Move Over Mary Poppins!

The real life adventures of one nanny, her husband, child, dogs, house, and whatever else crosses her path.

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Wednesday, November 19, 2008

One Woman's Tale of Health Care

N asked me what I though about health care. I could rant all day on the topic of health care, both as a national problem, and a ridiculous hassle here in the Bay State, but anger gets the better of me and I become incoherent, so instead, I shall tell a tale...

Once upon a time, a college graduate took a job as a nanny. Her benefit package included full health coverage. Since she'd always been a dependent on her parents' policy, health care was something she knew she should have, but to which she had never given much thought. Her employers purchased a policy through a smaller carrier that offered group rates to single employee tax ID folks, like people who have nannies. She was 22, healthy as a horse, and didn't ever even bother to get a doctor during the first year.

After the first year, the rates went up, and her employer discovered that Tufts Healthcare offered a comparable coverage for less money, so he switched her over. At this point, she began to take advangtage of the some of the benefits of an HMO. She got a PCP, used her discount at Weight Watchers meetings, and tried to get herself even healthier. Things continued on happily until she left them, three years later, to try out her culinary degree.

It was a little over six months before she found a job with health care benefits. That period had been the first time in her young life that she had been completely uninsured. Now she found herself with benefits she had to partially pay for, especially if she wanted to get benefits for her fiance as her domestic partner until such time as they were legally married. HarvardPilgrim was pretty progressive, huh? For the better part of a year, she worked for the hotel kitchen before the ridiculous hours and psychological exhaustion prompted her to leave, and go back to nannying. (While perhaps not the most relevant career choice, it does have its upsides.)

She took a job with a young family in Allston. Her health care was offered through NHP, a state affiliated HMO. It was perfectly sufficient. She was responsible for choosing her coverage from a number of options presented by her employers. While researching different providers, coverage levels, and price points, she started to develop a sense of what she wanted from her health care plan. Sadly, the one imperative, getting her fiance on the plan, seemed out of her price point now that she was out of the corporate infrastructure. The plans that offered DP'ship coverage were too expensive, and the cheap plans didn't offer it.

When that job situation tanked, rather spectacularly, three weeks before her wedding, she was again without health care coverage, this time before a two week trip to Hawaii and San Fransisco. All was, happily, well in the end.

She returned from her honeymoon, and started back at her old position with the very first family who had originally hired her. This go 'round, her employers let her take the reins and choose coverage that would suit her needs and price point. It was agreed that the cost to insure her as a single gal would be covered by her employers, and the extra cost of adding her new husband would come out of her paycheck pretax. She went back to the plan she'd lost with her previous job, added her husband for a small upcharge and felt great about getting him a PCP and seen by specialists for some of his recent complaints. He might be the bread winner, but she was contributing!

The next spring, yet another rate hike. Back to the drawing board for our heroine, who chose Blue Cross MA for her new coverage. This plan was actually less that the state affiliated plan's new rates, and had great coverage! Hooray! There is a benefit to the new laws requiring MA residents to either purchase health care or procure it through state funded initiatives (ie, her tax dollars paying for other people's health care, including those who abuse the welfare system and illegal workers... but that's a different rant. That's the rant about how she's a democrat with fiscally conservative leanings, and very mixed feelings on government aid systems, and how she feels that it's not wrong to ask that people become legal citizens in order to enjoy the rights and privileges of citizenship nor is it wrong to ask that folks who find themselves in the unenviable position of taking government money to survive be asked to give something back. There has to be a better solution than what this country's got going at the moment.)

Then, she and her husband decided to have a baby. Health care became the biggest financial concern she had, aside of making sure the mortgage got paid every month. The having the baby part was great. The hospital copay was only $500, for a stay that racked up almost $17,000 dollars (and that, praise the universe, was a healthy, mostly uncomplicated birth!), but once baby made three, the new premiums skyrocketed by over %50. Ouch.

She dug deeper, discovered a provider based out of Tenessee called MidWest Life, licensed to sell in MA, who specialized in the self employed folks, and switched from an in state HMO to a nationwide PPO system, with an a la carte based coverage selection. She went minimum on most things, and then made sure that well child coverage was strong, as well as emergency and preventative care. Brilliant, right? Paying for what you need, not paying for all the HMO extras that have to make up for the differentials between the healthy folks who don't use most of what they pay premiums towards and the chronically ill who use more than they pay for (because, if you're an HMO, you've go to balance those numbers, right?). Paying premiums based on a national average, as opposed to the spiked rates here in MA, where only a handful of providers are allowed to peedle their products sounded great.

And then MA decided to up the ante. The new minimum coverage criteria go into effect at the beginning of 2009, and guess what? Her coverage no longer makes the grade. What she felt was sufficient for her family and budget was no longer suffient according the great and powerful Oz, or whomever the hell is in charge of all this. If she does not switch to a compliant coverage minimum by year's end, she is fined approximately $75 per adult, per month until she does. There goes all the paycheck she was saving by switching away from Blue Cross.

On Saturday, she meets with an insurance broker to try to find a middle ground. This could be her fourth health plan in three and a half years. If she gets an ulcer from worrying about it, she may just send her medical bills to the state.



Blogger brushfiremedia said...

The next to last paragraph makes me blindingly angry. And is the reason that I was yelling and screaming about MA's plan to require healthcare for all individuals. Words fail.

11/20/08, 10:36 AM  

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