Like millions of others, my wife Josie and I are self-employed, middle-class Americans. We are old enough that insurance companies place us in their expensive high-risk categories, but too young to qualify for Medicare.
Until one of us got really sick, we lived under the illusion that we were adequately covered by our health insurance plan. Two or three months after my wife was diagnosed with cancer, bills from dozens of "excluded" medical expenses started piling up. All those bills had been submitted to our insurance company, and both our medical service providers and ourselves had assumed the insurance company would pay those bills minus the deductibles, and that our in-network and out-of-network caps would apply. Damn those fine print "exclusions" that I never paid much attention to before!
Unfortunately, by the time we realized out how utterly inadequate our health insurance was, we were stuck with it. My wife's cancer is now a serious "pre-existing condition," so we don't stand a chance of switching insurance carriers or upgrading our policy, until that day if-and-when Obamacare becomes a reality. For us, and many thousands of others in similar situations, Obamacare will make the difference between never ending financial struggles, or having an affordable yet comprehensive health insurance policy along with the prospect for a decent life without fear of bill collectors and bankruptcy.
I am approaching my 57th birthday, and have been exceptionally healthy my entire adult life. Josie turned 63 recently, and up until about one year ago, except for a close call with a deadly toxic mold (Stachybotrys) back in 2004, she has also been quite healthy. So much so that I have gone for entire decades without taking as much medication as a single aspirin, and neither of us had previously taken any long-term prescription medications.
As far as our insurance companies were concerned, prior to 2012 we had been the ideal clients -- dutifully paying into the system for decades, while almost never drawing funds for claims. Over the past 19 years of self-employment we have purchased high-deductible "catastrophic coverage" types of health insurance policies to provide medical coverage in case of a serious accident or illness. The unfortunate thing about high-deductible policies like ours is that since you almost never spend enough money on medical expenses to meet the deductible, you have no idea whether or not your insurance coverage adequate until someone gets seriously sick or severely injured. Once that occurs, you now have a "pre-existing" medical condition that makes it nearly impossible to upgrade your health insurance plan, or switch insurance carriers.
Starting early August of 2012, Josie could feel that something was not right inside her body, so she began an escalating series of medical tests, doctor's visits, and trips to the ER that yielded frustratingly little new information. It was not until shortly after Thanksgiving of 2012 that Josie ended up at the Tahoe Forest Cancer Center where she was properly diagnosed with Multiple Myeloma -- a serious blood-bone cancer that often masquerades with symptoms of various different medical conditions, making it difficult to properly diagnose unless one is a cancer specialist or otherwise intimately familiar with myeloma symptoms. It was not until several months had passed that we started receiving tens of thousands of dollars worth of medical bills for expenses that our insurance company had refused to pay. Our insurance policy has a $5000 in-network cap, and a $10,000 out-of-network cap. In the event of a serious accident or illness, I figured we could handle the $15,000 annual out-of-pocket combined medical expense cap.
Having never before dealt with a serious long-term illness, we had no idea how fast those fine print "exclusions" could add up. The fine print exclusions in our medical policy include doctor's visits, prescriptions, and lab work which, according to my insurance company, also excludes diagnostic tests critical to my wife's medical care, such as monthly tests to track special blood proteins that are myeloma markers, CT scans, X-rays, MRI's, and PET scans. In Josie's case, excluded expenses typically run about $6,000 in a good month, and in bad months those expenses sometimes exceed $12,000! My one-man engineering consulting business generates a decent income, especially when I do not have things like care-giving chores and doctors visits taking up most of my time, but not the kind of money it takes to cover the extra $100,000+ annually for all those "excluded" medical expenses!
Another option that I have been considering lately is abandoning my consulting business and taking a corporate job in Silicon Valley. Even though I have an impressive resume and an excellent education (BSME, MIT), at my age (57) it can be quite difficult to secure a good job in the high-tech world, especially once I disclose that my wife is struggling with a life-threatening illness. If successful at securing a suitable corporate position, someone of my caliber will generally be required to put in at least 50 to 60 hours of work each week. This would entail hiring a full-time caregiver for Josie, and vacating our home of 25 years.
How many other small business owners across America would face similar gut-wrenching decisions should one of their family members require long-term medical treatment?
My wife and I are at that stage in our life when we should be socking away money for our retirement -- not worrying about bankruptcy and losing our home. We have paid into the system all our life, but simply because one of us got sick, and we don't happen have a corporate or government job that provides comprehensive group health insurance coverage, we stand a good chance of losing everything. We live in the richest country in the world, yet millions like ourselves are either uninsured or under-insured, and just one medical catastrophe away from drowning under a mountain of debt. Obamacare is clearly not perfect, but it opens the door for regular folks like us to obtain an affordable comprehensive health insurance plan comparable to those offered to most government and corporate employees, regardless of pre-existing conditions or advancing age.