What's up with health insurance companies, anyway?

Have you ever heard so many people say so many bad things about a particular industry as you've heard said about health insurance companies? Maybe cable TV companies. Although according to a recent Gallup poll, these are the 10 most hated industries in America:

1. Oil and gas
2. Federal government
3. Healthcare
4. Banking
5. Pharmaceutical makers
6. Legal firms
7. Real estate
8. Electric and gas utilities
9. Television and radio
10. Filmmaking (seriously?)

I'm not sure if "Healthcare," in the third position, means health insurance or your family doctor. I suspect it's the former and I wish it were clearer. As for me, I love my family doctor. My health insurer?

Not so much.

If you live under an American rock OR if you live outside the U.S., you may not have heard by now that President Obama went on national television last night to apologize to the American people for suggesting over the past couple of years that if we liked our healthcare plan we could keep it.

Those who like their healthcare plans are likely to be those whose employers pay all or most of the monthly premium for a plan that actually covers both preventive and necessary services. Some of those plans are no longer going to be offered, because insurance companies are greedy for various reasons, and policyholders – mostly individuals, but also some companies – are receiving notices that, actually, they don't get to keep their plan. Because ABC Insurance Co. will no longer offer it.

I am one of those individual health insurance policyholders whose policy was cancelled. I found an alternate plan to get me through until the Affordable Care Act goes into effect. In my very humble opinion <snort!>, insurance companies ought to be the ones apologizing. My President accepts the responsibility, which is noble of him, but he didn't cancel my policy.

Aetna did.

[I posted that thought on Facebook yesterday; one commenter said "shitty" was the only word to describe Aetna. Her policy had been dropped, as well.]

Let's get back to my original point.

Suppose you're driving down the road and a deer jumps in front of your car. You didn't see it coming, and you slam on your brakes as the animal does $3500 worth of damage to your vehicle. Your auto insurance agent assures you that your policy will cover 100 percent of the repairs, with no deductible. Not because you've been a "loyal customer" or a "safe driver," but because this is how auto insurance companies do business. A deer strike is never the driver's fault, and the auto owner is not penalized (at least by Nationwide) in the event of one.

You love – or, maybe, appreciate is a better word – your car insurance company, and are happy – or at least willing – to pay the mandated premium for the peace of mind that expense provides.

What if your basement floods, as my husband's mother's did a couple years ago? We didn't know the cause of the flooding, only that we had to move everything in the basement to higher ground my guest room and remove hundreds of gallons of icky water from the area. We honestly didn't even think about calling the homeowner insurance agent, but since she's a family friend it didn't take long for her to learn what had happened. She immediately dispatched a water damage clean-up company to dry out and disinfect the basement. Not because she's a family friend, but because this is how homeowner insurance policies work.

My point being that when you pay hundreds or, in the case of my health insurance, thousands of dollars a year to an insurance company, you enter into a contract that assumes you're going to get something for your investment if and when you need it.

Health insurance companies have, until the Affordable Care Act, spent nearly ONE-FOURTH of each of your premium dollars denying your claims. They will, eventually, pay a legitimate claim, after you (or your doctor's staff) has argued about the legitimacy of the physician-ordered procedure/test/medication with an insurance company claims specialist. That argument costs money, anywhere from 19 to 24 (and sometimes as much as 30) percent of healthcare costs.

No one I know is happy with his or her health insurance plan except

• those covered through their workplace,
• veterans (who enjoy the socialist plan called the Veterans' Administration) and
• Medicare recipients

Dad's name badge from the VA Clinic in
Viera, FL, with an 800-hour service pin.

If you're on Medicare, make sure your Congressman and Senators know how you feel about proposed cuts to that program (and to Social Security while you're at it).

If you're a veteran, thank you for your service. I'm the daughter of a veteran and he was so happy with his healthcare plan that he volunteered at a VA clinic until he was too ill to do so.

If you have been and will continue to be covered by an employer policy, thank your lucky stars.

Just don't get sick.

And if, like me, you're going to eventually, someday, hopefully, maybe be covered under the Affordable Care Act, thank President Obama.

Or Mitt Romney. He thought of it first.

A good day

Apologies to you lucky readers who don't live in the United States and who currently enjoy universal healthcare. This post is all about justice prevailing here in America.

I tried not to get all caught up in the hype yesterday morning, waiting for the Supreme Court decision on the constitutionality of the Affordable Care Act (ACA). I posted on Facebook that it felt like watching the "Buckwheat Dead" sketch from Saturday Night Live, oh so many years ago.

And both of you know I'm not really happy with ACA anyway. Removing the public option weakened the bill considerably and left insurance companies in the mix. It's a fact that Medicare's administrative costs are 3 to 5 percent, while commercial insurance companies spend 30 percent just to process (or, more likely, deny) claims. Single-payer (Medicare for all) is the most economical, humane, just, fair way to deliver healthcare to everyone. Period.

So while I was a disappointed Democrat after ACA was signed in 2010, I'm still a devoted Democrat in 2012, and I wanted the Supreme Court decision to uphold the law.

I was surprised at how happy I was, once Wolf Blitzer got it all sorted out. (He originally reported the individual mandate had been struck down, which was not the case.) Giddy, even. My President won! A very good day! And he gave a very classy statement a couple hours later in which he pointed out who the real winners are: Me. And you, if you live in the United States.

I haven't benefitted from any of the ACA provisions yet. My insurance company (I pay through the nose for a private, high-deductible, catastrophic policy) has always offered an annual free well-woman visit to my OB-GYN, including an in-office PAP smear, and I can get a free mammogram every year, as well. Which I haven't done in a while, so I'd better schedule that soon. Those are a couple benefits from the law that some insured women now receive.

What the law didn't prevent, however, is my insurance company dropping all its individual policies. I learned this spring that as of July 1, 2013, I will no longer have health insurance. I'll be 62 at that time. It's not likely that I'll be able to find anything even close to the already expensive policy I now "enjoy." (Considering that this policy doesn't cover office visits, lab work, X-rays or diagnostic tests, and that I rarely visit a healthcare professional, Aetna has profited quite nicely from my premiums.) I've already started researching replacement policies.

Deductibles in most plans have gone from $3000/year (which is what mine is) to $5000/year. Most policies now cover office visits, with a $30 to $35 co-pay (my doctor charges $72 for an office visit for his uninsured patients). They typically offer 80/20 coverage – they pay 80 percent and the patient pays 20 percent – after the $5000 deductible has been met.

I'm grateful for my relatively good health. I'm glad I have a health savings account (which will pay for the upcoming dental work). I haven't contributed to the HSA since I originally funded it several years ago, and I still have most of it in the bank. I'd like to say my BMI is normal, but I'm beginning to believe it may never be. Obesity may be a pre-existing condition, but it's not going to keep me from being insured. Eventually.

I'm willing to go without insurance for the six months from July, 2013, to January, 2014, but my husband won't hear of it.

My hope is that West Virginia will begin setting up its insurance exchange well before the January, 2014, deadline, and that we will be able to opt into it ahead of schedule. I'll be making some calls to find out if that's being considered.

My other hope/wish/fervent prayer is that President Obama is re-elected in a landslide. Talk about a mandate. This signature legislation has helped and will help millions of Americans stay healthy or get treatment for conditions which were previously denied coverage. Once I'm eligible for the state exchange policy, I will save more than $2000 a year in premiums. And, truly, it's not all about me. It's about moving this country forward, eventually, to that ideal single-payer, Medicare-for-all system. Health reform in the United States will be a long slow process.

Yesterday's decision was a major step in the right direction.