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Sunday
Nov242013

About the Affordable Care Act: Are you your brother's keeper? #Obamacare

     My memory is not short, and I am confident things can change, do change, and have changed for the better. When I began my journey out of the closet at age 21 I was fearful that it might be true that our kind grow old and lonely, more so than any other group. When Jeff and I announced we were getting married the week I turned sixty, our underage nieces and nephews hollered in joy and began planning and envisioning a ceremony we had not yet contemplated by asking if they could be in the wedding party. What seemed radical and possibly offensive to family and friends in 1972 feels so right to many more today. Sometimes I have felt out of sync with many around me, and I have had to simply be okay with it.
     So it is today with the question of access to healthcare. Currently there is so much background noise and hysteria about ACA. Much of it seems to be coming from the 7 out of 10 Americans who have access to healthcare and see no value to their own well being if the other 3 in 10 Americans get access to affordable health insurance. Those among the 7 in 10 who are speaking their mind are being heard the most because of their access to a lazy and ineffective press with no interest in giving voice to the 3 in 10 who are not so privileged to be able to make the technical glitches of a digital world their biggest problem. 
     The cries from fellow small business owners about the horror of ACA, who get interviewed, even as the press should clearly know how ACA applies to them, are just not credible from my experience. Employers with under 50 employees are not bound to provide insurance or pay a penalty if they do not. For some, depending on their business model, they may be able to begin providing benefits based on new tax provisions. That did not prove to be a benefit that applied to my business. Those who do provide healthcare benefits, well it is business as usual, except perhaps you can no longer get substandard plans.  Yes, I remember the hollering when you could not buy a car without seat belts any more.  I am confident that ACA will mean much more to the employees of these small businesses if they are not covered through employer paid health insurance. Here is my story. 
     Between 1991 and today I have run a consulting business, with some good years, but also some bad years from the standpoint of profitability. That is not unusual. Our employees have ranged from just one, to as many as four full-time employees and several dozen independent contractors. From the very beginning our work has been concerned with HIV and behavioral healthcare services. Our workplace and our workforce reflected the values of advocating for and caring about access to healthcare. As a business owner, it was inconceivable to me, although it would not be illegal, and certainly might be arguably, although I disagree, more profitable, to not offer my employees health insurance benefits, and so I did offer these benefits, consistently.
     When I was the sole employee, it was extremely difficult to get insurance. In 2001, at age 50, I was simply growing older while Black,  when for the first time I was diagnosed with a chronic illness that affects us disproportionately, hypertension. Jeff and I had just met and the first crisis we went through together is my having been denied health insurance because of a pre-existing condition. If you tell me from the comfort of your employer paid healthcare insurance that ACA is a curse on the land, the best you can expect from me is an angry and disappointed frown. Fortunately for me, not too long after Jeff moved to San Francisco, his employer, the ACLU of Northern California offered an alternative. In a world where Marriage Equality had not yet become a reality, they offered health insurance coverage for same sex partners, and I was covered for a while under that plan. You may want to see the whole thing thrown out as demanded by Romney, the former Governor of a state that fully and successfully implemented the model for ACA, then just go ahead and advocate for that, I cannot join you in making that demand.  More than ten years later, I now have other pre-existing conditions as a condition of just living.
     Between 2007 and 2012 I had two publicly funded contracts to deliver training and technical assistance services throughout California's 58 Counties. That project employed between two and three full-time paid employees, and many more independent contractors. Every year the health insurance premiums went up significantly, sometimes in the low to mid-teens percentage wise. The premium for just my personal plan went from about $500 to $1,000, and I had large co-payments. Overtime, while we continued to offer health insurance we had to ask each employee to contribute more and more to their own health coverage. Mind you, if you are a small business and you have a contract that has the same dollar value for three years, it is difficult to near impossible to soundly run your business when one single cost increases unpredictably and by points far higher than the rate of inflation. The threats from powerful Blue Shield of California to cancel our coverage if we did not agree to these increases were real. Oh yes, and every-month's premiums were required to be pre-paid, while my client, the State of California, could go 90 days or more before reimbursing me for costs.  Heath insurance costs exceeded all other cost, except salaries, including rent (in the Financial District of San Francisco) and taxes. However, then came the passage of ACA, and in the last two years before closing the office in San Francisco, I received notices twice, in each of those years, that Blue Shield would be rebating part of the premiums I had paid, and doing so because of ACA (aka Obamacare). It amounted to $3,000, and trust me, like the many thousand if not more of their customers, I CASHED the check (it was not a check literally but a credit to my account). I know people, including me, can sometimes have selective memories. Hard as I try I cannot recall a single policy initiative in the last 20 years of being a small business person that has returned $3,000 to my bank account from a vendor because their ability to be abusive in charging me for their services had been curtailed by law. Again, you tell me that because of this website roll-out problem ACA is a failure, then the best I can offer you is an angry and disappointed frown.
     Speaking of problem websites. You often hear of the virtues of the private sector versus the public sector. Governors like Arnold Schwartzenegger get elected on the promise that the business sector knows best.  I lived through his administration sending small businesses IOUs that the banks would not honor.  Well I can also talk about private sector websites and the efficiencies of private insurance. As an employer who actually paid the bills and was simultaneously the HR person, I went online month after month, between 2007 and 2012 to pay my Blue Shield bill.  For the armchair critics, including members of the press, who speak from the comfort their employer paid health insurance plan, with a paid HR person to deal with the technical aspects, I have some news. Blue Shield of California's use of technology and their website for handling these transactions sucks...trust me--it is balky and not user friendly, or was not user friendly when I last did use it! Like many business owners who handle their transactions online, I get to compare. For a company that charged so much, in fact, they were paper heavy in my experience, paper wasteful, and paper dependent, and I regretted their need to drop ten pound packages in our office of three employees every so often. It will be a relief for people when they can perform real comparisons, apples to apples comparisons between plans. This can and will happen, despite this noise.
     Again, when you cry about the marketplace website that most Republican-run state governments tried hard to undermine by forcing the need for a more complicated national one because they refused to build their own, I provide one suggestion: be patient, ACA has already worked, and help is increasingly reaching those who do not have the luxury of employer paid health insurance. This will happen despite the fact that their horror stories about their lack of access to health care also fail to generate much interest in the press. These stories are not a cause for concern for many of the 7 in 10.
     Finally, I must say, that another aspect of my work has been working with clients in Los Angeles and other regions of California to assist them to obtain resources and to develop programs for the uninsured. The costs of providing health care for people without insurance are hidden costs that get passed on to you through higher taxes and through higher private health insurance premiums. People without health insurance, and they are your neighbors, and they are in the millions, show up at the emergency room when things get to a critical point and get the most expensive care available. The costs to us could have been far less if we had handled the problem of access to affordable healthcare coverage before they had a need for acute care or care in an acute care setting were services cannot ethically be denied. When a hospital provides care that is uncompensated (the technical term) they have to recover their costs from some other source, either through a publicly funded program (I help organizations obtain these kinds of grants and contracts) or through tax deductible private sector gifts that reduce tax revenues to the government, or by raising the fees and costs charged to their customers with private insurance. It is a fallacy to believe that you are not paying for these hidden costs, but it is a scandal that you are paying so much.  Are you your brother's (and sister's) keeper? I will let you answer that question for yourself? For me, the answer has always been yes! It is inescapable!

 

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