Sick and Tired

Like many Americans, I’m confused about the health care reform legislation currently taking form in Washington. I understand that one of the main goals with this reform is to provide insurance for people who don’t have it/can’t afford it. What I’m not seeing clearly spelled out (and admittedly, perhaps my work-life demands are getting in the way of me researching this properly) is: what about those of us who have insurance but the insurance is crappy? As in, the premiums increase every year, the deductible increases every year, the amount of coinsurance increases every year, and yet if anything you get less care?

Right now in the Blah Blah’s employer-provided coverage, we pay insurance premiums and then we also have a $500 deductible apiece, on top of which we each have to pay 20% of any medical costs beyond that, up to $3,500 per year per individual or $5,000 per family. What that means is that if we had serious medical problems we’d have to pay up to $2,000 in deductibles, plus $5,000 in coinsurance out of pocket. There is also a lifetime cap but I haven’t yet paid attention to that because our insurance carrier changes almost every year as costs go up and the company negotiates with various carriers to get the best deal.

Now, the insurance premiums are no joke either. At my job to pay for yourself and a family you can expect to pay some $1,800 for premiums per month. The company will pay your premiums, but not those of your family. Fortunately for me, Sweet Dub’s job offers a better deal on insurance and will actually pay for part of the premium, so I’m covered through his employer rather than my own. I realize we are privileged because we both have jobs that offer insurance, but it sure doesn’t feel like I’m getting what we’re paying for when even with insurance, I’ve paid over $7,000 out of pocket this year for having a baby in October and having her end up in the NICU.

Yes, at least we have insurance, but I fight with the insurance company at least once every couple months. The latest thing we’re dickering about is me having a mammogram. Isn’t it recommended that women age 40 and over have an annual mammogram? (Answer: why, yes – yes it is!) Particularly if they (like me) have a history of breast cancer in their family, or (like me) have had a suspicious lump biopsied in the past. And yet, I’m having to fight with my insurance company over whether I have coverage for this procedure, which was recommended by my primary care physician and my gynecologist. They want me to pay 300 bucks and some change for this screening.

I’ve been trying to get caught up on the health insurance reform storm, I swear I have. I have heard so many horror stories of people who are uninsured, and as we’ve seen with the recent Remote Area Medical Foundation visit in Inglewood, which wrapped up yesterday, there is a huge need for free and/or affordable medical care here in my own neck of the woods. But I want some reassurance that those of us who are “insured” are also going to get some help. Am I missing something?