As a nearly 25-year-old, healthy, non-smoking male living in San Francisco, I’ve spent the last six months preparing to be screwed by the Affordable Care Act. Everywhere I’ve turned there’s been talk of "rate shock," and a "War on Bros," with even the most reassuring pieces telling me that my premiums would likely go up. And all of that came before website glitches hobbled exchanges nationwide, even here in California. It was enough to convince me to consider just paying the $95 penalty and going uninsured yet again. Then I actually logged on.
I was uninsured for about 10 months. Both of my parents lost their jobs—and their insurance—during the Great Recession, with the coverage I received through my father expiring at the end of 2012. Working as an unpaid intern at The New Republic, and living off of unemployment insurance and the money I made by selling my car, I wasn’t in the financial situation to consider insurance for the first six months of the year. Finally, I got a well-paying contract job at a Bay Area tech firm in August, but the staffing agency that employed me offered such an awful plan that I was better off buying insurance on the individual market. I decided to risk going uninsured a little longer.
At midnight on October 1, 2013, I tried to log on to California’s health care exchange website, CoveredCA.com. The site wouldn't load. Three days later, I tried to sign up again. This time, the site was down for maintenance, and wouldn’t be back up until the following Monday. I promised myself I’d return and sign up for coverage then, but simply forgot. When I checked the following weekend, the site was again down for maintenance. I was finally able to get past the homepage on October 18, but after creating a login, I hit a wall. Every time I entered my information, I got caught in an infinite loop. The message on my screen read: "Logging in. Please wait... (If you are not logged in within ten seconds, please click here to proceed.)" Every ten seconds I would click the link, and every ten seconds I’d find myself back at the login page. It was an infuriating experience and, after an hour, I decided to give up. Rather than risk going uninsured any longer, I decided to sign up for a Kaiser Permanente plan that wasn’t compliant with ACA requirements. The plan, an HMO, would cover me through the end of the year, with the option to buy a similar Kaiser plan on the California exchange in 2014, and would run me $286 per month.
I should disclose here that I want the Affordable Care Act to succeed. I was an intern in Senator Ted Kennedy’s office when he was helping to draft the framework for what became the ACA in 2009, and I worked on President Obama’s re-election campaign in 2012. I’m sure I’m more willing than most to tolerate website failures and to try, again and again, to sign up for insurance, but the process was testing my patience. Someone less wrapped up in the politics of the issue, just trying to sign up their family for a health-care plan through a bum website, would be rightfully outraged by the entire experience. It’s no wonder that a mere 34,364 people signed up in the first month in California.
On October 23, I was finally able to log on to the Covered California exchange. The experience was surprisingly painless. Once you've logged in, there are four steps to find out your eligibility, with each step giving you a time estimate for how long it will take, and what information you’ll need to fill out the forms. The estimate is 40 minutes to fill out all of the information, but it only took me a quarter of that. My biggest surprise was the “Personal Data” section, which required virtually nothing in the way of medical history.
When I'd signed up for the Kaiser plan to cover me for the remainder of 2013, I was faced with a form asking about 29 potential health issues, with a total of 178 highly specific questions, each seemingly designed to catch me in a lie. Questions like: Within the last 10 years have you suffered from “situational stress, anxiety, or depression”? What about “mild depression/anxiety”? Or "have you taken or used illegal drugs or prescription drugs not prescribed by a medical professional” within the last five years? I wonder how many 24-year-olds could honestly answer "no" to all of those questions? And yet, if I lied, Kaiser could simply terminate my coverage.
I expected similar questions on the Covered California exchange, but I was wrong. Since pre-existing conditions can no longer be considered, the most personal question the site asked was whether I was “blind and/or disabled.” After filling out a few more impersonal health-related questions, I was asked to enter some very basic information about my income—and after discovering I was ineligible for subsidies—I was ready to compare my potential plans.
To my surprise, despite all the scare tactics about rate shock and lack of choice, the health-care plans on offer were both affordable and plentiful. I had 23 plans to choose from, ranging from $183 per month for a catastrophic “bronze” plan—which, without subsidies, is almost double the cost of the cheapest 2013 Kaiser plan for someone of my age and health—to a $477 per month “platinum” plan. The exchange very prominently displayed how much each plan would cost per year, and what sort of product the plan was—HMO, EPO, or PPO. Underneath that, there were drop-down menus that showed each plan’s deductibles and what the coverage entailed, from doctors visits to drugs to children’s vision to ER visits. There was even a feature that allowed me to favorite different plans to compare them side-by-side on a different page, as if comparing cable-TV plans. The “silver” PPO plan I signed up for is more generous than my Kaiser HMO, and has a much larger doctor network. The deductibles are slightly cheaper, and the coverage is more comprehensive. It’s $297 per month—just $11 more than Kaiser's.
As of January 1, 2014, I—along with millions of other Americans—will have a comprehensive insurance plan that cannot be taken away at an insurer’s whim. That is a “big fucking deal.” But the disastrous roll out of the Affordable Care Act, with all the talk of dropped coverage, rate shock, and broken websites, has obscured that truth. If my experience is any indication, when Healthcare.gov is eventually fixed, people will be in for a pleasant surprise. Yes, without subsidies the plans are pricey—so is American health care—but they’re also guaranteed, comprehensive, and easy to sign up for, none of which could be said about health insurance until now. Once we get past the Sturm und Drang of the initial rollout, securing good health insurance in America will be simpler than ever. Be patient—it’s worth the wait.