Finding safer ground through the Affordable Care Act

A freelance journalist on the uninsured life and the relief of health security in the New Year

January 9, 2014 4:15AM ET
Freelancers can now more easily view different options for health insurance using HealthCare.gov.
Reed Saxon/AP

On a warm afternoon in July three years ago, I played in the water at the beach on Belle Isle in Detroit. It was a spontaneous stop after a day of dancing, eating and the energetic company of my friend and his two great kids. Perhaps the buoyantly unfurling day was to blame for my inflated sense of my acrobatic abilities, as I found myself doing a backflip into the water. It was only four feet deep. My head hit earth. My legs crumpled. My scalp cracked and bled. I needed help tottering to shore. If not for persistent efforts to keep me talking, I would have promptly passed out on a beach towel.

For the next 40 minutes, my friend asked me questions. What is the name of this flower? Who is the president? Words came slowly. I kept sliding into the dangerous black sleep that slunk at the edges of my mind. A police officer asked if he could call an ambulance. When I said no, he urged us to go to a hospital ourselves. This was my head that we were talking about. “The brain, it’s the main computer,” he said, several times. “You don’t want to take any chances.”

He was right. But did I go to a doctor? No. I did not.

Instead, I went home. While I laid on my futon, my friend trawled the Internet for articles on how to treat head injuries. He didn’t let me sleep for more than 20 or so minutes at a time.

The next morning, I got up, brushed my hair and got on with the day.

There was no willful pride in this. No stubborn sense of immunity. I didn’t go to a doctor because I didn’t have health insurance. Medical costs frightened me more than my bleeding, concussed head did.

Here in Detroit, I have been a full-time, freelance journalist for nearly four years. I love what I do — as I must, given that this vocation comes with zero insurance, sick days, employee protections, benefits or regular paychecks. At a glance, working without insurance may seem like a reasonable risk: I am single, am in my early 30s and have no dependents. I am in good health. I could pay out of pocket for periodic checkups with the dentist, gynecologist and eye doctor.

But I was unsafe. Though I pretended otherwise, the massive risk I was taking would occasionally come into plain sight. The day at the beach reminded me. So did a car accident a year ago that set off an airbag, cost me $2,000 in automotive damage and left me achy and rattled for several days. (I again did not see a doctor to confirm that I was fine.) Friends’ stories about unexpected diagnoses, pregnancies, broken limbs — these, too, frightened me. But what was I to do?

I took the best care of myself that I could. For nearly four years, I just worked and lived.

It was with a reporter’s eye that I followed the politics of the Affordable Care Act (ACA) and the government’s health care exchange website, HealthCare.gov. Of course, I had a stake in the law’s success. But I couldn’t let myself think of it. Surely something would go wrong — the HealthCare.gov website broken, the ACA outlawed, Michigan’s refusal to set up its own exchange making it difficult to get accurate insurance information, my unpredictable income making enrollment impossible. I couldn’t quite believe this would work for me. I waited. Two days before the enrollment deadline, I finally logged onto HealthCare.gov for the first time. Item by item, I typed in my information.

An hour later — with no delays or glitches — I had health insurance. With some modest budget adjustments, I can afford it too: It is about $232 a month for the Humana Connect Platinum 1000/1500 Plan. An HMO with a $1,000 deductible, it costs $25 for primary-care visits and $35 for specialists. My medical out-of-pocket maximum (including drugs) is $1,500.

This stunned me. For many long moments that snowy morning, I sat still. My coffee cooled beside me, and my skin bristled. With a shock, I felt, for the first time, how unsafe I had been over the years. Before, there was no use noticing this fear. But with the email confirming my enrollment blinking before me, I suddenly had permission to recognize the fear and relief that welled up in me, and it took my breath away.

The pre-ACA market was not set up for me to buy individual insurance, even though self-employed workers like me are a massively growing sector of our economy.

There is no way to discuss health care without also discussing politics. Reporters have told me that it is just about impossible to write a plain-Jane, just-the-facts article on the ACA without folks from one or the other side of the issue — or both — decrying it as biased. When I tried to talk about signing up for insurance with people who oppose the ACA, I got a fair number of eye rolls. They probably thought that I, as an ACA supporter, was gearing up for a fight rather than simply telling them how I felt. So I held my feelings back.

But what is the point of the politics if not people? Forget the horse race for a second. The fact is, in the past when I tried to purchase individual insurance, the market was not set up for it, even though workers like me are a massively growing sector of our changing economy. Nearly 1 in 3 American adults is independently employed. That is almost 42 million people. And yet I was searching hostile terrain for basic information: who to call, at what phone number. I tried to go through an independent professional who could help navigate the morass and realized, once I researched the options he showed me, that all the plans came from the same company. When I asked for other choices to consider, he declined — making it obvious that he was working on commission and skewing the information he gave me.

The Freelancers Union, with more than 231,000 members, was founded to provide benefits for the self-employed. While many freelance writers, designers, lawyers, nannies and other workers are supported by their spouses’ benefits, plenty of others are unable to find or afford coverage. The Freelancers Union does good work in support of the self-employed, but its insurance is largely limited to residents of New York state, where, not coincidentally, more than half its members live. (With the rise of the ACA, the union is making some changes to offer its low rates to a wider swath of the state’s population as well as to freelancers in Oregon and New Jersey.)

Even if had I been willing to accept the uncompetitive pricing (and inaccessible customer service), buying individual insurance did not work for me in a pre-ACA world. Now through HealthCare.gov, I just answered a series of simple questions about myself and was presented with more than two dozen plans for which I’m eligible. The site uses a gridlike format, so you can easily compare plans for price, deductible and some key coverage — sort of like buying an airline ticket. You can opt to add dental benefits or not. While it was reported that many enrollees needed to take an extra step to ensure their primary-care doctor was in their prospective plan’s network, I didn’t need to because I didn’t have a doctor. I simply chose the plan that seemed like the best fit in terms of benefits and price. When coverage kicked in on Jan. 1, my insurance card was already tucked proudly inside my wallet. More than 6 million others and counting can say the same.

No doubt, as I try out my insurance, I will have complaints. Maybe I will even be dissatisfied enough to change my plan. But I am in a better position than I was just a week ago. I have sturdier ground to sustain my life as a writer. Getting sick or hurt will not financially destroy me. If I get a concussion, I will go to a doctor.

We won’t be through with the politics of “Obamacare” for a long time. That’s fine: This is one of most significant policy developments of our generation, after all, and scrutiny is welcome. But let’s not let politics distort what is at stake here. We are trying to save our lives.

Anna Clark’s writing has appeared in The New Republic, Politico, Next City and other publicatifons.

The views expressed in this article are the author's own and do not necessarily reflect Al Jazeera America's editorial policy.

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