Pre-Existing Conditions in The Era of The ACA WEB

Pre-Existing Conditions in The Era of The ACA: A Healthcare Consumer Speaks

For Tracy Rude, a lifelong campaign for better healthcare began when several friends had to deal with their children’s cancer diagnosis’, and then moved into dealing with personal health struggles. Those moments caused Rude, a self-employed artist and independent consultant, to become a health advocate and active participant in the healthcare system. However, until the Affordable Care Act became law, the system was not always on her side. HealthCare.com recently spoke with Rude to find out what she has dealt with on her health insurance journey, and what the ACA has given her as a healthcare consumer.

Can you tell us why you are so passionate about the Affordable Care Act?

One of the biggest topics for me is pre-existing conditions. Being a human being qualifies as a pre-existing condition. For me, it’s been a lifelong struggle with depression. I kept a lot of things secret and only saw a doctor when I needed to. I chose deliberately what I shared with my doctors through my healthcare provider.

I have been faced with a pre-existing condition clause four times throughout my life. The last time before the ACA took hold, the only way I could change my plan at the company I was with was to decrease my options. I couldn’t get a better plan. I could only stay with what I had or get less coverage.  Then, for a short period of time, before the ACA came into existence, I was in Minnesota’s high risk pool. The beautiful thing about our state is that you do have access to healthcare. But the unfortunate part of it, for those with pre-existing conditions, is you had to pay a lot for coverage. I had to work very hard to stay well and not use my healthcare to prove that I no longer had a pre-existing condition. With the ACA, they decided to not look at lifetime maximums or pre-existing conditions. Instead, they give everyone affordable healthcare at a balanced rate, understanding that there would be an increase to some and a decrease to others when buying coverage. Because as humans, we are a pre-existing condition.

You have been in the individual marketplace since the first day open enrollment was available in 2013. So what do you advise your friends to look for?

I tell everyone they need to know what their personal needs are as individuals or families. Are they taking medications, are they are doctoring for current illnesses, do they have children, are they are near retirement – it’s all individual. And our healthcare insurance is just as individual. They need to ask, ‘Is a monthly premium more important to me, and do I have the money if I get sick?’ or ‘Do I have a health condition that I have to pay so much every month for prescriptions?’ and things like that. They need to look into the future and think about not just the total amount right now, but what they can afford later on. Then they need to compare options they have. I know it’s very complicated. Insurance – period – is a very difficult and complicated thing to look for. Anything that deals with our life in such a personal way is really hard to look at, so you have to be realistic. That’s what I tell people – be realistic and shop for your needs. Don’t shop for a dollar amount, but for how you use your healthcare.

Did you re-shop for health insurance between 2014 and 2015 open enrollments? Did you select a new plan?

I did re-shop, but I kept my same plan because it was the best plan for my particular needs. At this new enrollment period, just like the past renewal periods, I will always re-shop.

As a self-employed individual, you have purchased health insurance on your own for awhile. What differences has the Affordable Care Act made in your life?

First and foremost, the ability to make a decision based on my own personal needs instead of having to take something that is force-fed to me. As I mentioned earlier, pre-existing conditions is a really big deal for me, lifetime maximums is a really big deal for me, especially with people living longer. It’s not carrier-specific. These rules exist because of the ACA. And the ACA is not going away. It is going to be redefined and fine-tuned. My personal hope for the future is healthcare for all.

As far as the number of plans, do you feel like the Affordable Care Act has given you more choice, the same choice or less choice than what you had access to previously?

I feel I have more choice, although the choices can be confusing. One insurance company might have five plans, and another might have four. So what’s important? Office copays or no office copays? Once you figure out what choices are most important to you as an individual, you can just tick them off as you compare plans while shopping.

What sage advice do you most frequently remind people of when they ask you questions about healthcare?

The price we pay for healthcare, in our insurance premiums and related expenses, is far less than the amount we would pay if we didn’t have it. People need to be realistic about that. We look at the moment, and we look at the dollars first. And I get it. It is extremely difficult for my husband and I to afford my healthcare, even though I’m healthy. But the fact is, we will all have to use healthcare at some point. Even for those that are younger – you start a family, your children get sick. We have illnesses that come from growing older. No matter what we chose, whether we have insurance or not, it’s going to cost us either way. And just because you have insurance, that doesn’t mean you can get medical care and not pay anything at all. Healthcare is going to cost us something. You have to pay for what is it worth, and what quality of care you want to have during all stages of your life. You are going to pay it now or you are going to pay it later.

For me personally, I’ve always had healthcare insurance because I know all too quickly what one accident did to my life, and because of that accident, if I did not have healthcare insurance to at least cover the costs of getting me better, I don’t know where I would be. You do have to pay for it, but at the same time, people need to prioritize health insurance in their lives. Whether that’s one less latte, one less – whatever – health insurance needs to be a priority. 

NOTE: The views expressed here are those of the author and do not necessarily represent or reflect the views of Healthcare, Inc. and HealthCare.com.

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Colleen McGuire

About Colleen McGuire

Colleen McGuire is an independent consultant who has spent most of her career writing about healthcare and the health insurance industry. For fun she blogs, travels and takes a lot of pictures along the way.

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