Health Insurance

This post is going to be full of numbers.  However, it is important to me and an important issue affecting the general population.  Health insurance has become a topic avoided like politics and religion.  We only speak of it in times of great frustration and desperation as we struggle with something health related.  An open dialogue that doesn’t blame current problems on the left or the right but instead gives insight to current problems and possible solutions would be a nice change.

Last week while I was sitting at my obstetrician’s office, I overheard a pregnant patient declare to the front desk ladies that she does not have insurance and would be paying for her care out of pocket.  At first, I was a bit flabbergasted.  How could anyone afford such a thing?  What’s more, doesn’t she realize she will now be penalized for not having insurance under the Affordable Care Act (otherwise known as Obama Care)?  I don’t even know how much that will cost.  This, combined with a the knowledge that our insurance is going to be renewed in a month (which might result in an increase in premiums) has made me stop and think about the cost of having insurance versus the cost of not having insurance.  Once I started doing the math, I was a bit surprised.  Well, disheartened might be more accurate than surprised.

Our insurance premium every week for me is $81.88, a whopping $327.52 a month.  That is $3,930.24 a year.  I have been to the doctor exactly two times in the last year previous to my pregnancy.  If we paid out of pocket for those doctor appointments it would have cost $350.  Previous to pregnancy, I had two prescriptions I purchased regularly that would cost $44.00 each month without insurance.  Now, maybe my math is off, but I don’t think so.  My insurance has only had to pay out $614 minus a $25 copay, which equals $589.  Let’s see…

$3930.24 (my premiums) – $589.00 (health care expenses paid) = $3341.24

That’s $3,341.24 in profit, from me alone.  Wow.  Call me inarticulate, but just wow.

I am currently in my 19th week of pregnancy.  My estimated pregnancy costs are just over five grand, and my insurance covers everything…except for my deductible.  I have a $2,500 deductible that must be met.  The insurance will pay for everything else, leaving $2,500 behind for me to pay.  My appointments I have attended up until the birth will be billed under something called global billing.  For those of you that have never heard this term, it refers to a specific method of billing used in instances that care will follow an expected pattern over a defined period of time, such as in pregnancy.  As I go each month to my obstetrician, my insurance and I will not be billed.  My insurance and I will be billed after I attend my post-natal appointment (six weeks after I give birth).  This means that I will only be paying my deductible in 2015 as long as I do not have any pregnancy complications requiring hospitalization in 2014.  If I have any such event, I will then be paying my full deductible in 2014, and again in 2015, resulting in $5,000 out of pocket instead of $2,500.  

So, how much will my insurance pay out for my pregnancy as I’m paying $2,500, possibly $5,000?  According to WebMD, the average cost in 2008 of pregnancy and delivery in a hospital is $9,600-$15,800.  My estimated cost as explained by the billing department of my obstetrician’s office for prenatal care and hospital delivery is just over $5,000 if the birth is via vaginal delivery.  There is obviously quite a disparity between the national average and what my obstetrician’s office has predicted will be my total costs including hospital stay.  But, I at least know how much the self-pay pregnant lady is anticipating paying, just over $5000.  In 2012, 32.8% of all births in the U.S. were via Cesarean section according to the Center for Disease Control.  This means in 2012 32.8% of women giving birth had their delivery costs almost doubled because of C-section.  I wonder if the self-pay lady has budgeted for this.

The American Congress of Obstetricians and Gynecologists published that in 2010, Medicaid was responsible for funding 42% of all births in the U.S.  It did not specify what percentage of the total cost of those births was covered by Medicaid (for example 100%, 50%, etc.), and I have been unable to find any statistics to give me answers.  I have known many women that had Medicaid as secondary insurance during a high risk pregnancy.  I’m starting to wonder if maybe Medicaid will end up being my only source of insurance.  If my premium goes up again, I won’t be able to afford to pay it.  As my insurance is right now, I’m not sure I should continue to paying for it.  My family is only within a few hundred dollars of qualifying for Medicaid.  One bad month at work for my husband (most of his income is commission based) and we would most definitely qualify.  No deductible with Medicaid.  Too bad I can’t just pay Medicaid what I pay my insurance.

So, again, how much is my insurance going to pay for my pregnancy?  Well, somewhere in the ballpark of $2,500.  How much will I be paying for my pregnancy and my insurance for the entire pregnancy and birth?

$2,500 + $3,766.48 (cost of insurance for 46 weeks) = $6,266.48

That’s more than my car cost.  That’s more than what we pay in car payments for my husband’s car in a year.  That’s more than we will pay in mortgage for a year.  That’s more than, well, a lot of things.  That’s almost worth having the baby at home on my kitchen floor (the only non-carpeted floor other than the bathroom) even though that thought makes me want to vomit and cross my legs and hold my baby in for the rest of my life.  I’m not much of a granola-crunching-hippie type (yes, that is very stereotypical of me, but you know what I’m saying) so that’s not really a viable option for us.

Why am I paying for insurance?  What’s the point?  Insurance is like a bad gamble.  The only way it will pay to have my insurance is if I have a C-section, or if there is something wrong with my baby and he or she ends up int he NICU (that’s like $2,000/day).  The only point in having insurance is to cover us in case the unthinkable, or worst possible scenario becomes reality.  Looks like the self-pay pregnant lady is way smarter than I ever would have anticipated.  So, now what do I do?  Do I drop my insurance and accept whatever “tax penalty” comes my way via the Affordable Care Act (Obamacare) penalties?  How do I find out how much that’s going to cost me?

I have been writing this post for days now.  Every time I come back to it to edit or add to it, I can feel my blood pressure rising.  I can feel a bit of itchy, leg-twitchy panic start to creep up.  I feel like I’m talking in a circle.  There isn’t a good answer for any of this.  Health care costs too much, health insurance costs too much, the economy is crap, Obamacare is crap, etc. is all a bunch of rhetoric that doesn’t get me a single real world answer.  Not one viable solution is going to come out of a conversation based on where to place blame.  I need something practical that will impact my life, the life of my family.  Maybe modern fairy tales won’t be about a boy and a girl saving each other, but instead it will be a story about affordable health care.  It doesn’t look like we will be getting any real world solutions any time soon.

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