Monday, November 21, 2016

Please Don't Make Me Go Back to Pre-Obamacare!

Great. Now I'm forced to write this stupid post because of stupid Donald Trump's stupid victory.

I think I'll start this post off with a story about how lame and ill-informed anti-Obamacare people are. I was in Washington, DC for a job interview, and I happened upon an anti-Obamacare rally. So I decided to infiltrate and ask some questions of the demonstrators, with their signs talkin' bout constitutional rights being violated and all that.

One middle-aged white guy (surprise surprise!) that I engaged got to hear a bit of my story. "Without Obamacare, I'd most likely be totally broke, if not dead," I told him. "You don't look unhealthy," he responded. "Yeah, that's the thing, healthcare is more complicated than looking or not looking healthy."

Here are my worst stories from pre-Obamacare:

1. The time I couldn't get insurance in California in 2004/5 because I was working for a temp agency and no insurance company would cover me. I had landed a REALLY good job working at McGraw-Hill on various educational projects. I hadn't even graduated college yet, so it was a really amazing opportunity. Unfortunately, the temp agency that I was technically working for didn't offer benefits under a group plan, and they informed me that I would just have to get an individual plan. So I called. And called, and called. Kaiser, Blue Cross and Blue Shield, they all literally said, "We don't offer individual plans for someone with type 1 diabetes."

But it gets kind of worse. I went to the county health department and talked with a social worker there. I was in tears as she told me that there aren't any programs for a person my age (not under 18 or over 65) with no kids. She said I could go to the public health clinic and they would see me under some county program.

My experience there is that I couldn't see a doctor more frequently than every 3 months, including diabetes visits. I got 15 minutes MAX with the doctor. When I needed him to write me a prescription, HE LITERALLY WROTE "INSULIN" AND "TEST STRIPS" ON A PIECE OF PAPER. (In case you are wondering, this is a useless way to write a prescription.)

Lastly, and worstly, this county program would only allow me to use Regular and NPH insulin. If you know anything about insulin, this is the kind I was taking back in 1996, and insulin has gotten MUCH better since then (more fast-acting, fewer peaks and valleys). No self-respecting doctor would prescribe it today. Unsurprisingly, the program also considered the insulin pump, a device that had already been around for decades, to be "experimental."


2. The time I went to grad school at Brandeis and got on the university coverage that paid for my prescriptions through mid-February each year. This was actually really bad, if you understand anything about insurance policy.

In Massachusetts, if you don't have a job, you can still get insurance through the state-sponsored program. It is REALLY GOOD. I got to see a qualified endocrinologist at Mass General, all insulin was modern and paid for, and amazingly, all of my diabetes supplies, including pump supplies, were automatically delivered to my doorstep each month like clockwork.

I had moved to Massachusetts in January and was starting grad school in June. Filling that gap in coverage was much-needed. So you can imagine my dismay when I was being made to switch to the plan offered by Brandeis. Here's why it was so bad:

There was a yearly max on prescription benefits of $2,000. That wouldn't have been a problem if not for this: the plan had recategorized insulin pump supplies (reservoirs, tubing, etc) as prescription benefits. This is unprecedented. Every other plan I have ever know deems these supplies to be durable medical equipment (the same category as prosthetic limbs) and is usually covered 80-100%. They are really expensive supplies.

So, doing the calculation accounting for the life-saving prescriptions and supplies I needed, the coverage would have gotten me through mid-February of each year. From there on out, I would have had to pay for everything out of pocket (about $1150 each month). Luckily my program was only 15 months long, and I had hoarded enough supplies to (barely) get me through. Diabetics are hoarders for this very reason.

Here's my message to the Trump Administration and to Congress:

Without Obamacare, insurance companies will pull off sketchy shenanigans like I have described: they won't cover those vulnerable populations that need it most, and even if they do, they might recategorize supplies to their bottom line.