My (quite) personal experience with the ACA...

Discussion in 'Too Hot for Swamp Gas' started by DaveFla, Dec 26, 2013.

  1. DaveFla
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    DaveFla VIP Member

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    My 20 year old son was diagnosed with Type 1 Diabetes on July 5, 2013 (this year) after an episode of acute appendicitis which ended in a ruptured appendix. I don't know how, or even if, the two are associated, but his pre-OP blood tests showed no signs of the disease. He was always healthy, not overweight in the least, and an active sportsman. Funny because after our family doctor diagnosed his condition and rushed him to the hospital for emergency surgery, the attending surgeon wasn't sure it was appendicitis and sent him home. Within 4 hours, he was in the OR as his appendix burst and caused a considerable amount of damage in his abdomen. 7 days in the hospital, 4 were in intensive care (any med-mal lawyers out there?)... But I digress.

    As a full time student, he was covered under my wife's employer health insurance, and, thanks to the ACA, would continue to be covered until he reached his 26th birthday. In early (this) November we were notified that our insurance provider (Aetna) was discontinuing the coverage of his diabetes related medication beginning on January 1, 2014. As you can imagine, the medication and associated supplies, is quite expensive. Insulin, test strips, syringes and pods for his pump come to about $1,100 per month. Were it not for the prescription coverage, our share, after the $1,500 annual deductible is met, comes to about $220 per month.

    He recently moved into his own apartment (a frightening experience in and of itself, considering his condition). Given that he is no longer our 'dependent' and because his income would likely qualify him for a tax deduction for his ACA coverage, we set off to get him registered on the ACA site here in Florida. We began the process in mid-November.

    Long story short, we couldn't get him registered. It took me several days of attempting to get onto the site. After I was able to access the site, and after successfully registering him, we were prevented from signing up for coverage because they were unable to verify his identity (they use Equifax, and he has no credit history). After spending hours and hours of time waiting on the phone to speak with an Equifax representative, he was told that he would have to call the ACA directly in order to verify his identity (you can vote without an ID, but you can't get Obamacare without one).

    This verification process began on December 19. As of December 24 at 5pm, we were unable to speak with anyone on the ACA via telephone. We constantly received messages that the system was overloaded and to "please call back" at a later time. We did.

    He missed the deadline, and because our provider has now eliminated his prescription coverage, our cost, contrary to the many Obama promises, has increased substantially.

    Although I am thankful of the new laws which require dependent coverage until age 26, and that he won't be denied for coverage now for his pre-existing condition, I can't help but to think the entire Act will, at some point in the future, be amended and/or repealed in its entirety.

    I am also thankful that we are in a position to pay for his medication.
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  2. fredsanford
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    fredsanford VIP Member

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    While I am sorry about your son getting caught up in the ACA setup shortfall, it is somewhat comforting to see that is difficult to get coverage if there are doubts about anyone's identity.

    That was one of the opponents' biggest gripes--that anyone, including illegal aliens, would be able to get signed up willy nilly. Your story belies that claim.
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  3. DaveFla
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    DaveFla VIP Member

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    I don't recall the application process ever asking if he was a citizen or not. Could an illegal call and get his/her identity verified? All He had to do was call and have them verify he was who he was, not that he was here legally or not. I don't know either way...
  4. DaveFla
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    DaveFla VIP Member

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    BTW, legal or not, they can still show up in the ER and receive free healthcare.
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  5. fredsanford
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    Illegal aliens are not supposed to be eligible for ACA.
  6. gatorman_07732
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    gatorman_07732 Well-Known Member

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    So because they could not confirm his identity with his SS# and DOB that is comforting? The word comforting comes to mind if you're that person.
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  7. tim85
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    tim85 Well-Known Member

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    Fantastic Fred. You took a sad story and politicized it; Thank God that those "opponents'" gripes are now proven wrong, because that's what all of his is really about. My Side > Your Side.
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  8. fredsanford
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    fredsanford VIP Member

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    I don't think it's a sad story overall and he was the one that posted it on a political discussion board. If anything it's a mixed bag, to whit:

    1. His son got coverage until age 26 where he would have been cut off at 22 pre-ACA.
    2. His son can get individual coverage now which would have been impossible with pre-existing conditions pre-ACA.
    3. His son got caught up in the website/program launch cluster****.
    4. His son is temporarily without coverage due to the program's identity verification rules being worked out.
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  9. asuragator
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    asuragator Well-Known Member

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    Have to disagree. I think dave's posting the story on here and bringing politics into it shows it was intended to serve as a personal example of the political. Fred responding to the political aspects is not politicizing it anymore than dave already did.
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  10. GatorNorth
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    They don't need the ACA. They just need an ER.

    True story.

    My daughter was a Olympic-development volleyball player throughout high school.

    At one point, she started having extremely random allergic reactions that couldn't be diagnosed by her physician or an allergist, or by Children's Healthcare. Some were minor, and others resulted in her going into anaphylactic shock, so we resorted to treating symptoms and armed her with 2 epi-pens while she was away from home to buy us time to get to her in case of an attack.

    One night at practice she had a bad reaction but had only brought on epi-pen with her, and the coach hit her with it while another parent called us. Epi-pens last about 15 minutes before you either need to be in the ER or another hit, so my wife and I frantically drove to practice to pick her up, give her another hit and get her to the ER.

    By the time we got to the ER the second epi-pen was wearing off and she was clearly having breathing difficulties from the underlying allergic reaction. There was a line of 10 family's at the ER, all with colds, sniffles or a minor fever, all of whom were using the ER as their GP. I politely stepped to the front of the line and asked the admin for help as we had a true emergency that required immediate attention.

    I was told 2x to go to the back of the line and wait my turn as my teenage daughter was now starting to gasp for air as well as have a panic attack.

    Left with no choice I broke through the metal doors, grabbed a health care worker and was able to get immediate attention from a physician, who later apologized for the admin's inability to discern a true emergency and thanked me for being proactive.

    There's nothing the ACA does that cleans out our ER's to be used for true emergencies.
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  11. DaveFla
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    FTR, I agree with this. I would not have brought in here lest to prove just how convoluted this system is. It's seriously screwed up, and I speak from experience.
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  12. cocodrilo
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    Any day now the White House will announce that it's changing the law to make them eligible.

    Any day without a change in the law by the White House is like a day without dictatorship.
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  13. fredsanford
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    fredsanford VIP Member

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    Yes, it does. It gives people who ONLY had access to healthcare before via the ER a way to get into a doctor's office instead before issues become chronic or serious.
  14. tim85
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    tim85 Well-Known Member

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    There's a difference between talking about something political, and politicizing something. There's nothing wrong with discussing the inherent [ir]responsibility of our government in Dave's story. Like Dave himself said, he meant for that. However, it's completely different to turn it into "their side is bad, see why!"-type discussion. That's what Fred did. "Our opponent gripes," he had turn it into it, but that is Fred. He's as black and white as the Conservatives he slams on here are.

    My point is - it's possible to talk about politics, and the topics therein, without resorting to this, "our your, your side"-mentality that seemingly has to permeate every thread.
    Last edited: Dec 26, 2013
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  15. asuragator
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    asuragator Well-Known Member

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    Fair point. And ftr, I wasn't criticizing your posting a personal story while linking it to something political just as I didn't think there was anything "wrong" with fred's responses. In fact, even if we might disagree on pretty much everything, it's a legit thread worthy of serious discussion, political and personal as it is, imho
    Last edited: Dec 26, 2013
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  16. tim85
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    tim85 Well-Known Member

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    Well, if by legit that this is a message board, and he posted a message, yes, I agree. I wouldn't debate that.

    I just don't see any reason to turn this into a rant against the other side; apparently you're fine with that type of debate that leads nowhere but to insulting posts from old-guard Too Hot-posters who can only see things in "Reps Bad, Dems good" or "Dems bad, Reps good"-type terms.

    Go back and read his post and ask yourself, "What is the point he's trying to make here?" To me, it seemed like, after reading this:

    "That was one of the opponents' biggest gripes--that anyone, including illegal aliens, would be able to get signed up willy nilly. Your story belies that claim."

    After reading Dave's story, all Fred got from it, was that, "hey, see, those guys on the other side WERE WRONG."
    Last edited: Dec 26, 2013
  17. asuragator
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    I think you've seen enough of my posts to know that I try to avoid simple left/right binary responses...not saying I am immune to it, just that I do try to stay away from them. But to the topic specifically, many claim to hate and others love the ACA, both with legit reasons, but many are also conflicted depending on how they are asked. Mention ACA and they hate. Start mentioning individual components, views change. Run into verification issues hat prolong the process, dislike; having and onerous verification process that keeps ineligible, illegal aliens from enrolling, like.

    All worthy of discussion.
    Last edited: Dec 26, 2013
  18. tim85
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    tim85 Well-Known Member

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    Fair enough, jd. Perhaps it's the incessant tone around here sometimes that it makes me weary.
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  19. JerseyGator01
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    I have a pre-existing condition and I can never recall having a problem getting coverage because I wanted to enroll in an individual plan. That point baffles me. This part is STILL a gargantuan mess that could easily get worse, and likely will, with ACA.
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    I had problems. The agent told me BCBS basically didn't want me and the premiums were extremely high. Life insurance is just a flat turn down for any general plan.

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