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Thursday, June 16, 2016

Health Insurance Gives This Father Peace of Mind

Jenna Temkin

Story Bank Associate

Before the Affordable Care Act (ACA), Don would give himself a pep talk every time he stepped on a ladder. Don isn’t clumsy or afraid of heights—his primary worry was getting injured and racking up medical bills while he was uninsured. As an owner of an exterior construction company, Don gets on ladders and performs other potentially hazardous activities at work almost every day. Without health insurance, Don doesn’t know how he would support his family of four if he got injured or sick.

This Father’s Day, thanks to the ACA, Don doesn’t have to worry anymore about getting injured at work or paying off medical bills. Instead, he can focus his attention on his business, his two sons, and their favorite family activity—Cub Scouts.

Before the ACA, health insurance wasn't a guarantee

In the years before the ACA, Don and his wife, Karen, struggled to pay the exorbitant premiums for their private market insurance. Don and Karen jumped from plan to plan to keep their premium down, but the monthly payment was still too expensive. During the winter months, when Don’s business slowed down and the premium became unaffordable, Don and Karen took themselves off their health insurance policy. When Don’s business started to bring in more money, he and Karen would re-enroll. They always paid the premium for their two sons to remain covered.

In 2013, Don’s coverage for his family of four cost $1,100 per month—almost as much as their rent. Don was floored when he saw that their premium would have gone up to $1,300 in 2014. But, thankfully, there was another option.

Once the ACA marketplace opened at the end of 2013, Karen explored their options and enrolled herself and Don in a policy for $172 per month, thanks to a tax credit. Their sons, who are now 9 and 11 years old, qualified for the Children’s Health Insurance Program (CHIP), so they didn’t have to pay a premium.

Affordable health insurance provides relief in an emergency

Don’s family loved their new coverage. They received routine preventive care from their long-time doctors and immediately started benefitting from their premium savings. In 2015, they re-enrolled in the same plan.

Don’s business had been slow that winter. In the years before the ACA, that meant Don would have taken himself off his health insurance plan to save some money. Luckily, that was not the case when Don experienced severe acid reflux one Friday morning in February.

By Monday, the pain became so severe that Don went to his primary care physician. Don’s doctor immediately sent him to the hospital, where he had an emergency gall bladder removal surgery. Doctors said that Don’s gallbladder may have burst if he had waited much longer to get medical attention.

Without health insurance, Don’s emergency surgery would have cost $70,000. “I can’t imagine how we would have paid for that,” he said.

Fortunately, Don only had a $300 co-pay for the procedure. Don was also grateful that he was able to bounce back from the surgery and go back to work relatively quickly. “This would not have been possible without Obamacare,” Don said. “The speed at which I was able to get back to work was huge.”

The coverage has also come in handy this year. Don was recently able to get a colonoscopy, and he’s thinking about scheduling some other important procedures he’s been putting off, like a foot surgery. Don can also rest easy knowing that his sons get free allergy and asthma medication through CHIP.

Premium savings mean more fun for Don's family

Don’s family is not only pleased with the level of coverage they receive, but they’re also ecstatic about the cost. In the first year, they immediately put their $900 in premium savings to good use. Don and his wife were able to get dental coverage for the first time in years, and Don got a much-needed teeth cleaning. Karen was also able to go back to school to study dental hygiene.

Their savings have also meant more opportunities for their kids. Don’s sons started taking piano and guitar lessons, and his son also got orthodontia. The family even had enough money saved to send their son to a science camp at University of California-Berkeley. Don may also use their savings for Cub Scouts events, like the Boy Scout Jamboree—a large gathering of scouts from across the country.

Mainly, Don is grateful that he can be healthy for his family and participate in activities with his children. Don loves leading his sons’ Cub Scout troop of 112 boys and was recently named Leader of the Year in his county. He also trains other Cub Scout leaders and oversees archery and BB gun shooting at the local range.

“It’s been such a relief to have this coverage. I can’t fathom what we would have done as a family without this,” Don said.