My Story

At the age of 27 I had a stroke.  Many would often presume that this life changing experience solely leaves one with profound insight into the fragility of our personal health.  While this goes without saying, the unexpected lesson of my journey took me into the dark, desolate and potentially perilous under-world we used to refer to as health insurance in the United States.

As a public school teacher, I had health insurance.  I soon discovered that in the current system, that was no consolation.  In the months that followed my attack I battled the demons that lurked in the shadows of insurance claims that were denied and battled the collection agencies that relentlessly stalked me for payment.  Payments could not be made from a salary that was being garnished and credit cards that were being overdrawn to pay medical bills.  In fear, I watched my financial security sift like sand between my fingers as I desperately tried to grasp tighter.  As I laid in steadfast stillness in the confining chambers of an MRI machine, my thoughts should have been focused on my health situation.  Instead, my mind was muddled with the worry and anxiety of whether or not the bill for this most-likely expensive procedure would be covered.  The voice of the customer service agent from my HMO resonated through my head, “We’ll pay to take the MRI, we just won’t pay to READ the MRI”, she said in response to a pervious procedure.
 

The desperate and tear-filled phone calls to faceless customer service agents came days after I stood in the office of the woman who ran human resources for my school district.  I watched her nervous face as she flipped the pages of her calendar and counted days.  What was she counting?  Why was she flipping through the months that had passed?   As she completed her flipping a glimpse of relief filled her eyes as she looked at me and uttered the statement, “Phew, you made it”!   What did I make?  Unaware, I found out a clause that was in my insurance plan that stated that as a new employee who had just completed graduate school and had only begun employment the previous August, I had a 6 month grace period before my insurance was active.  I made it in less than 48 hours. 

In the years that followed, I found a sense of stability but the shadows of anxiety continued to hover over me.  Everyday I am grateful for my health, but I continued to worry about what would happen if I had another incident and it was more serious.  Would my family go into financial ruin if I ended up in a long-term care facility?  After all, my policy had a $1 million lifetime cap.  Would they then have to resort to liquidating all our assets (our house, savings, retirement, college savings) in order to meet expenses after the lifetime cap was filled?  What would happen when I change jobs?  Would I be denied coverage because of this condition I now have?  I just didn’t understand it.  I did everything our culture asks of me.  I received an education, established a career that contributes to society, saved wisely and obtained health insurance.  The only thing I did wrong was get sick. 


The security of my health is now on the horizon for me.  Because of the Patient Protection and Affordable Care Act, by 2014 the demons that haunted me will now be confronted with justice when the lifetime caps that threatened me with financial ruin will be eliminated and my insurance company can no longer recind coverage when someone gets sick.  In 2011 patients can appeal when an insurance company denies their claim.  In 2014 I will have more healthcare security when I can no longer be discriminated against based on my stroke condition because it is a pre-existing conditions.  No longer will someone have to go uninsured while having a lapse ofcoverage for six months when they leave school or change jobs.  Finally, because of the Affordable Care Act, we will know that patients will be returned the power and control they lost from a corrupt system.  Insurance companies will now be held accountable to a Medical-Loss Ratio, a provision that states that they have to spend 80-85% of my premium dollars on actual care and not the administrative costs that they used to deny me coverage during those dark days when I was 27.

It’s been 10 years since my stroke incident.  Maintaining my medical condition is a natural part of my daily life.  However, like many Americans, another predictable part of my life has been watching my premium responsibilities substantially increase and consume more of my take-home pay.   A hidden tax per se.  In 2014 my "hidden tax" will be lowered and I’ll be able to take home more of my pay because the PPACA states that insurance companies are subject to rate review.  In other words, my premiums cannot increase higher than 9.5% of my income.

I'm a health educator by profession and have spent my entire career dispelling myths regarding a variety of health issues.  Recently, my greatest frustration is on how little the public really knows about the PPACA and how many false pieces of information they believe.   I often look back at my endeavor and feel a sense of guilt.  I was one of the lucky ones.  Yes, I fought many battles over denied claims and spent years paying off healthcare debt.  In the end however, I was the last drop of water that made it through the dike before the flood waters could swallow me up.  I avoided the lifetime caps and grazed the six month lapse of coverage by hours.  It was with sheer luck that I circumvented the cracks in our system.  Many others out there have not been so lucky and have fallen through those cracks. 


As an educator, I have done my share of “powerpoint presentations” filled with facts and data to drooling audiences with heads ready to fall onto the desk.  Yes, health policy is pretty boring stuff!  People however, are not boring.  It is with this inspiration that in the summer of 2011 I headed out to cross the state of Pennsylvania and find others willing to share their stories and see how the PPACA will apply to them.  Beginning today, every friday for one year I will share their stories.