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Perspective: Obamacare isn't working for middle-class American families like mine

Perspective: Obamacare isn't working for middle-class American families like mine

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Last April my husband and I were discussing whether I could leave my job as a registered nurse, as we were planning to have a baby, and paying for childcare would be too expensive. We looked into how our health insurance would work through the Affordable Care Act, since my husband is self-employed.

Before becoming self-employed my husband worked at an hourly rate, and was enrolled on an Obamacare plan. He wasn’t making as much money, so he qualified for the subsidies. When he started working for himself, his income level changed, and when we got married I put him on my employer’s insurance plan. Now that we’re considering going back to being a single-income family, since his business is going so well, we can’t afford to do so because paying for insurance wouldn’t be feasible through the ACA’s exchange plans. The premiums for our family would be around $850 to $1,400 per month. (For a bronze level plan?) Those plans also have high deductibles where you’re paying out of pocket up until about $10,000, at which point your coverage kicks in. I’m a nurse and my husband is a tradesman with his own business, but the ACA still isn’t affordable.

My husband and I are relatively healthy adults; he takes a few maintenance prescriptions that are all generic, relatively cheap, and can be bought at Walmart. Obamacare doesn’t work for working middle-class Americans, especially those who are self-employed and don’t go to the doctor except when something is serious. It’s also not good for those who have a household income that puts them above the limit for any sort of subsidy.

Additionally, my employer-sponsored health insurance is good, but the amount of money I make per month, minus what child care would cost us, would leave me bringing home about $700 per month — and that’s working full time.

Ten years ago, this wouldn’t have been a discussion. We would have gone back to using cash for doctor visits, cheap generics, and only going to the doctor when we’re sick. I’m not going to the emergency room on every whim. I have enough skills from being a mom and from my nursing training that I can treat a lot of ailments at home before they require a physician to step in. It’s great that more people have health insurance, but it hurts the people who are healthy and don’t really use health insurance all that much.

I would prefer the ability to make my own decisions as an adult who knows my own and my family’s health, and what problems require care. I’d like to be able to say, “Hey, it’s my choice not to carry insurance for doctor visits. I want a catastrophic plan so that if we go to the hospital we can have coverage for care once a deductible is met.” As a small business owner trying to figure out budgeting, that would be a no-brainer, and I could stay at home with my kids and raise them, instead of shipping them off to day care. We’d have the option of putting money in a savings account, so that if something happens we’d have money set aside to seek care.

Right now, insurers can’t reject people based on preexisting conditions, and so everyone gets health insurance, which has dramatically driven up costs. You don’t have to have a healthy lifestyle; you can just have coverage. Penalizing people for not having insurance and forcing them to pay isn’t right either. That’s like telling people they aren’t smart enough to manage their own health, so we’re going to force you to have health insurance. And if you don’t, we’re going to penalize you. 

Kimberli Markowicz is a resident of Overland Park, Kansas.  


Other posts in this series:

Perspective: How Obamacare allowed me to become my real self


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A solution for affordable, accessible and low-cost primary care (which covers 80% of all care needs) is a combination of 1) a Direct Primary Care physician, 2) cash pricing for ancillary services, i.e. labs, prescriptions and x-rays, 3) price transparency (to allow for consumer choice and 4) product transparency (which treatments are best for given diagnosis). The direct care model also offers same or next-day appointments, 24/7 access via e-visits and no copays or deductibles.

In other words, take insurance completely out of the picture for primary care. Including insurance for primary care is like having auto insurance for oil and gas.

The only need for insurance is for catastrophic care, regardless of what the government/insurance company wonks want you to believe.

Interestingly enough, utilizing direct care also results in lower downstream cost due to more timely treatment.

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