NELSON'S doctors found the bulge in his abdomen on a Monday. An ultrasound and CT scan showed that a mass was crowding out his stomach and kidneys. It was one of the largest the doctors had ever seen. If they didn't do something, he'd be dead in a couple of days.
The hospital gave him a blood transfusion because he was anemic. A radiologist noticed that something might be wrong with his adrenal gland. His surgical team removed what turned out to be a 12.5-pound tumor, lifting it out like an overgrown newborn. Nelson's intensive care nurse called his family that night, and his internists gave them regular updates until he was discharged.
Nelson's health insurance covered 90 percent of the costs after a reasonable $500 deductible. I'm happy he has such good health coverage. He's my dog. And I'm jealous of him.
He has the kind of health care that I'd hoped the Affordable Care Act would usher in for those who, like my wife and me, have to buy health insurance on the open market. I'd long been frustrated at how health care shackles people to corporate jobs. I believed this legislation, signed four years ago this month, would free people to pursue their dreams, start new companies and not worry about the health insurance penalty.
What I didn't count on was that it would make things harder for me and my wife.
First, we were notified that we would be kicked out of our existing $263-a-month Anthem Blue Cross plan because it didn't meet the minimum standards of the new law. No problem, I thought. The plans in the new Covered California exchange would most likely be better and cheaper.
But we were shocked at what we confronted. The least expensive premium for a couple like us in our 40s would be about $620 a month. And because our household adjusted gross income is likely to be over the $62,040 cutoff this year, it's doubtful we'll end up with a subsidy to help offset that price increase.
Having always had insurance, we began to wonder if we might have to go uninsured, but in the end, w e enrolled. It's as if we just bought a new car that we will never see and that we can never pay off.
The gulf between my health care world and my dog's was driven home the other week. I have mild asthma. Normally it's not a problem, but when I get a chest cold, it becomes severe. One recent day I found that I couldn't breathe. My inhalers were all expired. I'd held off refilling them since my insurance would reduce the costs of the $58.99 inhalers only by a little more than $9. I knew from past experience that I probably needed a prescription for antibiotics, so I tried frantically to find a medical facility that would take our new Covered California Anthem Blue Cross bronze plan. When I did, they said it would be three weeks before I could see a doctor. Instead, I went to the drugstore and bought all the nonprescription medication that might help.
Around the same time, Nelson developed a skin infection. I got an appointment at the vet's the next day. They prescribed an antibiotic and did some blood tests. The medication caused diarrhea so I called his internist at his vet hospital, PetCare, and she prescribed a probiotic. Nelson's $40.42-a-month pet insurance isn't perfect — for instance it doesn't cover pre-existing conditions — but it paid almost all of these costs, and the vet followed up to make sure he was doing O.K.
I was envious. My 11-year-old brown Labrador was getting the kind of treatment that I could only dream of. I wanted to go to PetCare. I wanted pet insurance.
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I know that Obamacare is helping a great number of people. I understand that for the first time millions of people are getting health insurance. It's the one thing that gives me solace.
But let's not pretend that this new policy is the affordable health care savior that many of us were hoping for. For us, our new plan is a big financial hit for a product that does not make it any easier to get basi c health care.
It's still hard to understand what coverage we have. It's like trying to read tea leaves. Benefits descriptions can be contradictory and run nearly 200 pages long. One summary attached to my online account seems to say that if I go to the emergency room, I could potentially owe thousands of dollars. Another document suggests that I'm responsible for only $300. I've had two representatives give me two different explanations. The more I questioned these well-intentioned people, the more I realized how confused, overwhelmed and at times plain wrong they were.
Here's what I've been able to piece together. Previously, our family deductible totaled $13,600 for outpatient care and $6,600 for hospital care (with a maximum combined out-of-pocket cost of $13,600). Under our new plan, we have a deductible of $10,000 (and an out-of-pocket maximum of $12,700). In both cases, having deductibles that high means this is largely insurance to make sure that we don't go bankrupt if we become very ill. Yes, the new plan has more coverage, including pediatric vision. But we don't have children, and I'd trade coverage for things like substance abuse treatment and mental health in return for lower premiums.
And if you see a doctor outside your network, look out. We found this out the hard way. My wife and I both had to see a doctor in January. Our old policy and our new Covered California policy were both with Anthem Blue Cross, so a representative there told us to use our old ID cards for our visits since our new cards hadn't arrived yet. We were covered, he assured us. At the medical center, we gave our ID cards to the receptionist, who accepted them as valid, and went in to see our regular doctors. But later we found out that they were not in our new network's plan. The out-of-pocket cost for my simple 30-minute office visit: $303. My wife's annual exam and a couple of minor procedures: $918.
We're still waiting for quality health care that we can actually use, afford and understand — the kind of care that Nelson gets.
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