If insurance companies are allowed to deny coverage for people with pre-existing conditions as they did in the past, her story could be very different.
Sarah was born with a pre-existing condition: a club foot. One of her feet was facing the wrong direction, a birth defect that required two surgeries by the time she was two years old. Surgeons rebuilt the bone structure of her ankle so her foot faces the right direction, making it functional so she could walk.
For the most part, she’s been able to walk and do “ordinary things,” although during college she couldn’t walk easily without the assistance of a brace and a cane. “When you’re 21, that kind of sucks,” Sarah says.
Because her foot had deteriorated badly by that time, Sarah needed another reconstructive surgery when she was 22 years old. It was then that her doctors told her she’ll need periodic surgeries for the rest of her life to stay mobile.
It was a hard, five-hour surgery. I was on crutches for six months after. But now I walk without the assistance of a brace or a cane 95% of the time. It’s been a significant improvement in my quality of life.
Fortunately, when Sarah had that surgery, the provision of the Affordable Care Act (ACA), or Obamacare, that lets young people stay on their parents’ insurance until they turn 26 was already in effect. Sarah was on her mother’s insurance, which paid for her very expensive surgery.
But once she aged out of her mother’s plan, Sarah was still in law school and had no coverage through her job at the time. She applied for her own coverage at the insurance company that covered her mother, and was denied. That’s because the protections in the ACA that forbid insurance companies from denying people with pre-existing conditions hadn’t kicked in yet.
Sarah then applied to a second insurance company, which required her to submit to a 20-minute interview during which she was forced to answer questions with only a “yes” or “no” response.
Yes or no answers aren’t always possible with a medical condition. When you say, ‘Can you walk unaffected now?’ I could say 95% — not yes or no. It’s not a yes or no question. Trying to explain that was like talking to a brick wall. It’s a very stressful, difficult conversation to have with some stranger about your limitations.
In the end, the company agreed to offer her insurance, but they would not cover anything having to do with her ankle. “I currently have screws in my ankle from my last surgery,” Sarah says. “If a screw broke, I’d be screwed.”
But she accepted the insurance offer, even though she admits that amounted to dealing with a major medical condition by “crossing my fingers.”
After a couple of years working at a job that provided health insurance, Sarah now gets her health insurance through the HealthCare.gov marketplace. Her current employer is a small organization, so they don’t offer benefits but they do provide a stipend to help employees buy their own insurance. Sarah’s current plan costs about $200 a month, of which she only pays about $50.
Sarah, who is now 30 years old, admits she’s concerned about what might happen if the ACA is repealed or dismantled, particularly if the protections for people with pre-existing conditions are eliminated.
Being without health coverage is terrifying. I was so lucky the ACA took away the pre-existing coverage denial. If that changes, I would probably have to move jobs to get a plan that would guarantee coverage. I’d rather make my career decisions based on the work, not the ability to take care of a healthcare need.
Sarah admits that the ACA isn’t perfect, but she doesn’t think dismantling it is the answer.
My story is small potatoes compared to what this law has done for some people in this country. Some people are literally alive today because of the ACA. It’s hard to imagine the thought behind belittling this piece of legislation that’s done so much to improve and save people’s lives. We’ve learned what needs to be fixed, so let’s work on fixing it instead of repealing it.
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Open enrollment for 2017 insurance continues through January 31, 2017. You must enroll by December 15, 2016, for coverage to begin January 1, 2017. Get covered today at HealthCare.gov.
[Photo credit: LaDawna Howard via Flickr.]
