Five days after Donald Trump became President-Elect a policy journalist tweeted this:

I saw it and realized that, as someone with a decent understanding of healthcare policy, I was likely one of very few individuals to be living with the direct consequences of “Repeal and Replace” who could also understand the system level politics at play.

This post serves as a recounting of sorts.  Regardless of my intimate understanding of The Affordable Care Act it did little to prepare me for the journey that is buying insurance.  And if it’s been a roller coaster for me, I can only imagine how stressful it is for others.

I don’t have access to employer sponsored insurance in the traditional sense.  As a “poor college student” Tulane is required to offer me something, but that something is Swiss cheese at best, and nearly as expensive as my other options.

So the day I turned 26, I looked elsewhere.

I ended up on Healthcare.gov debating the merits of a variety of platinum plans.  I choose platinum because I assumed bigger is better.  I’d never had to handle my own healthcare bills, and while I could model a fake patient through a fake insurance plan on an Excel spreadsheet (thanks Dr. Long), estimating my own costs proved nearly impossible.

Therefore I choose the cheapest plan from Blue Cross Blue Shield solely on familiarity.  My father was a federal employee meaning I’d had BCBS my entire life.  And for six months I paid $306 a month, barely using my coverage for fear of unanticipated costs.

Lesson learned.

During last year’s open enrollment I switched to a silver plan from Humana.  I picked silver because I knew it had the minimum coverage, and I picked Humana because it had the cheapest monthly premium.  No pro/con lists, no spreadsheets, just basic logic.

In December, I made one of the more anxiety ridden decisions of my newly acquired adulthood status, I didn’t pay my final BCBS premium.  Doing so meant that I would be unisured for 24 hours since I only had a 30-day grace period to make the payment, but December has 31 days.

Why? Because saving $306 was worth all of the “what ifs” that piled on until the stroke of midnight.

This year I’ve been lucky.  Or maybe I learned how to make the most of my string bean plan.  Although I’ve experienced a number of healthcare encounters, none have required high intensity encounters that would result in bills I know I won’t be unable to pay.  I’ve managed to manage migraines, allergic reactions, and all the standard ills and ailments via outpatient services…just like the system intended.

That said, even though I’ve respected the system I’m forced to function within, that doesn’t mean it has respected me back.

My neurologist, the one that helps me live with the above migraines, isn’t considered in-network by Humana.  Hilariously that was the one thing I checked before choosing the plan, and per healthcare.gov he was.  It’s a mistake that costs me $180 cash every six months.  But I’ve been seeing him since the migraines started, I trust him, he trusts me, and for someone that writes a rather large number of “controlled substance” prescriptions, trust is a necessary ingredient.

So I pay up, with a smile on my face.

My PCP is a similar story, only in reverse. Humana covers her, but since she’s via Tulane’s Student Health Clinic, they don’t take insurance.

So I pay up, with a smile on my face.  At least this time, I am hopeful I will be reimbursed.

Dental and vision coverage are offered via the Marketplace, but they are an expensive add-on.  In this case I play the “Young Invincible” card.  I haven’t been to an ophthalmologist since a month before I turned 26.  I plan to avoid going until I run out of contacts, can’t see using my glasses, or get insurance with real benefits…whichever comes first.

I’m less willing to forgo my semi-annual dentist visit.  So I pay up, with a smile on my face.  At least this time I get a cash discount.

If I’m being realistic the only entity that makes my insurance card look slightly used is CVS.  But occasionally they, or maybe the drug manufactures, get the better end of the bargain.

I tell my story because in the heat of debating politics we forget there are real people with real needs at the center of it all.  Obamacare isn’t perfect, the Marketplace is scary, and the idea of paying an additional 25% in healthcare premiums next year isn’t my idea of a good time.

But for all its faults, I have insurance.  As do another 22 million Americans.

And I have to admit that healthcare under President Trump scares me.  Over the course of his campaign he stuck with the broad and general “repeal and replace.”  Something that’s easy to contextualize by looking at the half-dozen Republican authored plans.  But now that the reality of office is setting in he has started to backtrack on that broad promise. Which means there is uncertainty around what he might do.

And while uncertainty may make for great TV, in healthcare it is rarely welcomed or appreciated.

CrC

I am not the only person that is enrolled via Obamacare.  Others have spoken about, with or are trying to speak to patients about how they are approaching their new reality. You can see those stories here:

• Vox
• New York Times
• Washington Post