The Affordable Care Act

image of the Supreme CourtThe Supreme Court’s affirmation of the constitutionality of the Affordable Care Act surprised, delighted and dismayed some. I have seen firsthand what not having adequate insurance coverage can do. Several of the people I have hired over the years have not had any insurance coverage at the time of hire. When they had to wait through the first 3 months of employment in order to get coverage, they held their breath hoping to avoid illness. One person immediately scheduled a group of preventive and treatment medical appointments the minute she received coverage. The last few people I hired negotiated with me to get medical coverage as soon as they began their employment. Their anxiety about being without insurance touched me.

One of my support staff people suffered the most from the impact of my company insurance choices. She was hired at a time that we provided 100% insurance coverage with no copays by the employees. As I watched the cost of insurance rise year after year, I tried various methods of controlling costs. With the help of my insurance agent, I looked at different plans and companies. Costs were going up 15-25% a year. A few years back, I gave this employee a choice: pay $80 a month as an employee contribution towards the premium and I will keep the current plan, or continue to receive insurance without a copay and live with my decision to change the plan. She refused to make a contribution, and I chose a plan that required a higher outlay of money for medications.

In the first month of the new plan, my employee paid $1000 for her prescriptions. Stunned by the cost, she decided to take her medication every other day. Her autoimmune disorder worsened and she began losing time from work. Companies like mine are impacted by absenteeism as well as the complex health needs of people with chronic illnesses. She got sicker and sicker over a period of 3 months, and then finally told me what she was doing. I immediately called the insurance company and asked to return to our previous plan. I explained the impact on my employee’s health. I was outraged by the response: “It is not in (name of insurance company)’s best interest to let you switch back. That means you are going to use the benefits.” Yes, that is why we pay a premium. She used the benefits before we switched. There was no way to reason with this company. Frankly, it was very hard for me to be sympathetic with the best interests of the insurance company. I wanted to say it was not in my best economic interests to pay thousands of dollars every month for insurance for my employees, but I do it. I want them to have the coverage they need for medical care.

My employee took a second job so she would have the money she needed to pay for her medications. At the next opportunity, I switched insurance companies.

I applaud provisions in the Affordable Care Act that limit the insurance company’s administrative costs. Our premium went down this year. I can’t remember the last time that happened. The Affordable Care Act puts insurance within the reach of people who have been doing without. We have all been paying to provide medical care to uninsured people. I am delighted the Supreme Court upheld the law.

Pat Iyer MSN RN LNCCC is president of Med League.

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