By: Judith C., Miami-Dade, County
My husband and I are self-employed. We signed up for health insurance through the Marketplace when the Affordable Care Act was implemented. It was the first time that we were able to be proactive with our healthcare. I make sure we have our annual checkups so can prevent illnesses as much as possible. And while it is a relief to have insurance, our plan is extremely expensive. Our monthly premium is $1,665 for both of us and we each have a $8,600 annual deductible. We’re paying close to $20,000 a year for health insurance. Yet, we could still end up on the edge of bankruptcy.
When my children were little, my husband and I made the decision that I would go without health care. Between the two of us, I was the healthiest. So, he enrolled in a health insurance plan through his job and added the children. Then I got pneumonia. I was sick for months before I finally went to the ER. To this day I remember the nurse saying to my husband ‘a few more hours and she wouldn’t have made it’. Her words have always stuck with me. Up until that time, I was a stay at home mom. Then, because of the bills from my pneumonia, I had to get a job. It took me over a year to pay off all of the bills. I still remember the fear and stress. I’ve been working ever since, just so we could have health insurance.
In 2018 my husband had pneumonia. That was a little scary. Because of our high deductible, we ended up paying a lot out of our pockets. Initially he went to the clinic covered by our insurance plan, but he wasn’t diagnosed right away. It took him three trips to the clinic before he was finally diagnosed. I felt like his trips back and forth to the clinic were the clinic’s way of making more money. Our insurance plan pays for each doctor visit, so it was to the clinic’s advantage to make him come back, again and again. I think that health care professionals control what they can so that they can control their cost.
Recently we were leaving a neighbor’s house and I tripped. I missed a small step on her walkway and rolled on my ankle, falling into a sitting position. Everyone was stunned. I couldn’t stand on my foot, so my husband went around the block and got our car. Another neighbor who witnessed my fall wanted to call an ambulance. We told him no, it cost too much. My husband got back with the car, helped me up, and I hobbled to the car. At home, I iced my foot and wrapped it. My foot had swelled up. I sent a photo to my daughter who is an ER nurse and her partner who is Fire Rescue. They both said it looked broken and that I should go to the ER to get it x-rayed. I refused to go to the ER because our deductible is so high. We have an ACA Bronze HMO plan which means that out of network doctors are not covered. In an ER I cannot control if the doctor is on my plan. So, I can’t control the cost. My decision to not got to the ER was based solely on money.
The next morning, I went to the clinic on my insurance plan. By that time my foot looked like a balloon with toenails. They x-rayed my foot and found I had fractured the talus bone in my ankle. They sent me to another clinic to be fitted with a boot and made an appointment for me to see a podiatrist the next day. The podiatrist took more x-rays to verify that the only fracture was the talus and to evaluate whether I needed surgery. I am very lucky that I did not need surgery. It has been 16 days since I fractured my ankle. I see the doctor again March 10th. Hopefully I will be healing well. I have not received any bills yet, and I have no any idea what this is going to cost. That unknown creates anxiety. In retrospect, I should have gone to the ER right away. I was lucky that I was not hurt worse.
My husband and I are financially comfortable, but we know that a major medical event would bankrupt us. That shouldn’t happen in the wealthiest country in the world. No one should be afraid to go the doctor or hospital because of cost. Yet, the vast majority of Americans make health care decision based on cost and availability rather than need. One fifth of me and my husband’s gross income goes to health insurance-- that doesn’t cover everything. Health insurance is our single highest expense. It is scary that my situation is not unique. We need to heal our health care system.