Behind the 8 Ball

free-magic-8-ball-vectorIf you live here in the states and have had to rely on the  Affordable Care Act (ACA) I would truly like to know how you are managing, or if not, how you are faring.  If you wanted it, then are you getting what you thought you were getting?  I’m not trying to be flip, I just really am interested to know if you are getting the help you need through this program.

~*~*~*~

When Bob’s previous job realized that they were going to have to give up their current coverage due to the insurance changes, they began paying him a bit extra to help defray the cost.  It wasn’t enough.

When he was then a victim of downsizing, he was out of work for months.  We had to change our ACA coverage to reflect that he had no income other than unemployment wages.  This still cost us about $400 a month and incurred a mammoth deductible for each of us. (About $5,400 total).

We got sick.  Very sick.  Both of us.  The bills piled up, we became overwhelmed and had to take money from our retirement savings to help cover costs.  Irritatingly, I had a TSA that had matured and was worth almost $25,000.00 at the end of the year, but we had to wait to cash it out because we didn’t want to end up owing back all the subsidy money for the ACA coverage we relied on…  By the time I cashed it out in January, it had dropped in value to $18,000.00 due to the stock market crash.

Bob finished the taxes today.

Bob:  You don’t want to know how much I am hating Obama care right now.

Me:  What?  We don’t get anything back?

Bob:  I really don’t want to tell you.

Me:  We owe some?

Bob:  Sigh… We have to pay all of the subsidy back and we don’t get anything from the Federal at all!

Me:  How much?!

Bob:  $8,000.00!

He explained that in the midst of trying to make ends meet and paying the regular bills and necessities, plus the ACA payments, plus the deductibles, plus the co-pays, plus being out of work and being sick, we managed to make about $1,500.00 too much (remember that was the money we socked away for retirement!)  and now they want all the subsidy monies back.

In the past week we have sprung a leak in the roof and need a new roof.  The roofer has patched us up and it stopped the rain from running down the stove-pipe, into my cupboards and out onto my stove and counter tops, but the roof needs replacing.  $8,600.00.  He found hail damage and we are waiting to see if the insurance company will cover the new roof…

Are you keeping count?  We need $16,600.00 to pay for it all.  There goes the left over from my TSA monies and Bob’s IRA ++++++

After our talk, I felt awful.  I wanted to cry, but couldn’t.  I felt sick to my stomach and just wanted to crawl into bed and pull the covers up.  I wouldn’t.  After I calmed down some and began to feel better I suddenly flashed on a scene from my favorite movie of all time:

My Man Godfry

It is one of those madcap BW comedies from 1936, staring William Powel and Carole Lombard.  If you haven’t seen it you must, and if you do want to see it , well look up the copy from the Criterion Collection (<— link to synopsis, etc) because it has a missing scene that makes the whole thing make sense!!!

Here is the scene I remembered and which gave me a chuckle in spite of it all!

In the meantime I am grateful to God that we are once again in better health.  Feeling better makes it easier to take things in stride, although it doesn’t preclude the changes we will need to make over the next year.  We are talking it out, and thinking about our options, but we don’t have a definite plan as yet.

I’ll tell more when we figure it all out.

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24 thoughts on “Behind the 8 Ball

    • Lynda says:

      Annie, it is, but thankfully(at this moment anyway) we are doing well health-wise. And that is saying something! Thank you for your well wishes!

  1. katechiconi says:

    Oh my word…. I am so sorry to hear this. I thought I was hard done by when the tax office stopped giving a rebate if you had medical treatment over $3,500 per year, when my pain medication went up $3 per prescription (for which I had to pay a bill of $85 to see the doctor each month), and my oral chemotherapy went up by the same amount. Even in my worst moments of going through cancer treatments alone and unemployed, I kept my medical insurance going, and I was so very glad I did. I think healthcare is going to hell in a handbasket the world over… I wish you a large and helpful dollop of Divine Providence, and the love and support of family, friends and your community.

    • Lynda says:

      Kate, how awful to have to go through all that alone! And what a low cap on your medical coverage for the year! Actually, when we added up what we paid for the privilege of having the insurance vs. what all the medical bills would have cost us it was almost the same.

      When I was very young my mother used to give us our beverages in a jelly glass because we broke the drinking glasses regularly. One night when she was cooking she poured the grease into a melamine bowl and it began to melt. She then quickly transferred the hot grease to a jelly jar…

      Aaron, my youngest brother saw it, reached up and grabbed it, and before his hand could register the heat he tried to drink it. I won’t tell you all the gory details, but it was horrific for him and us. Mom treated him at home because we had no insurance.

      Later that week Eric, my other brother stepped into the rim of an old coffee can (the kind you had to peal off the top with a key) and nearly cut his toe off. (Yes really). She had to take him in to our family Dr. to get it stitched back on and for antibiotics.

      When the Dr saw Aaron he asked what had happened. Mom told him and he told her that Aaron had second degree burns and that he too needed treatment. He demanded to know why mom had not brought him to the hospital when it happened. “No insurance” was her reply. After examination and treatment he told mom that she had done exactly the right things to treat his burns, but that he would like to take over treatment and checkups till he was better.

      He treated Eric and Aaron for FREE, and continued Aaron’s treatments with topicals and antibiotics until he was fully healed! In this day it is so rare for that to happen.

      Often a Dr. will give you a reduced fee if you haven’t any insurance, but many can’t even pay the reduction cost. I have met far too many people who have no coverage and hence, seek no treatment. They simply can’t afford the cost of insurance through the insurance exchange. Further, the least expensive plan has a deductible well over $10,000 dollars.

      So I have to agree with you when you state that “…healthcare is going to hell in a handbasket the world over…”

  2. Marianna says:

    Boo! That’s terrible! I feel so sad for you because you are a nice person and you deserve better.

    For us, we are okay, We are both earning a decent paycheck and although we have changed insurance providers just about every year, things are okay for us. My husband has been in the hospital twice this year and he has gotten good care. We paid for our own insurance before because my husband is considered self-employed.

    Back in the day, I had insurance through my job as a server and it was cheap, and it covered everything. EVERYTHING! I think it was 18$ a month for Blue Cross/Blue Shield.

    Where I work now, there is no insurance available because we are a small shop. The back of house workers all have bunches of kids and live paycheck to paycheck, mostly their wages are garnished to pay for other kids who don’t live with them. They never really had insurance before…generally they just presented themselves to the E.R and then dodged the bill or got a big discount because they were poor and pleaded for a break…usually there was an infected tooth or chest pain or something that needed immediate care. One guy got drunk and got into a fight and was knocked unconscious so they airlifted him by helicopter to the tune of $30,000. I’m sure he never paid any of it because he quit work in the kitchen one day and started painting houses, under the table. Most of them never signed up for the ACA, so the income tax refund they counted on as a savings plan all went to pay fines and fees. Well, the “working poor” are paying for their own insurance now, where they previously did not so I guess that makes some people happy.

    • Lynda says:

      Marianna, I know of few “working poor” who are paying for insurance here. They simply can’t afford it, and it would never cover for anything less than a catastrophic event! Meanwhile, those of us who are paying are being bled dry.

      Bob had a lot of sleepless nights last year due to all our medical bills and insurance payments. There were other debts as well, but they were payable till the system changed. After the insurance change it just kinda snowballed.

      At the first of the year being able to pay off so much of our debt was such a relief! It was great to have extra money each month for our needs and not living hand to mouth. Now the tax man has reached out and snatched our victory away. So right now we are working on doing with less and selling things to help ourselves cover it. I think we can make a big dent if we tighten our belts and let go of a few items we really don’t need. Ya gotta do what ya gotta do, ya know? 😛

  3. Joan says:

    We had great insurance before….

    Now it is so expensive. So much less coverage. On the things we need.

    But hey, our policy now covers ACA mandated pediatric dental care! At our age, not much chance of ever using that

    • Lynda says:

      Joan, I totally agree! And hey, it is such a relief for me to know that at age 63, with no female plumbing, that I am paying for and covered in the event that I become pregnant. 😛

  4. tootlepedal says:

    Your story horrifies me as it seems so unnecessary. Many other countries manage to provide affordable healthcare without undermining the morals of their countrymen and the stubborn refusal of the American electorate to vote for a properly funded national health service has always mystified me.

    It is terrible that you have had to suffer financial worries on top of your health problems and I hope fervently that your better health continues and that you can find an acceptable way out of your problems.

    • Lynda says:

      Tom, thank you for your kind words. It really helps.

      Sometimes I find that I am so uniformed about all of this. I was absolutely stunned to learn that the system uses our income total BEFORE deductions for medical are taken into account and deducted. We paid so much out of pocket last year with the exchange insurance for the fees, deductibles, hospital, ambulance, and meds but we couldn’t take it off. If we could have it would have covered that overage of income that got us into trouble with our taxes and is leaving us paying back the subsidy. Well, at least we had heat in winter, and food on the table when we needed it last year. We will figure it all out for this year too I suppose and thankfully we have coverage through Bob’s work again so we don’t have to worry about making too much money… like we make too much money. Yeah, we’re rolling in it; don’t ya know? 😉

      • tootlepedal says:

        I am glad that things are looking up a little. Good health to you both in the coming year.

        What is so amazing to us is that some of our politicians actually think that your system is better than ours and we should change to it….but they are all rich people of course.

  5. wildninja says:

    I hope you are writing all of your elected officials– or sending them a copy of this– and also sending the link to this post to national news outlets that will listen. This makes me righteously angry.

  6. Lynda says:

    I would feel like a *Who in Whoville.

    Those of us in the lower-middle to low income brackets have been complaining all along. We are suffering under this ridiculous plan and our complaints have fallen on deaf ears.

    Now, interestingly, in just the last few months the news media has actually been admitting and talking about how the great ACA has failed us… It took them this long to figure it out? (sick)

    *Reference: Dr. Suess, Horton Hears a Who

  7. shoreacres says:

    This really is a mess, isn’t it? I’ve said from the beginning that universal insurance coverage is not the same as universal health care, and your situation is a perfect example. I could gripe and moan about the required Medicare coverage, but it won’t do me a bit of good. I’m in good health, but the so-called “annual physical” is a joke. After two years of a “well woman” exam that consisted of a physician’s assistant asking some questions and taking my blood pressure, my own stupidity (asking for fasting blood sugar, lipid panel, and so on) led to me being charged a thousand bucks, since Medicare no longer includes such extravagances in an annual exam. So, last year I solved the problem. I simply didn’t have a physical. This year, I don’t believe I will, either. If I’m lucky, I’ll stay healthy until I fall over dead. Two of my friends have recently gone to concierge practices, and I may consider that. At least they get to see a physician who actually pays attention to them.

    • shoreacres says:

      I hit “post” too soon. I was about to add that I’m glad you’ve got coverage now, and are going to be able to get past these difficulties. With good health and jobs, the worst of the frustrations can be ameliorated a bit. Here’s to a placid, peaceful, and healthy rest of the year!

      • Lynda says:

        Bob did say that he felt much better to have posted our tax return and sent in the payment. However, we are sad that we had to use a credit card to do it.

        This Friday I talk to the roofer again to try and set up a time with him and the insurance company to come out and talk about our roof. I hope we get some help from our insurance to cover the repair. BTW, we had more rain and the patch has held! 🙂

    • Lynda says:

      Linda, I had never heard of concierge practice until you mentioned it. I like the idea of paying the Doctor directly instead of the the insurance company. However, I do wonder what happens in the event of a catastrophic illness (CI). Would you still need insurance to cover CI? Ultimately, I think even if we had to have CI to compliment the retainer fees, that it would still cost us less than what we had to pay these past few years. It bears investigation. Interestingly, my doctor recently raised her office visit fees, BUT I also noticed that she has been more attentive to my health issues and gives me more of her time in the exam room.

  8. pattisj says:

    My husband’s sister needed to switch to ACA, but they can not afford it, and ended up paying the penalties. I don’t know what people are supposed to do, things are certainly in a turmoil in this country right now. I’m sorry to hear you’ve both been ill and had to go to your savings. Everything is taxed or penalized, it seems. BUT! Our God is bigger, and He is our provider. Ask, and you shall receive. He provided the funds (from a totally unexpected source) for our HVAC system last fall! He is able!

    • Lynda says:

      Patti, we haven’t been given any magic bullets, but we are making do. I worry about our future and Bob’s eventual retirement. That is when I will really be relying on Him to see us through!
      I have met so many people who have been unable to afford the ACA coverage. I really feel for them and hope they never have a catastrophic medical event. How will they cope? It is all just anti-logical.

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