Steve Ramirez: Navigating Skyrocketing Costs of Coverage

Steve Ramirez describes himself as a nomad. Born in Nebraska, he spent his life moving from state to state for work, living in Texas, Colorado, Florida, Georgia, Illinois, and even Beijing before finally settling with his family in South Carolina. Trained as a mechanical engineer and later working as a product manager, Steve built a career around analyzing complex systems and solving problems. “That’s what engineers do,” he said. “They fix problems.”

Steve’s first experience with the Affordable Care Act (ACA) Marketplace came during a period between engineering jobs. After being laid off, he needed health coverage and quickly learned that COBRA was prohibitively expensive. Turning to the Marketplace, he found coverage that was workable, even if imperfect. “Despite the lack of a public option, it was still moderately reasonable,” he said. “That’s when I really started paying attention to health care and the problems baked into the system.”

Before that point, Steve had employer-sponsored insurance through large, well-established companies. Over time, he watched premiums and cost-sharing steadily increase while coverage narrowed. “Every year, the costs were escalated, and the coverage turned out to be less,” he said. “You start learning how companies decide what they’re willing to cover and what they aren’t.”

When Steve and his wife relied on the Marketplace more fully, he approached the decision like an engineer. He built detailed spreadsheets comparing bronze, silver, and gold plans and modeled different health care scenarios, from routine preventive visits to major medical events. Even with careful planning, Steve says navigating insurance remains exhausting. Though he and his wife are generally healthy and mostly seek preventive care, they still face obstacles.

“You have to specify at every step that you’re there for preventative care only,” he said. “Setting up the appointment, checking in, prep work with the nurse, talking with the Doctor, making sure any lab work is sent to an in-network lab, making sure that all work is coded correctly for preventative, making sure you are not a day short of the period for coverage. We have been tripped up and billed for each of these along the way.”

For several years, enhanced premium tax credits made their coverage affordable. But as those credits face expiration, Steve saw the cost of their plan skyrocket. When he logged into the Marketplace to review his options, the numbers stunned him. Keeping comparable coverage would mean a 642% increase in cost.

“That’s the first time I seriously looked at [going with no insurance at all and accept the risk, and I investigated] private coverage outside the ACA,” he said, “and the fine print on preexisting conditions was shocking.” He described how insurers could use vague language to deny coverage for nearly any past symptom.

Ultimately, Steve and his wife adjusted their plan to manage the increase. Even so, their annual costs jumped by roughly $10,000. “We live very frugally,” Steve said. “We can make it work. But most people can’t.”

Steve sees the problem as far bigger than individual plans or policies. In his view, legalized corruption and profit-driven incentives distort the entire health care system. “There is so much money to be made,” he said. “For-profit health care businesses are allowed to write the rules and line their pockets.”

That realization pushed Steve into advocacy. After spending most of his life avoiding politics altogether, he became deeply engaged following 2016, eventually serving as first vice chair of the Greenville County Democratic Party. “I didn’t want to do this,” he said. “But when you look at health care, guns, racial justice, all of it, the overlap is policy. And if you want to fix the problems, that’s where you have to go.”

As an engineer, Steve believes solutions are possible. Larger risk pools, simpler systems, and a focus on people over profit could dramatically lower costs and expand access. “ACA was a huge step forward,” he said. “But until we address the profit motive embedded at every level, we’re going to keep asking working people to carry an impossible burden.”