Sara Goodrich: Balancing Self Employment and Soaring Health Care Costs

Sara Goodrich and her husband are both 44 and live in Maine. She works as a massage therapist, and he works as a carpenter. Because they are self-employed, they have relied on the Affordable Care Act for their health coverage for the last decade. She recalled, “We have used Obamacare since its inception really and I can remember it being less good before the Enhanced Premium Tax Credits.”

Because they are young and healthy, they often chose the cheapest plans, usually bronze or silver. But Sara explained that these plans still came with high costs. “Our out of pocket max is like $9,000 per person and for the family it’s $18,000 and that number honestly does not change very much whether you have silver, gold, or bronze. So we’re facing an $18,000 hit if something major goes wrong.”

While glad to be covered, Sara still struggles with the steep deductibles that come with that coverage.

She gave a recent example of this frustration, sharing, “I got my first mammogram in August. It’s covered because it’s preventative care. They determined that I have dense breast tissue. So, they want me to come back. It’s going to be $600 out of my pocket.” She added, that cost does not even cover the radiologist looking at the images.

While the coverage itself may be limited, the Tax Credits made a major difference for the couple to afford their premiums. “Before the enhanced Tax Credit, it was between $250 a month to $400 a month. After the Premium Tax Credit, we were sometimes able to get a bronze plan for just $50 and then a silver plan for like $100 or $200. This makes a big difference, remember if anything goes wrong we’re in it for $100s of dollars: a few years ago 3 stitches at urgent care for my daughter was $600 out of pocket. Low premiums help us save so we can afford the high cost of routine care for getting sick or a minor accident. I worry if the price of monthly premiums go up some people will drop coverage and just take their chances because they wont see the value of being insured in a year when they are relatively healthy. I personally would rather pay more and have no financial risk if someone in the family gets sick or injured, but that is not the system we have. Right now we pay a little and have a lot of financial risk, if the enhanced Premium tax credits are not extended; we’ll be paying MORE for a lot of financial risk. It’s a step backward.”

When asked what they would do if Congress lets the enhanced Premium Tax Credits expire at the end of this year, Sara shared, “We would just find a way to make it work. We would divert resources from something else.”

Raising two young children has already strained their financial security. “Since having a second child, in particular, and maybe since having our first child, we have felt less economically secure. There was definitely a period before where it felt like we were moving forward and “getting ahead,” now it feels very difficult to make the income that we need to feel secure.”

Her children now qualify for Maine’s Cub Care program, which has been a relief. “Our youngest needed tubes in his ears this spring. That probably would have been thousands of dollars out of pocket, just knowing our system, and we would have had to pay it. I know I would have also really questioned if it was worth it and felt stress and guilt about wether to do it. So it has been a blessing. My son’s speech development really exploded after the tubes were in and he could hear properly”

Sara wants lawmakers to understand what families are really facing to stay covered. She emphasized how drastic the differences are in the health plans available to members of Congress in comparison with the average American.

She concluded by sharing her frustration about the broader system and how it impacts our society at large, “If you’re constantly fearing that you can’t retire, that you would be bankrupted by your health insurance if somebody gets sick, that you can’t afford a house… These are legitimate worries. And unless you cover housing, health insurance and retirement and get those working for people, you are not going to have a healthy populace and you’re not going to have a stable society…It’s gonna devolve into more violence and disorder and more polarization. And unless law makers solve this, I do fear for the longevity of our country.”