Just How Affordable is “Affordable Care”?

When the Affordable Care Act (ACA) went into effect in 2014, those of us on the front lines were in for some roller coaster ride experiences in helping people cope with the changes that came with it.

As a Registered Nurse (RN) Case Manager at the time, part of my job was to find out what the patient’s insurance would and would not cover and what out-of-pocket costs the patient would be responsible for as we made plans for transitioning the patient’s care to another setting after the patient left the hospital.

Much to the surprise of most patient’s who were covered by health insurance for the first time or whose policy had changed due to higher costs to their employers, there were now huge deductibles ranging from $2000 to $12,000 as well as copays up to 60%. Many of the individuals were having trouble paying their part ($25) of the monthly premium that was mostly covered by government subsidy. And had no way to pay the deductible or copay.

As a RN Case Manager, my job was to arrange home care and durable medical equipment for home use. Prior to ACA, most patients with insurance could afford their $500 deductible or had already met it prior to hospitalization. Most could afford the $20 – $40 copay for their rolling walker or bedside commode. Most had the $5 to $100 copay for the prescriptions the doctor wrote for the patient to continue treatment at home. Many could arrange to pay the $25 – $30 per visit copay for their home nurse or home physical therapist.

Not so much after the ACA came into being.

For purposes of discharge planning, I now had to treat my insured patients as if they were uninsured. I was sending family members to the local Goodwill in search of the rolling walker and bedside commode. I was begging home health agencies for home visits. I was asking doctors to re-write the home prescriptions for something on the $4 list.

The patients were shocked that their insurance didn’t cover everything 100%.

Another group of patients in for a rude awakening were those who were used to having coverage through their employer. Small business owners who had been able to offer health insurance to their employees in the past, now found the massive increase in cost to be totally out of reach even with cost-sharing with the employees. Therefore, the employer could no longer offer health insurance to his employees. Instead, these employees were left to shop the insurance marketplace on their own. Because they had full time, good paying jobs, they were not eligible for assistance with paying the premiums. And the premiums, even for the cheapest plans, were out of reach financially. Therefore, the employee had no choice but to go without insurance.

A third group of patients in for a very rude awakening were the ones with insurance through their employer and the employer had been able to continue paying the same amount in premiums, but for much less coverage and much higher deductibles and co-pays. This situation was brought to my attention by a patient who was undergoing chemotherapy on a monthly basis. Up through December the hospital co-pay had been $100 per hospital stay. She and her husband had been able to handle that. He had continued working passed retirement age to keep insurance to cover her cancer treatments.  When she came in to the hospital for her January treatment the year that the ACA went into effect, her husband talked with the insurance company and discovered that the new insurance policy had a $12,000 annual deductible and only covered 40% of the charges after the deductible had been met. When her husband told the patient what he had found out, her response was, “Well, I guess we might as well go home so I can die. We can’t afford that and I won’t be responsible for putting you out on the street after I am dead and gone.”

He smiled and kissed her and said, “I already took out a second mortgage on the house. Don’t you worry about me.  We’re going to get you the care you need to get well!.”

So again, I ask: Just how affordable is the Affordable Care Act? And for whom?

Telling it like it is,


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