On the night of July 27, I, like so many others, stayed up late awaiting the vote on the Senate’s “skinny repeal” bill, frantically refreshing Twitter every few seconds in hopes of a clue as to which way the vote was going to go. When tweets tallying the vote finally appeared in my feed — “MURKOWSKI VOTES NO ON SKINNY REPEAL.” “MCCAIN VOTES NO ON SKINNY REPEAL.” “COLLINS VOTES NO ON SKINNY REPEAL.” — I wept, as much from exhaustion as from relief. It was the culmination of half a year’s worth of anxiety wreaked by Congress’s attempt to repeal the Affordable Care Act — an attempt that, for me, had been very personal.
Because most of the recent repeal attempts included severe cuts to Medicaid, much has been written about how the safety-net health insurance plan is more than just “an entitlement program for the poor.” It is there for you if you or your children have disabilities. It is there for you when you can’t afford your own nursing home bills. What hasn’t been talked about as much is how Medicaid can also be there for you when you lose your job. Which is what happened to me when my son was four months old.
Two years ago I was laid off from my job at a well-known magazine, at whose parent company I had worked for over a decade. By then, I had worked my way up to a senior-level position. And I had been back from maternity leave for seven weeks. I can’t say I was entirely surprised when the editor-in-chief called me into his office and told me the news; several people had been laid off the previous week, and layoffs always went in waves at this company. Nor, despite some later moments of real panic — which manifested as what felt like an animal trying to claw its way out of my chest — was I particularly upset. I was a new mother, and a first-time mother, and, thanks to a decent severance package, I felt I had been gifted more time at home with my child, whom I had not yet been ready to leave when I went back to work twelve weeks after he was born. But I am also what’s known as a Single Mother by Choice: I chose to become a mother on my own, without a partner, and as such I am solely responsible for my son’s well-being. And so I was equally thankful that my package included health insurance.
My intention, of course, was to find a job before my severance ended. Yet when that time came, despite some interviews, and many, many more networking coffees, I had still not found full-time work, or its accompanying employer-sponsored insurance. I have had friends who, after losing their jobs, have considered letting their health insurance lapse. But I had a young child at home. Not only did I have to keep him healthy, but I myself had to stay in good health so that I could care for him. My son was only a year old then, an age at which the American Academy of Pediatrics still recommends well visits every three months. He is a very healthy child; the worst we have had of it was a two-week bout of conjunctivitis (which occasioned three visits to the doctor). But even he has been hospitalized, a prescribed precaution when children under two months spike a fever, as he did at five weeks. Forgoing insurance was not an option.
My plan was to put myself on COBRA while getting my son coverage through Child Health Plus, a low-cost, state-sponsored plan that I knew of from friends. CHP provides insurance for children under the age of nineteen who don’t qualify for Medicaid but whose parents make less than 400 percent of the federal poverty level (parents who make more can also use the plan, but have to pay full price), and it pre-dates the ACA; created in 1990, it actually served as the blueprint for the federal Children’s Health Insurance Program (CHIP) that was enacted in 1997, during the Clinton administration. (Thanks to both Child Health Plus and Medicaid, over 96 percent of children in New York are currently insured.) After getting utterly lost trying to sign my son up for CHP through New York’s marketplace, and fearing I would miss the deadline to get him covered, I contacted an insurance navigator. She told me that I could also get low-cost insurance for myself, through the state’s new Essential Plan.
The Essential Plan, like CHP, is a state-sponsored plan, implemented through private insurers, that offers low-cost insurance to adults who make too much to qualify for Medicaid but who still live at less than 200 percent of the federal poverty level. Rolled out in 2015, the program, which was made possible through the ACA, covers all ten ACA-required “essential health benefits” such as primary care, urgent care, emergency care, and reproductive healthcare. Depending on enrollees’ income levels, monthly premiums are either $20 or free, with no deductible.
I qualified for the $20-a-month plan, and ended up purchasing vision and dental care for an additional $26.56 a month. I received this insurance through the United Healthcare Community Plan, the insurer’s Medicaid managed care plan. And I was able to get my son coverage through Child Health Plus — via the same insurance plan — which, for a $9 monthly premium, provided him with comprehensive healthcare for free. (He was also able to keep seeing the pediatrician he’d seen since birth.) Had we both gone on COBRA, I would have been paying $1,500 a month.
As the weeks turned into months and I was still unable to find full-time work, this difference in cost proved crucial. Thanks to my low monthly premium payments, I was able to stretch the money I had saved from my severance — putting it toward vital items like food, mortgage payments, and diapers — for six months. Had I added insurance premiums to that list, my cushion would have been gone in two. And that’s not to mention the $3,500 deductible included in that COBRA plan. Before my son went on CHP, I paid upwards of $100 every time I took him to the doctor — for a funny-looking rash, or a fever that had lasted more than three days, or out of fear that he had hand, foot, and mouth disease because he kept complaining something was in his mouth (all examples of actual doctor’s visits we’ve had). After CHP, those visits cost nothing. And my own trips to the doctor, of which there have been many as well, have been covered by a $15 to $25 copay.
As grateful as I have been for the Essential Plan, it was humbling, to say the least, to go on it. Although I like to refer to it euphemistically as “low-income insurance,” it is in essence just a different tier of Medicaid. Growing up the daughter of a pediatrician whose practice proudly saw Medicaid patients when others wouldn’t, I have always been aware of the program, but I certainly never thought I would one day find myself benefiting from it. And I have always been aware that not all doctors will accept Medicaid, as my father did — and that remains the case today, as does the stigma surrounding the program, even in the medical community. When I called the office of a gynecologist I had seen a few years before who was listed on my plan’s website as an in-network doctor, the receptionist, responding to my query if the practice took my insurance, replied, “That’s Medicaid. No, we don’t take that.”
This attitude is in part what led to my going to Planned Parenthood for my women’s health needs. The healthcare provider not only took my insurance, but would have seen me even if I were uninsured. And, as I continued to go to its clinics — for well woman’s visits, birth control-related visits, general women’s health visits — I discovered Planned Parenthood provided superior healthcare, even when compared to previous doctors whom I had really liked and respected. On my first visit, for an issue I’d been suffering from for half a year that neither my PCP nor gynecologist had been able to resolve, both the provider and the nurse who did my intake exam were able to pinpoint the source of my troubles within the first few minutes of speaking with me. On another visit, the provider I saw, a midwife, was able to determine the source of symptoms that another doctor — the head of his hospital’s OB/GYN department, no less — had written off as essentially being in my head. (As an ultrasound later discovered, I had an ovarian cyst — something the Planned Parenthood provider had predicted based on the same complaints the OB chief had dismissed.)
I had known since election night that the Republicans in Congress would go after the ACA, and with it my insurance; after all, this is what they’d been promising to do for the past seven years. Their attempts to defund Planned Parenthood were also nothing new. What I hadn’t entirely understood was how Congress’s attempts at repeal would affect my son’s coverage. Child Health Plus began as a fully state-funded plan that offered only care for children up to twelve years old. It didn’t become the robust program it is today until it started receiving 65 percent matching federal funds under CHIP; additional funding, which brought the total amount of matching money to 88 percent, came courtesy of the ACA. The ACA repeal bills would bring with them a loss of that extra 23 percent, meaning New York State would either have to make up the difference in funds or make some tough decisions on how to scale back the program.
It’s this aspect of the repeal attempt that has always made me feel the most impotent, and the most enraged. If the representatives and senators drafting this legislation want to do nothing to help me as I struggle to support my son while looking for full-time work — if they perhaps even judge me for being a single parent in the first place — then fine. There is nothing I can do about that. But they are trying to take healthcare away from my child. And this I find heartless, and unconscionable.
I wish I could say that, with repeal dead for now, my story has a happy ending. After all, I am finally getting back on my feet, having found just enough freelance work (thanks in no small part to the Voice, whose online content, full disclosure, I copyedit) to make ends meet. But even if the repeal stays dead, even if President Trump doesn’t stop subsidy payments to insurers or undermine the ACA in a myriad of other ways, my financial situation is such that — knock wood — I will not qualify for the Essential Plan next year. Instead, I will be stuck with the same predicament as so many other struggling families, and the one that has made the ACA, until recently, so unpopular. For while I will still qualify for subsidies for my monthly premiums — which, because of the uncertainty surrounding the ACA’s future, are predicted to spike — my deductibles may be double what I paid when I had insurance through my previous employer, when I was making twice what I’m making now. I’m encouraged by recent talk of bipartisan healthcare reform, as there is still much work to be done to make the ACA truly viable for the middle class.
And then there is Child Health Plus. In that surreal moment when the ACA repeal died, I thought CHP, for which we will still qualify next year, would be safe. But I have since discovered that it too may be in jeopardy: It seems that while the repeal effort was stalling in the Senate, so was other legislation, including the renewal of federal funding for all CHIP programs, which runs out in September. There is still time to renew this funding, but there is also the very real possibility that CHIP renewal will get held up by all the hot-button legislative issues currently swamping Congress — tax reform, the federal budget, even the new bipartisan healthcare effort itself — or get lost entirely. And even if the funding is renewed, it still might be altered in drastic ways: Some members of Congress have proposed reducing the eligibility cutoff from 400 to 250 percent of the federal poverty level, which would exclude thousands of children in New York from receiving those federal funds — including mine.
There is strong support for Child Health Plus in the New York legislature, so the state will likely try to make up any federal funds it loses. But even then, it would translate to cuts for other programs. Democratic assembly member Richard Gottfried, the chair of that body’s health committee and the sponsor of the original Child Health Plus legislation, and his Republican counterpart in the senate, Kemp Hannon, are drafting a joint letter to the New York congressional delegation urging them to support a straight extender of CHIP and to keep it intact. But for now, the future of my son’s insurance is in the hands of an increasingly dysfunctional Washington. And so, as much of the country continues to celebrate our nation’s close call, my anxiety only continues.