At 100 Days in Appalachia, we asked our readers to tell us their health care stories. As repealing and replacing the Affordable Care Act remains the most talked about issue under the Trump Administration, we wanted to shine a light on how health care policy has and would affect those in Appalachia. Here is just one of those stories. To share your own, fill out this form.
Ten years ago, I was living the high life. Or at least what I thought was the high life. How I was raised dictated who I was and who I now am. I was born in southern Ohio, the foothills of Appalachia, grew up on a small farm and had parents who toiled daily in one of the many factories scattered around the region. We weren’t rich — nor poor, for that matter — we had everything we needed: food, shelter, money for the occasional extra expense, which in my case was $25 for high-tops to play high school basketball, and adequate healthcare. My father had health insurance through his job and so whenever one of his three children (mostly me) needed a doctor, we thought nothing of going to the emergency room.
Now, it’s not that simple.
Ten years ago, at age 40, I had a job that paid a decent wage working for the USPS. I had good health coverage, and best of all, four weeks of paid vacation. Over time, I developed multiple chronic health conditions which required me to utilize my insurance frequently. My job became physically unbearable.
I was healthy when I was young. None of the conditions which I now have were of concern to me 25 years ago. You could say that I grew into them. But the insurance companies would call them something different, like a preexisting condition, for example. Before Obamacare, my medical conditions would be uncovered by any insurance company.
It was a year before Barack Obama took office when I decided to leave my job and look for something else. I took the COBRA option and paid $400 a month to keep the same level of insurance I was accustomed to — which was a low co-pay and had predictable costs for my medicine. I’ve lived with diabetes for 20 years and take insulin injections several times daily. It’s an expensive disease.
Eighteen months after I left my job, the COBRA ran out. I applied to several insurance companies and was denied because of my preexisting conditions. I spoke with the Georgia Insurance Commission’s Office in hopes of finding a plan, but they couldn’t tell me anything. I called a local consumer protection organization looking for a recommendation or information about a continuation policy since I’d maintained health insurance continuously for many years (That was a requirement in those days.). At this point, I was desperate to find insurance because I’d never been without it. What if something immediate or life-threatening occurred?
How would I pay for it? Finally, after scouring the Internet, I found a company, for a fee of $500, that would guarantee coverage since I was covered by a COBRA plan. Some thought it was a scam, but I was desperate, so I paid the fee and waited. A few weeks later, I received a letter from the Georgia Insurance Office that stated I would be in the Georgia high-risk pool with coverage offered by Blue Cross or another company. My monthly premium increased to $410, with a $2,500 deductible, no co-pays or predictable medicine costs. Everything had to be paid up front. When I did meet the deductible, a 70/30 split kicked in, which helped, but the cost of my medicines kept increasing.
Insulin was the most expensive. A five-pack box of insulin pens that once cost roughly $100, now was almost $400. Several times, I purchased insulin from Canada because it was cheaper. There are pharmaceutical companies that offer programs for low-income individuals, but I didn’t meet a key requirement: not having insurance.
Several years passed and when President Obama introduced the Affordable Care Act (ACA) in 2010, I listened carefully. What I remember most vividly are two things: “Subsidies” and “You can keep your doctor”.
Neither of which happened for me.
Late in 2013, I received a letter from Blue Cross stating my plan would be discontinued because the ACA would be going into full effect. I could now purchase my own insurance from the new Healthcare Marketplace.
No, I couldn’t.
I didn’t qualify for the subsidies because my income was too low. Georgia opted out of offering expanded Medicaid — as did several other states.
According to my research, the basic bronze plan offered by several companies didn’t include this, nor that, but would gladly pay for a gynecological exam if you went in for a sore throat. Prescription drugs were not covered and — to keep the customer from ever using the plan — a $10,000 deductible was thrown in just for fun. You got all of it for about $450 a month.
The decision was scary, but simple. I was without insurance for the first time in my life.
Before my insurance expired, I saw my doctor for the last time and he wrote scripts for six months of refills. I had enough insulin to last until early summer.
I went to the local health fair in late April and — for $40 — received a comprehensive health screening, an eye test, a hearing test, and a lot of information about things that I didn’t know. Mainly, I learned how people in my area who didn’t have health insurance received treatment for their conditions without going to the emergency room.
Good Samaritan Health and Wellness Center in Jasper, Georgia, is where I was told to go.
Their mission: “The mission of this not-for-profit health and wellness center is to provide the medically underserved in our community with compassionate and individualized health care and related services in an atmosphere of respect and dignity.”
I was scared the first time I went. And embarrassed. I didn’t know what to expect. I’d always had insurance. I’d always paid my way. I didn’t want a handout and I wasn’t used to asking for help. I waited over three hours to see a medical professional that morning. It was a bit hectic — the staff is mainly volunteers — and the waiting room was overflowing. I didn’t have an appointment — I was told on the phone to just show up. They were open only in the mornings and shortly after noon my name was called, and Lois Bryant, NP, spent 30 minutes with me going over my medications and writing refills. She was retired professionally, but volunteered at the clinic several days each week. It kept her young, she said to me on a subsequent visit.
Good Samaritan lives up to its mission statement. Over the last three years, I’ve become a regular. Many I know on a first-name basis: Lois, Pat, Debra, Dr. Serrao, Dr. Nardo, Eunice Momeh, NP, and Susan the pharmacist — all of whom go out of their way to help the people of North Georgia.
I’m lucky to have found them.
But, I still worry: “What if?”
The ACA didn’t work out for me as planned. I don’t have a card that says “Insured By” or a monthly premium I can’t pay. What I do have is a new appreciation for those who work to help the medically underserved with compassion and dignity.
On a recent vacation, I tripped up a flight of steps and hit my head. My initial thought was — once the fog lifted — I hope I’m okay because I didn’t want to go to the ER. An MRI can cost $10,000 — I know because I had a bicycle wreck in 2012, when I still had insurance.
After my most recent fall, my 16-year-old niece asked why I didn’t go to the doctor. I explained I didn’t have any insurance and it was too expensive.
Her response sums it up really well: “I thought everyone had insurance. It doesn’t make sense that you can’t go to a doctor because it costs so much. Why does it cost so much?”
I have no idea.
Gianetta Palmer is an author and blogger living in the North Georgia Mountains. You can read more of her stories and contact her through her website at gianettapalmer.com.