For all its promise, the Affordable Care Act has holes


The Los Angeles Times

It’s 3:14 a.m.

I’m awake. Every night for the last six months, my eyes have opened just after 3. It’s my personal witching hour when my demons come out of the closet and surround the bed whispering messages of doom. My husband sleeps on, oblivious. I’ve developed some tricks to keep the creatures at bay. I count backward, I count my blessings, I recite what little poetry I know by heart. If I start listening to the goblins, that’s it, I’m up for the duration.

What am I worried about? I have smart, healthy children, one college graduate and one in college. I have a house and a husband and a car. What I don’t have is a job. And because I’m unemployed, we don’t have job-based health insurance. My husband works hard. He works a lot. But he’s always been freelance, and he’s hardly ever had insurance. That’s what I get from my kind of work, teaching at the university level — never much in the way of salary, but benefits. Now the work has dried up, and I’m benefit-less again.

I had a great one-year appointment teaching at a California State, with wonderful colleagues and interesting students. When the school decided to make the job a permanent position, I couldn’t apply. I didn’t have the required advanced degree. Twenty years working in my field, four published books and many published articles and stories, and I wasn’t eligible to continue doing exactly what I’d been doing. I know it has to do with the school’s accreditation. My department would have kept me if it could, but it couldn’t. I looked into getting that advanced degree and was even accepted at a school nearby, but I wouldn’t have been able to have the degree “in hand” by the time the permanent job started this fall.

So I’m out of work. Again. And because healthcare in this country is tied to employment, we are out of luck. Again. I had cancer. My daughter was hit by a car and got a concussion and a fractured ankle. I know bad things can happen to me, to my family. We have to have health insurance. And we have to pay for it ourselves. And that keeps me up at night.

I was excited when the Affordable Care Act was introduced. I thought it was about time everybody in this country had insurance. I believed it was ridiculous that we’re the only wealthy, Western nation without universal care. But the Affordable Care Act is not universal care. It’s not the single-payer system I so hoped for. It’s a step in the right direction, but for people like my husband and me, who make a pretty good income, it’s unlikely to give us any kind of break. We’ll still have to pay for our insurance entirely ourselves, and I’m not optimistic the price will go down.

Thanks to the Affordable Care Act, my new insurance company can’t deny me because I had cancer. Unfortunately, at least until January, when additional provisions of the law go into effect, they can charge me for it. For my family of four, to get care comparable to what I had through the CSU, we will spend $1,500 a month, or $18,000 a year. That’s a lot of money. I have to teach a lot to make that. The insurance through my former job was fantastic. We could choose our doctors, our co-pay was low and our deductible very reasonable.

We had that same insurance when I was diagnosed with cancer. Back then I was working at a different Cal State school and thank God I was. Without insurance, we would have lost our house, decimated the college funds, spent every bit of savings we had, and, six years later, I’m sure we’d still be paying off those bills. Or we would have gone bankrupt. Some 700,000 Americans every year declare bankruptcy because of medical bills. The number in Japan? Zero. The number in Germany? Zero.

I was lucky my cancer diagnosis came when it did. I had a job and I kept it until a year after treatment, when, due to budget cuts to the CSU system, I was laid off. We went on COBRA, because no other insurance would have me — the cancer survivor — until this latest job came along. COBRA is even more expensive now.

“Do something else,” the demons whisper. I have pored over Craigslist looking for different kinds of work. I recently applied to be an animal-control officer — no lie — but withdrew my application when I read the blog, “A day in the life of an animal control officer.” Too sad, too confrontational, too many pit bulls for me. And really, I love teaching. It’s what I have done for 20 years.

“Go back to school,” other demons — and my husband — sometimes say, but it’s expensive, we’re already paying my daughter’s college tuition, and I’m in my 50s. Who’s going to hire me as a full-time teacher for a permanent position when I’d be eligible to retire in less than 10 years? And if some school does hire me two years from now, will I work long enough to pay back my college loans?

I could hobble along, teaching where I can, doing some independent work, and my income would pay my daughter’s tuition or at least her living expenses, if it wasn’t for our health insurance. The Affordable Care Act mandates I have it, and I know my family needs it, but paying for it means other things will suffer. We’re not poor, I don’t want to suggest that we are, but we will have to make some hard choices if I’m not working and we’re paying $1,300 a month to an insurance company.

I had hoped that, under the new healthcare system, essential services for everybody would be covered by the government, as they are in every other First World country. At the very least I wanted the Affordable Care Act to be what it says it is: affordable care for everybody.

That said, I’m glad that an insurance provider can no longer deny me for having had cancer and that our unemployed son can stay on our insurance until he’s 26. By then, I tell myself, surely he will have a full-time job.

“But will his job have benefits?” Those are my 3 a.m. demons hissing at me again. And I have no answer for them.

Diana Wagman’s most recent novel is “The Care and Feeding of Exotic Pets.”

©2013 Los Angeles Times

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