With all the Obamacare debate, I bet many of you think you're okay because you have employer-provided insurance. I’m about to burst your bubble.
You or someone you love will have a healthcare crisis.
Last year was the year of health nightmares. My father-in-law was diagnosed with cancer while I was doing radiation to treat my cancer. A friend from college who thought she had beat her breast cancer, discovered it had spread and is now metastatic. Another friend spent the year trying to deal with an unexplained illness that was so debilitating, she couldn’t work. And then my step-father had a massive stroke while on vacation, paralyzing half his body.
Often we see an impending health crisis looming: stressful job, lack of exercise, or poor diet. Sometimes it’s just bad luck: everything's great when something hits you from out of nowhere. And then there’s just old age which, unfortunately, none of us can escape.
It’s depressing when you think about it and that’s why we don’t. It’s much easier to live in a world of denial. We tell ourselves it’s those sick, old, or lazy people that have problems. It won’t happen to me! It will, it’s just a matter of time.
A healthcare crisis will severely impact your life and financial situation.
A health crisis will rock your world in every way. You may be unable to work. You will be paying out of pocket for expenses not covered by insurance. You may need to change your lifestyle. You may have a lifetime of on-going care.
Three months ago, my mom and step-dad were vacationing in Hawaii to celebrate their wedding anniversary when Tim had a massive stroke that paralyzed the left side of his body. Since then their lives have revolved around doctors, hospitals, therapists, and insurance. Tim lays in bed for most of the day in an adult-care home and needs help with every facet of his life. My mom struggles with the possibility that he may never come home. It is heartbreaking to see their world completely unravel in an instant.
They have Medicare along with supplemental long-term care insurance but even that doesn't cover it. There’s a lot of gaps and rules that turn a health crisis into an even bigger nightmare. She had to get approvals from his primary doctor in Seattle for treatments in Hawaii. She had to pay to medevac him to Honolulu because the Kona hospital didn’t have the facilities to care for a critical stroke patient. She had to pay for a private company to transport him on a commercial flight with a nurse so he could be home with family in Seattle. It’s been a never-ending saga of insurance bureaucracy and out-of-pocket expenses. Right now they have some financial cushion to afford this but she’s looking ahead and worrying if this will wipe them out.
A healthcare crisis will put your job and insurance at risk.
The biggest lie we tell ourselves when it comes to healthcare is that our employer-provided insurance means we’re safe. Most of the time we deal with preventive care and the occasional surgery or illness that requires some PTO. We don't think about what will happen if it's more serious.
When I was first diagnosed with cancer my employer was very supportive. Take all the time you need! As the weeks turned into months and with many days when I couldn't get out of bed, we had to talk about a leave of absence. They had paid my salary much longer than expected but eventually they docked my pay by 25% each month. As the breadwinner it was a bit scary but l was relieved they would continue to pay my insurance which is highly unusual. Most people aren’t as lucky as me.
If you have a health crisis, you will quickly use up all of your PTO and any employer-provided medical leave. If your company has over 50 employees and you’ve worked there for at least 12 months or 1,250 hours, the Family Medical Leave Act requires your employer to offer health insurance and up to 12 weeks of unpaid leave. This means you likely will have no paycheck within a month or two and will be paying out of pocket for pricey COBRA insurance, if you can afford it, in less than five months. Ultimately you may need to purchase your own coverage through an insurance company or exchange.
The longer you’re away from work, the stronger the chance your job will not be there when you return or you may not be able to perform at the same level. Of my two friends and me who dealt with long-term healthcare issues, only one of us returned to their employer but part-time, in a different role.
After you go through something like this, it’s incredibly difficult to job hunt. I had many people question whether I was able to handle a job and given the treatment and recovery time for cancer is so long, I sometimes had my doubts. Thankfully some great friends believed in me.
I understand that companies can't afford to pay employees for not doing work. But I don't understand how we continue to think tying insurance to your employer is a good thing. Health insurance should lessen the impact of a health disaster, not increase it.
Only rich people can afford to get really sick.
If you’re faced with a medical catastrophe, you need an emergency saving account, disability insurance, or long-term care insurance to financially survive. It takes some serious funds to afford these and supplemental insurance can be difficult to get, the older you get. Of course we know many people can’t afford even basic insurance because of the high premiums and deductibles.
The costs are not just financial. It includes navigating the complex rules, random limitations, and mind-numbing hospital administrators and insurance companies when you’re emotionally and physically drained. It is amazingly frustrating when it affects the choice of treatment.
During chemotherapy, there are two drug options for increasing white blood cell production: Neupogen or Neulasta. Neulasta is given once per chemo dose while Neupogen is given daily from 3 to 10 days, depending on your blood counts. My insurance would only cover Neupogen because it’s cheaper. The only choice I had was a shot in my stomach for 7-10 days during each 2-week chemo treatment. Rather than 18 shots of Neulasta, I had around 100 shots of Neupogen. I hated it.
It’s inhumane that money is the only factor that determines who can get insurance and the type of treatment you can receive.
A Pre-existing condition is not a choice.
My son and I have pre-existing conditions. He was born with autism. I got cancer. Neither one of us could help our twist of fate. Yet we face the possibility that an insurance company can and will discriminate against us. Thanks to Obamacare, we are safe but that may not last long with its repeal.
As people with pre-existing conditions, we are healthy than most people. The more help my son can get now at his young age, the less help he’ll need as he gets older. Happily, we’ve seen tremendous results with his therapies and are optimistic for his future. My cancer is gone and my on-going care consists of occasional doctor visits and taking Tamoxifen for five years.
If all of us were required to get a physical examination to receive health insurance, many Americans would be in the same “high-risk” boat due to poor nutrition, lack of exercise, stress, and obesity. In most cases, these can be controlled but cancer and autism isn't a choice.
Rather than punishing people for pre-existing conditions, our healthcare system should do more to incentivize and reward good healthcare to reduce costs.
what can you do?
By reading this, I hope you takeaway three things:
First, make sure you have an emergency savings fund. If you can afford it, consider supplemental insurance such as disability or long-term.
Second, educate yourself on your employer’s policies in case you need to take an extended leave of absence. Know your employee benefits. Know your rights because your employer loves you only as long as you can keep working.
And lastly, as the healthcare debates escalate with the repeal of Obamacare, realize we are all affected by the outcome, no matter how you get your insurance currently or which party you support. You could be a job loss or a health crisis away from having no insurance which could endanger you both physically and financially. Ignore the party rhetoric, focus on the facts, and demand details.