time job, I got coverage through my employer for a little while. When I left that job, I applied for coverage through the Marketplace and got a plan with Florida Blue. I have pretty good coverage and my premium is $56 a month. I only take prescription medication for my thyroid and high blood pressure which Florida Blue covers completely. My copay is reasonable at $65 per visit. So far, I’ve been pretty happy with my coverage, but I’ve had no major medical situations. If anything goes wrong, I don’t know how much it will help. I haven’t gotten that far. Although I have a primary care doctor, I end up rationing my own care, especially when referrals to specialists enter the picture. For example, I’ve moved some specialists’ appointments to next month due because the co-pays from these visits add up quickly. I pay $56 a month for my premium but if you add three specialists visits to that cost, and I’m at $250 for the month. I can’t afford that each month. I believe that we need universal health care as a way to ensure that everyone has health care coverage. I work as a personal shopper which is part of the gig industry. These jobs fluctuate based on demand and COVID has many of us concerned about the future. With gig workers there is no employer health insurance option. The ACA is pretty much all you have. But it’s just a stop gap measure. Health insurance affects almost every decision you make in your life. Moving. Changing jobs. Getting Married. There will be a big problem if Trump gets rid of the ACA. I and millions of others will be without coverage.
Adam’s Story. From 2008 to 2014 I had my own private medical practice. Most of the time people hear that and automatically think I was rolling in the dough. People do not realize that there is not a lot of money coming through the door when you start a new business. We had a small family practice with one physician and one massage therapist. During that time, I didn’t have health insurance and could not afford to offer health insurance coverage to my employees. I researched the small business owner health insurance options through the Healthcare Marketplace, but it was too expensive. Even for an individual policy I made just slightly too much for the ACA, but far too little to be able to afford health insurance on my own. The employees went without coverage or they had coverage through a spouse. When an employee got sick, if we could handle their care in the office, we took care of each other. Looking back, I always felt rather terrible for all those years. I was in the business of helping people feel better yet I was unable to provide a sense of security that comes with health insurance coverage.
During those seven years when I got sick, I simply avoided seeing a doctor. I only had one incident that required me to see a doctor and I did so begrudgingly because of the cost. Luckily, my wife, now deceased, and I had a relationship with a primary care doctor who was willing to negotiate a fee for service. He was my primary care doctor before we lost our coverage. We bargained with him to pay out of pocket, and it was not an easy process. In 2015 I decided to close my practice and started seeking employment where health insurance coverage was part of the benefits package. The lack of health insurance coverage was definitely one of the reasons I decided to leave private practice and went to work for someone else.
Today I work as a teacher in the public-school system, and now I’m faced with a whole new battle. When I first started teaching there was a sense of relief around what would happen if I got sick. I knew that I could easily access a doctor. Now, in the wake of COVID-19, there are new fears and concerns. Teachers are set to go back to school in about two weeks, just as the state’s COVID-19 cases are surging. The administrators and district are trying to figure out how much staff they can do without when faculty and staff inevitably fall ill and/or need to quarantine. They’re calculating their mortality and morbidity rates while simultaneously saying that returning to school will be perfectly safe. This is an unprecedented time! During those years without coverage I certainly felt that, as a single male, no one really cared if I was alive or not. I knew that if Florida had expanded Medicaid my employees and I would have been covered. But in Florida we were left with zero options. Health care coverage should not be tied to where you work. It leaves you worried out getting another job for fear of changing doctors and insurance and hamstrings entrepreneurship. It decreases what I feel my options are.
I lost my first wife to cancer. We had insurance coverage at the time, but the insurance would not cover many tests my wife needed. According to our doctor we had to wait until there were sufficient symptoms at a specific level. When the brain cancer was found, it was too late. My wife died five months later. It’s ironic because my wife was a physician who would see patients regardless of income. She took, literally, produce and farm-goods in payment. Yet, her doctors would not see people regardless of income. We tried for years to get her tested. But we lost everything. I lost everything. Wife. Home. Car. Business. Savings. All of it. I ruined my credit, then could not get a rental. I ended up homeless. A homeless teacher!
Health care coverage has been a deciding factor in many of our life decisions. Lisa’s Florida Blue program is expensive and limited. We consider her to be under-insured. I have been using a credit card to cover what her insurance does not. That can't continue. Because we’re not married, Lisa and I are considered domestic partners. My employer’s health insurance plan only covers married individuals, not domestic partners. So, marriage for us would mean better and less expensive health insurance coverage for Lisa. However, if we were to get married my student loan payments would double because Lisa’s income would be counted with my income. If she has a job, we have to report it on our income taxes which is how student loan payments are calculated. If she loses her job anytime during the year, we have to continue to pay the predetermined loan payment until the next income tax year comes around. So, health care coverage must be considered, unless you’re very well off.