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An Open Letter from a Physician and Patient

By Dr. Rebecca Love
. 2 Comment(s)

I'm 62 years old, disabled but not eligible for Medicare until 2015. Because of my all too common preexisting conditions like arthritis from injuries, migraines and hay fever I was not able to buy health insurance for many years. The ACA required states to form insurance pools to provide a last ditch insurance vehicle for people like me. So I had health insurance for several years after my COBRA benefits expired. But in 2011 my rate rose by more than $150/month. Paying $785 a month for a $2500 deductible policy with a very narrow provider network was financially untenable and I dropped the insurance.

My doctors are in Colorado since its only 110 miles from Moab to Grand Junction. They continued to treat me as a cash pay patient. But I have a degenerative disease that is progressive. I have put off preventive procedures because of the expense. I need insurance.

The ACA web site's problems are frustrating. But I'm a patient adult. I was able to create an account the first week and was able to see my options by the third week.

I am not entirely happy with the insurance I chose. The state approach to regulating insurance means that people are mostly restricted to networks in their locales. But here in Utah that means I will be required to drive to Salt Lake City for specialty care, almost 300 miles while my neurologist, neurosurgeon, orthopedist and internist are all only 110 miles away over a much safer highway. I will have to choose one of four local doctors. All were colleagues. None of us are comfortable with this arrangement.

There are economic, social and ethical imperatives driving this social change. I am pleased to support the ACA despite losing my physicians. I expect to ask for exceptions to the network rule so this I can continue to see the people who have gotten me through crippling disease and 3 big procedures in 2 years. I expect to be denied and to appeal.

I used to stand in the midst of the chaos that is urban emergency medicine and propose that "anything is better than this". The ACA is better. My hope is that this is the first step toward reigning in the profiteering and marketing in medicine. Simply insuring everyone will improve the health of the nation. Reforming the way American physicians practice medicine, banning drug and procedure advertising and lifting the burden of debt newly trained physicians face are all parts of this puzzle.

Rebecca Love MD

PS. Someone needs to point out that the governors who rejected Medicaid expansion and refused to run state based exchanges bear much of the responsibility for the federal marketplace's problems. If they had acted responsibly there would have been no need for a federal marketplace. Low enrollment numbers in states that spent no money to promote the exchanges are to be expected. Withholding encouragement and information is a disservice to the public and yet another form of obstructionism from the Republican Party. 

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  1. Scott Poppen

    Great post Rebecca. Another one of the prices for living in a gorgeous rural spot like Moab. It points out a major flaw in state based exchanges. I suspect there are more than a few folks like you who live in a rural area and access health care in a neighboring state. I wonder if folks who live in places like Evanston, WY, are finding that they are no longer able to see their doctors in the Salt Lake City area? The next advance in the ACA exchanges would be for neighboring states to be able to set up regional compacts and exchanges that cross state borders. That would help you out and bring costs down considerably for very rural states, like Wyoming, who have such small populations that prices in the ACA exchanges have skyrocketed.
  2. Lee levin md

    Did you ever live in cleveland

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