Obamacare and Me

Before Matins this morning, I turned on the computer and went to the official site for the Affordable Care Act.

When I saw their splashpage with the big title: "The Health Insurance Marketplace is Open!" I shed some tears. It has been a long time coming.

Many presidents, going back at least to Harry Truman, have sought affordable healthcare for Americans. Lyndon Johnson was the first to win a partial victory, by pushing Medicare through Congress. Harry Truman and his wife Bess were there when Johnson signed it into law in 1965, and were the first persons enrolled in the program.

That took care of the largest part of the issue: health care for persons over age 65. The rest should have been straightforward. It has not, however, proven easy. The debate over what became the Affordable Care Act (immediately labeled "Obamacare" by its detractors) is widely known, and I will not say more about it.

But it is perhaps worth a few minutes to relate how it affects me, a married person in his late fifties.

For a long time, I was a participant in the pension and healthcare plan of the Presbyterian Church (USA). Under their system (at least as it was in those days), the local church paid a fixed percentage of each employee's salary, which provided for a defined benefit pension and medical insurance. As they often said, it was a "community-based approach." Those who were well-paid (typically clergy) paid more, those who made less (typically lay employees, also clergy in smaller churches) paid less. All paid the same percentage, or rather the congregation paid on their behalf. It was (and remains) a thoroughly sensible approach.

Then I became an employee of the Episcopal Church.

Our diocese offers three medical insurance plans, and it is mandated by canon law that the local parish must pay the full cost of participation in these plans for the clergy. As it currently stands (2013), I may enroll in the insurance plan should I wish to do so. The cost for single-person coverage is about $9,000 a year; should I wish for my wife to also have insurance, the total cost would be slightly north of $20,000. The congregation would pay zero; it would all come out of my pocket -- which is not sufficiently deep for numbers like this.

Thus, my wife and I purchased individual coverage from the state Blue Cross/Blue Shield affiliate. We are on the cheapest plan they offer, which has such a limited list of coverages that it does not cover what the ACA calls "essential health services." We are both in excellent health, but have had "pre-existing conditions" ruled out -- for me, there was no coverage for anything related to the eyes, because I am sufficiently nearsighted to be at high risk for retinal detachment. The deductible for this policy is $11,000 a year -- that much has to be spent in medical bills before the plan pays so much as a penny. The premium is about $500 a month, covering the two of us; this premium has approximately tripled during the twelve years that we have had the policy. This is a "high deductible health savings plan" and is accompanied by a Health Savings Account, to which we can make tax-free contributions, and we have done so every year, right up to the maximum allowed. This money sits in a HSA earning about 0.5% interest with a $25 annual fee eating away at it.

In my opinion, this is not a satisfactory arrangement. But it is the best we can do, balancing affordability with at least a minimum of insurance -- for, if you are uninsured in America, you are one accident or illness away from bankruptcy.

Correction: you WERE one accident away from bankruptcy. Today, that all changed.


I spent only a few minutes on the HealthCare.gov website; it is a busy day for them and their servers are maxed out. I downloaded a form that my employer will need to fill out, which is part of my proof that I cannot afford the insurance offered by my employer (it is well over the 9.5% of family income that is the cutoff). Our income falls easily within the range that should make us eligible for a subsidy on our premium payments. It looks promising; the best I can tell, we should be able to find coverage in the "Marketplace" and get by for no more than we currently pay, and receive much better coverage.

"Obamacare" is a term of derision coined by the program's detractors -- there are some deep-pocketed people out there who have funded a sophisticated program of dis-information about the law, and at this writing, the Republicans in Congress remain determined to kill the program. I use the term in the hope that "Obamacare" becomes a badge of honor for this president, who has staked everything on it. I believe that it will do as much to benefit the ordinary people of the U.S. as Social Security.

At the least, this American, who on the whole is not a fan of President Obama, wishes to thank him for bringing us to this day. My hat is off to you, Mr. President.

[I tip my hat also to Sen. Edward Kennedy, of blessed memory, for whom this was an issue of utmost importance. And Pres. Richard Nixon, who was among those who tried and failed to bring universal health care to Americans. His proposals back in the 1970's, built around a mandate for employer-provided insurance, have many likenesses to the Affordable Care Act as it now stands.]