Avoided Medical Bankruptcy, and aren't threatened by lifetime caps

 

Dear Legislator,

I am writing about the Affordable Care Act to let you know that for me and my family, it has already saved us from having to choose between financial ruin and having affordable access to good health care not once, but twice. 

My family is firmly in the middle class. I am a physical therapist and my husband, Jim, is a commercial insurance underwriter. We have one daughter, Emily, who is almost 28 years old. 

Back on Labor Day weekend in 2010, Jim and I had just arrived at Niagara Falls where we planned on celebrating our 25th wedding anniversary when we got a phone call that no parents ever want to get. It was an emergency room doctor in Boston. Our daughter, Emily, had been at a Labor Day cookout and had fallen from a second story balcony when the railing broke. The doctor informed us that she had suffered a complete severing of her spinal cord with unstable vertebral fractures and would undergo major surgery to stabilize her spine the next morning. The doctor said, “Emily is now paraplegic and the surgery will not fix that.” 

Emily

Emily

 

Emily was a college student just beginning her senior year. She was 21 years old. The first provisions of the Affordable Care Act had just rolled out a few months earlier. Fortunately, because of that, Emily could stay on our family’s health insurance plan. Had it not been for the Affordable Care Act she would have suddenly had no health insurance since she had to withdraw from college for that semester. Prior to Affordable Care Act, our UnitedHealthcare policy allowed children coverage past age 21 only as long as they were full time students. 

Because she was insured, she had the opportunity to receive the excellent rehab services at the best rehabilitation hospital in the area. Had she been uninsured, her prospects for recovery and her future would probably have been very different. We would have been faced with making the horrible decision between spending every penny we have saved to send her for good rehab or sending her to whatever place accepts uninsured spinal cord injured people. Her acute hospitalization, inpatient rehab, and outpatient therapies in the first 6 months ended up costing well over $250,000 dollars. AND that amount takes into consideration the negotiated rate for someone insured by UnitedHealthcare. The amount we would have had to pay without the negotiated rates would have been more than double that. 

Partly because of the Affordable Care Act, Jim and I were able to see our daughter graduate that same year from MIT and continue on there for her graduate degree. Had she not been able to get the excellent rehab she did, in all likelihood her recovery would have taken much, much longer, would have been less complete, and her re-entry into society as a productive member would have taken much, much longer. Emily now lives in the Detroit area and works for Ford Motor Company as a mechanical engineer. She lives independently in her own home, drives her own car, and leads an active civic and social life. These are all things made possible, at least in part, by the Affordable Care Act. 

The ongoing monthly medications and medical supplies she requires cost over $3,500 per month. The botox injections required to help control her spasms cost over $40,000 per year. The wheelchair and specialty cushion which make her mobile in the world and help protect her skin and shoulders from injury cost around $10,000. Without the provisions of the Affordable Care Act which prohibit insurers from discriminating against people with pre-existing conditions, our daughter very well might face paying out of pocket for these very expensive necessities. As it stands now, these items are mostly paid for by her health insurance carrier. As you might expect, the provision under the Affordable Care Act that eliminated caps and lifetime limits is also extremely important for our family. 

More recently, the Affordable Care Act, has saved Jim and I from financial catastrophe once again. This past August, Jim lost his job. Our health insurance was through that job. We were able to continue our coverage for the remaining 4 months of 2016 through COBRA at a cost of $1,300 per month. Jim’s job search has thus far been unsuccessful. At the beginning of 2017, we obtained health insurance on the Maryland Health Exchange. We were able to get a very good Silver Level policy for about $380 per month with the subsidies and tax credits provided through the Affordable Care Act. 

It would have been practically impossible to have kept up the COBRA payments for much longer. We explored the option of buying our own private policy and found that there are few options out there, they are just as expensive as the COBRA payments we were making, AND they were very poor policies lacking in many of the benefits we need from our health insurance. Without the Affordable Care Act, we would probably be faced with the decision of either going without health insurance coverage or beginning to spend monies we have saved for retirement. It helps Jim and I sleep at night knowing that we have adequate health care coverage should a medical problem or injury occur AND we still have money in our retirement account. 

I am asking that you take into account my family’s story and the stories of millions of other Americans who have relied on the Affordable Care Act to keep them afloat and healthy as you make decisions about the next steps forward with regard to health insurance policy in our nation. 

While some of the details that come before you every day must seem mundane, I implore you to remember that the decisions you make and policies and laws you put into effect have enormous and far-reaching effects on the daily lives of those you serve. 

Access to affordable and excellent health care in America should not hinge on the political winds of the day.