25 April 2017

Feature: Word From the US!

The Dilemma of Health Coverage in the US

Have you ever wondered what it would be like if you couldn’t count on healthcare to be available to you whenever you needed it? To not be able to afford a visit to the doctor for a small issue, knowing full well that the issue isn’t going anywhere and is just going to get worse? Up until very recently in the US this was reality for many people. I grew up in England and France where we had access to free and universal healthcare (even though the system in France sometimes seemed a little convoluted). Everyone was on an equal level; you had your GP, your dentist, your optician if necessary. You had to wait for some tests, sometimes you couldn’t get a same day appointment, but at least you knew that you would be seen without being faced with thousands of dollars of medical bills that there was no way you could pay.

When I first moved to the US over a decade ago I worked for a company that provided health insurance. This really meant that every year or so they would negotiate with a new insurance and we would have to change our plans and premiums accordingly. I can’t even begin to explain how confusing the system was, you had to choose a network and a doctor, and depending on your choice, your bi-weekly premiums would be higher or lower. As a single woman blessed with very good health I always chose the lowest premium without really looking into the details. Things like co-pays, deductibles, covered and non-covered services went right over my head, and I just kept my fingers crossed that I wouldn’t have to actually go to the doctor. Every practice accepts a certain amount of insurances, and anyway, how do you choose one practice out of so many without even knowing anything about them? Why could I just not walk into a doctor’s office, make an appointment and be seen?

When I left that job I also lost my health insurance. This meant that if I ever fell ill, was in an accident, needed surgery or any other health-related service I would have to pay out of pocket. If you have a quick look at how much simple healthcare services cost you would be astonished… A simple trip to the ER for a broken bone or a rash can run into thousands of dollars. So what did people do? What do people still do? They wait until they are in so much pain and go to the ER, knowing full well that they cannot pay but cannot be turned away either. People end up with terrible credit due to unpaid medical bills. You know that whole thing about Americans having wonderful teeth? That’s just a TV myth, emphasised by the brilliant pearly white smiles you see on sitcoms. Most people can’t afford to go to the dentist until it’s too late, and then just get their teeth pulled because it’s cheaper that way.

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In 2010 President Obama passed the Affordable Care Act (ACA, often dubbed “Obamacare”), which was a first step towards ensuring everyone in the US would have access to affordable healthcare. Instead of insurances being able to pick and choose who they covered based on all types of criteria (have a pre-existing condition? Your premium would be much higher than someone without one), you could shop around for an affordable premium based on your earnings. In addition to being available to everyone, nowadays if you refuse to sign up for an insurance plan you will be fined, and this fine is taken when you file your taxes. While the ACA has many flaws it was a first step towards allowing everyone to be covered without worrying about having to pay extortionate medical bills. The ACA has been implemented in steps over the past few years, and while it has hit some stumbling blocks, all-in-all it has been pretty successful.
Cancer doesn’t discriminate, neither do congenital heart defects nor diabetes. However, before the ACA was implemented those with more money were more apt to be seen by a doctor earlier. The ACA was a start to make healthcare available for everyone. Some people found that they were paying a lot more than they had been before, but most people I know were able to say that they had health coverage for the first time in their adult lives. Pretty incredible seeing as this country is supposedly the leader of the world in so many areas! The ACA is NOT universal healthcare, far from it, but it is a step in the right direction. I honestly have no idea if there will ever be some form of universal healthcare in this country, there are too many people who “don’t want to pay for other people”. If they actually thought about it they would pay the same towards universal healthcare in their taxes as they already do in private insurance premiums.

In 2013 I was a bartender and restaurant manager, and not eligible for employee-based health insurance (while the ACA is now pushing all employers to provide health insurance to their employees, it doesn’t affect smaller businesses or those employees who work less than 40 hours a week). As I was rarely ill I hadn’t yet signed up for affordable healthcare, and was just waiting to see if the kinks would be ironed out… But then I found out I was pregnant. Honestly, the first thoughts I had weren’t about how I was going to raise a child and could I be a mother, but about how on earth was I going to afford to have a baby! Luckily, the ACA also expanded the coverage of Medicaid, state-run healthcare that is available only to those who earn under a certain amount. I was lucky to be in a state that expanded their coverage and had a great plan for pregnant women, and I fell within their income requirements. I was covered from my first visit to my 6 week post-natal check up, received great care, and my kids were automatically covered too. I don’t know what I would have done without it, because I saw a couple of hospital bills, and if checking into the ER before being led up to Labour & Delivery cost $1,000 I can’t even imagine what my very simple, no meds, 20 minute birth cost. I can’t even begin to imagine what an emergency c-section after 40 hours of labour would look like!!

My eldest has a congenital heart defect that requires yearly specialist check-ups and possible surgery in the future. Without insurance we wouldn’t be able to pay for the very expensive work-ups they have to do every year. You see, while we are covered this year, there are no guarantees that we will be next year. One of Trump’s main deals before he was elected was to remove the ACA and replace it with his own vision of healthcare, one that basically sent this country back into the dark ages again. Well if you weren’t well off. Luckily he didn’t get enough votes to push it through this time, but who knows what will happen next time? Obama fought tooth and nail to get only a small part of his vision approved, and nothing says that it will stay forever. As I said before, the ACA is far from perfect, but it is better than whatever was there before.

I basically just scratched over the surface of healthcare in the US, it’s very complicated and confusing and I still have no idea what I am doing half the time. For those of you who sometimes throw your arms up in the air because your public health system isn’t always perfect and you have to wait a while for certain appointments, please do everything you can to help save it. Don’t abuse the system and use it as you need it, but please, appreciate how important universal healthcare actually is. Because when you live in a country where it doesn’t exist it really, really sucks.

Next time I will touch on the current political climate now that Trump has been in office for a few months, and our personal journey into getting our kids all of their citizenship's sorted. If you are interested in reading more about the ACA, you can check out the website here

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