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October 01, 2014
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Breaking through (the ACA)


The ice dam has broken, finally. A huge berg twirls in the eddy, unwilling to float downriver to the sea. Chunks disengage, spiraling off from the mothership. I imagine a huge umbilical cord of ice holding on to the riverbed below like a tether, but it doesn’t sound likely, or scientific. I am witnessing the end of a long winter. The night’s rain has turned to frost on the lawn. The only color is the dull gray of tree trunks and the bright green of the Narrowsburg Bridge. My imagination is as dull as the landscape. But, look! Someone’s house is moving across the bridge in pieces, on three flat-bed trucks. A new life is starting somewhere.

Winter is not my best season. Fortunately it is followed by spring, which is. Like many Americans, I spent the last month of winter signing up for health insurance. A month, you say? A whole month? Yes, a month. And I worked at it almost every day. I had to find health insurance to cover our full-time employees, myself and our adult children, and a Medicare Plus plan for my husband. Except for two employees, we were all covered previously. But when the Affordable Care Act went into effect, our insurance carrier reduced our benefits while maintaining our premium costs. Suddenly, doctors we had seen for years were not in our network. Prescription drugs cost triple the usual price and every specialist needed a referral from an assigned primary care doctor we had never seen before. Surely, I thought, this is not what the President had in mind. Of course, it wasn’t. But it was exactly what some insurance companies and their political allies had in mind.

So I spent a month commandeering the dining room table with charts of health insurance plans. I learned the lingo of EPOs and PPOs, embedded deductibles and HSAs. I enlisted the help of an insurance broker, whom I chose by consulting my tarot cards. Not really, but I may as well have, for all the guidance I got. In fact, I chose him from a list of two on the New York State healthcare website. He had a soothing voice and answered my inquiry quickly. Through him I learned the meaning of CNT (contract year) and CAL (calendar year) coverage. I searched online for reviews of the companies and then e-mailed them individually to see who was more responsive.

Perhaps most important to me was the list of doctors in each company’s network. There is a particular vascular surgeon I may have to call on soon, and everybody says he’s the man, so I needed to confirm he was in my network. An insurance broker should be willing to pick up the phone to confirm those essentials for you.

In the end, with no time to spare, my choice yielded a plan our business could afford, with better coverage than we had before the ACA, for more people—two more employees and our 26-year-old son at the same cost we paid for four family members before. It wasn’t easy, and because I chose a calendar year plan, the out-of-pocket expenses we incurred from January to our starting date in April won’t be covered. But two employees with pre-existing health issues will have health care insurance for the first time in their adult lives. For me, the rewards of being better informed about our health care system will last a lifetime. And the long winter of 2014 will have found its meaning.