My ObamaCare Story

Covering the Affordable Care Act was going to be as exciting as watching paint dry. From the beginning planned Town Hall Meetings were disrupted by activists bent on preventing civil discussions on President Obama’s legislative accomplishment.  Nicknamed, “ObamaCare” the term became synonymous with the Affordable Care Act. In polling, participants choose the Affordable Care Act over ObamaCare which are the same thing. Fox News armed with right-wing provocateurs distorted the law designed to help millions of Americans obtain affordable health care. As a result Congress voted 50 times to repeal the Affordable Care Act.

The law was created to reduce the number of uninsured Americans. Locally, approximately 8.5% of Onondaga County residents are uninsured, 54% of those are employed. During this debate I didn’t really feel as though it applied to me. Things were going well; I can afford the premiums besides I had the fear of ending up like my elderly neighbor who died the county sold her home recouping their Medicaid costs. Having insurance protects your assets, while encouraging wellness, prevention and chronic disease management. The Affordable Care Act was to be the instrument by which we as a nation could improve our healthcare delivery system.

I wanted paid private sector insurance because I was shocked that most of the $67,000 bill from my last hospitalization was covered, anything health care coverage moving forward was not to be. I made my health care choices going to the so-called better suburban practices.  Found out the hard way when I was hospitalized my Board Certified Diplomat Doctor didn’t do Crouse.  Therefor the attending doctor was from the Syracuse Community Health Center. A Syracuse Community Health Center doctor saved my life. If I’d known do you think I would have paid thousands of dollars for so-call high quality care from a former Doctor of the year? At the post-hospitalization checkup he was reading my medical file for the first time as he walked through the door.

It doesn’t matter what zip code your medical attention emanates from or how many “Doctor of the Year” clippings adorn the waiting room. For each of the 5 years I was with this practice I would receive blood work at regular intervals it seemed like every time the calendar said Excellus/BlueCross-BlueShield will pick up the expense it was time for a procedure. For years, I complained about my deteriorating ability to complete a physical workout, his response was, “work through the pain”.

The attitude extended to my annual checkup during the days of Excellus/BlueCross- BlueShield my doctor would insist I receive an annual stress test that included a run on his convenient office administered stress test on their treadmill. “Uh, doctor do you know that running on an incline causes me extreme pain.” Again, the response, “do as much as you can”. At the gym on the treadmill I was somehow restricted to 2 miles then again that feeling of intense leg cramps.  I told the doctor it had become increasingly harder to do basic things like walking the dog. His response was “move, you have to keep running the pain should go away”.  I tried his suggestion and found some temporary relief by using the elliptical.

For at least 7 years I’ve cut down on basic movement running recreationally and eventually affected seemingly routine actions like walking the dog.  There was no immediate injury; no cringe worthy event that would lead me to believe there was a medical problem.  It wasn’t until I was walking across Chevy Court at the NYS Fair and suddenly my legs didn’t want to move the pain was coming from my calve muscles and after waiting several minutes I could continue my walk. The pain went away as if nothing happened.

While I was still insured I changed Doctors. I went to a facility that had a good reputation for having excellent physicians. There was no 45 minute to an hour waiting period, if you weren’t on time you may not be seen. This operation was run tight.

As of 4 years ago I become one of the self-employed uninsured. After paying the COBRA subsidized Excellus /BlueCross-BlueShield premiums, and then paying full shot for insurance through a group plan for small business I had to give up health insurance.

That is when I was forced to look at the details of the Affordable Care Act, ObamaCare or whatever the pundits called it that week.

After having Excellus/BlueCross-BlueShield while being employed, I continued to pay for health insurance maintaining coverage with COBRA subsidy during unemployment. Then I became self-employed which meant I had to carry the entire cost for health insurance coverage. What does it cover? Can I keep my doctor or did it matter, since my former health care provider didn’t even show up at the hospital.

I found that all health insurance plans in the marketplace must cover essential benefits, including hospitalization, medical care, mental health services, prescription drugs and rehabilitation services.

The New York State health plan marketplace allows individuals, families, sole proprietors and Small businesses to access tax credits and other tax benefits to help make health insurance affordable.

The health care law gives people with low incomes options for getting health coverage. New York State chose to expand Medicaid to more people. It also makes financial help available to people with limited incomes who buy health insurance through the Health Insurance Marketplace.

I applied online in January 2014 I didn’t know what it would take but I was desperate, I was looking for health insurance. Of course there were the glitches in the system but there was enough information online in the New York State Marketplace informative leading step by step. I spent hours on the phone until I was able to secure confirmation that I was eligible for coverage through this portal.

I also found once approved that my doctor would accept this particular insurance company since I was already registered in their practice.

But I had a more pressing problem; I could no longer walk extended periods without stopping for a moment and feeling the pain which began morphing into different parts of my lower extremities. I was in trouble. So I used my newly delivered health insurance card and made an appointment with my primary care physician.

I was seen and then sent to an orthopedic specialist, within 5 minutes in his office he looked at my feet and said, “You’ll keep your toes, but your blood isn’t circulating in your legs properly.” Within minutes he was contacting a vascular specialist, “Ken, your blood isn’t making it to parts of your legs so when you need the blood it’s not getting there, that’s why you’re having the pain.”  I was sent to a vascular specialist. Uh, what now?

Once at the vascular specialist office he ran a series of tests and within days he had a definitive answer to a situation that was progressively getting worse. “You have severe blockage in your Femoral Arteries, affecting both legs that’s why you are having these problems.”

So the adventure begins, we tried Angioplasty no chance, too blocked for that procedure. My next option was surgery.

It was determined that a Femoral Bypass was needed to correct my circulation issues. The best way to explain it is like our recent debate regarding the future of interstate 81. My Femoral Artery is route 81 and it’s congested now they’re going to build a 481 to bypass the obstruction.

On July 26th I went in for the Femoral Bypass procedure grateful that doctors were able to find the cause of this chronic condition rather quickly. Could my original doctor to whom I complained about this condition 7 years ago have prevented this operation, painful recuperation and a lifetime of monitoring?

That’s why I called this my ObamaCare Story because I saw from a patient’s point of view a change in the system. I was asked more questions at visits. I was no longer sent to the same arthritis specialist year after year as before. The minute a doctor suspected something serious he was clear, minced no words and sent me on to the proper physicians. Being borderline diabetic (a disease that runs in the family) they wanted me to know how to avoid complications if I don’t take care of myself.

The new healthcare law is based on preventing us from flooding the emergency rooms, since that’s the first place you would go in case of emergencies. The Affordable Care Act is preventing manageable conditions from becoming expensive hospital stays, preventing children from developing chronic conditions that can be managed by medical professionals; keeping more people in wellness than in health care facilities.

I have to ask those who are against this law, the Affordable Care Act or as I fondly call it, ObamaCare. Do you want to go back to business as usual?  Right-wing provocateurs, conservatives and tea party rhetoric guzzlers speak of “vouchers” which is simply a coupon that doesn’t cover the full expense. That’s no solution.  Until the Affordable Care Act AKA ObamaCare there was no safeguards preventing the medical profession from “gamming the system”. If my doctor 7 years ago looked into my complaints instead of his wallet I wouldn’t have had to undergo what will eventually amount to two surgeries. Being at high-risk for heart attack or stroke I never knew, without ObamaCare and its emphasis on prevention I might not be alive writing this column.