First off, let me say, this is not a tragic case. I was a kid with a serious pre-existing condition, and I never had to go without necessary medical care. My parents were often un- or under-employed, but they are educated, resourceful and lucky. They made a lot of sacrifices to get me the care I needed (with the bad jobs they stayed in for continuing health coverage, with putting medical costs above everything else in the budget, by countless other things), but they were able to get me care, which is more than many families who have to sacrifice more and are left with less.
I was on state-assisted health care through most of middle and high school, which didn't cover prescriptions. My parents spent untold hours on the phone haggling with insurance companies for treatment coverage, and I had to ask every doctor I saw for samples. I learned to fill out Proof of Hardship forms and wrote a lot of pleading letters to the executive offices of Pfizer and Glaxo-Wellcome, telling them what a good student I was and an athlete and how hard I worked to manage my severe asthma and how my parents are unemployed, which was the way to request complimentary "compassion" meds in the 90s. I fucking hated constantly having to justify my worth to powerful strangers, and I always had in my head — if I convince them to send me a $200 or $400 or $50 inhaler that I need, it won't be sent to another person who also needs it, and what if that person is sicker, poorer, or a more promising human being than me?
I got it drilled into me: You can never be without a job that has healthcare. Never have a gap in insurance, not even a day. I needed a career that was always in demand by corporations, and insurance was always much more important than pay.
I'd always get angry when people told me I could be the author I'd wanted to be as a child, or should start my own business based on a good idea, because I knew I was forever handcuffed to an office desk by Advair, Albuterol and the looming possibility of hospitalization, no matter how talented or diligent I was. I was so jealous of my healthy sister, who just walked into Kaiser Permanente and paid $95 a month for independent health insurance. She could do ANYTHING she wanted with her life!
I did all the right things — got a job with benefits, changed to in-network doctors every year, chose less expensive medication options whenever I could, and I still racked up a ton of debt from co-pays, coinsurance, and those fucking deductibles that hit at the beginning of every single year (When I was 24, I had a $2K individual deductible plus a $1K prescription deductible, and at 25 my monthly premium cost was over $500). Out of pocket medical stuff was like a mortgage – over a third of my income. (Not gonna lie, I was actually proud of that at the time because I was taking care of my own medical costs, if on credit. LOOK AT MY HARDSHIP AND INDEPENDENCE!)
Fast-forward to this month. I made the terrifying decision to resign from my Good Corporate Job when my FMLA ran out to take care of my mom while she goes through Ovarian Cancer 2: Chemo Boogaloo. I'm happy that I can pay her back for some of those times she drove me to the emergency room. One of my admin friends who got laid off from my former company in December told me that the COBRA option they offered cost $2,200/month, which is way more than our monthly take-home pay was when we worked for them. So I stocked up on my prescriptions (thank goodness the company took out a cheapo health insurance policy for this year with required mail order pharmacy!) and prepared to have that insurance gap I was never supposed to have, and crossed my fingers that I'd be able to buy insurance in Massachusetts with a pre-existing condition and a coverage gap of however many months it would take before residency and insurance would kick in. (I also hoped that coverage would cost less than $2,200, or, you know, more than I will ever make in a month.)
Part of MassHealth (the state-level model for the Affordable Care Act before congress got through with it) is a patient advocacy office in every hospital to help people get signed up for healthcare. It's a state requirement that almost everyone be insured, and these people help you find and apply for the right plan for you. I trooped to my cute rural hospital today with a notarized letter stating I live in Massachusetts now and my final pay stubs, proof of insurance, utility bills, and my pitch (like those old Glaxo-Wellcome letters): I grew up in this town! I'm such a good person! I'm here taking care of my mom, who has paid Massachusetts taxes for decades! My dad is friends with a guy you went to high school with!
The lady asks if I'm making any money now. "No, but here are my final pay stubs from May." She doesn't need them, just asks what I made in 2012. I tell her – I think it's a lot for this area, since I was working in a city with a higher cost of living – and she types it in and starts printing final forms for me to sign. "Should I tell you about my health history, or will I write it on the application?" That doesn't matter. Nobody needs to know. Unless I'd like to tell her about it so she can give me moral support, she jokes. Sign here, and here. I do. "How long until I know if I've been accepted?"
She smiles, and says that just by signing the form, I'm already covered for emergencies. In three weeks, I'll receive a note in the mail – she shows me what it will look like, minus my ID numbers – and then I'm completely covered. Pick a doctor, call a toll-free number. I won't have to pay premiums. It's free.
She adds, "Welcome home."
It's free. I'm covered right now. FOR FREE.
I didn't have to show proof of hardship, or write a begging letter to showcase why I'm more deserving than other applicants, or read out my whole medical chart, or even show my history of on-time insurance payments.
On my way out of the hospital, I pulled over and cried. The gardener nearby probably thought I was in the hospital to visit a dying relative. They're giving me health insurance, just for being a human being.
Thank you, Massachusetts.
(For those not from here and wondering about my lj-cut text, schoolchildren have to learn John Winthrop's City on a Hill speech. He was one of the Puritan founders of the Massachusetts Bay colony in the 1600s. All the eyes of the world are upon us, if we shall fail to do justly, love mercy, and walk humbly in the eyes of God. I loved it so much I put it up on my wall as a teenager.)