Between 2002 (when we got married) and 2010, my husband used to cost the insurance company $60K - $80K a year. Both the very good Aetna and the Anthem BCBS insurance plans my employer had provided over those years had a lifetime "cap" for individuals under lower cost group plans at $1,500,000 - and then they would have to either go into a special "High Risk" Pool or hopefully get on a Medicare/Medicaid plan.
We only had another year or two coverage for him on my employer's insurance.
I'd already been to six funerals where co-workers I knew who had family members with heart or other severe conditions buried those "high risk" family members much too soon if they couldn't get them onto a government plan since the Reagan years. I've had 10, maybe 12 co-workers - some pretty well off, with decent savings - who retired between 55 and 65 due to health who died of health related issues within two years of retirement because they didn't already have a government provided health - the VA or Tricare - to fall back on before they would have qualified for Medicare.
While the ACA was torturously making it's way through Congress, I was in the process of researching and estimating how much we'd have to pay Medicare if we remained married or if we got divorced but he still lived with me and his daughter, as opposed to how we could manage both his ability to keep receiving his SSDI and a minimum standard of living in some form of home - because he can't work or live on his own for any length of time - if we got divorced and he moved out into a studio or something.
I made way too much for him to get Medicare or support from MediCal, and way too little to afford the high-risk/high cost insurance pools that were available for someone in his condition.
In 2010, individual "insurance" for him would have been over $28K a year out of pocket just for the f'n premium with a $20K deductible with high co-pays, lab work and therapist coverage that were exempted from of the deductable - we would still have to pay out of pocket for those visits. With monthly lab work (~$200 a month according to the cheapest rate locally/$2400 annual), 2 monthly doctor's visits ($75 apiece - $150 a month/$1800 annual), 3 other doctors visits on a quarterly basis ($900 annual), 2 doctors visits on an annual basis (another $150 annual), Dental ($250 - $1500), Optical ($250 - $800), and two different therapists on a monthly basis- one mental, one physical (2x month) ($1600 and $5400) respectively, just his health care on the "Insurance Marketplace" would cost us. Not to mention one of his necessary just to be able to function enough to drive occasionally medications cost around $8K a year - if he went across the border and got it in Mexico for 1/6 of the price they charged in the U.S.
Estimated total cost out of pocket with that health insurance if it were a not a perfect year for my spouse with severe arthritis, diabetes, Fibromyalgia, degenerative spinal damage, Sleep Apnea, GERD, and Bi-Polar on the market just to cover him would be...$51,550 a year.
Because as a household, we had too much income for him to qualify for the VA, Medicare or MediCal, his health care alone in one year would have cost more than I was making as a full-time engineering specialist at the time.
That's what we as a family was facing in 2010. That's what going back to "Before ACA" means to our family.
My husband probably wouldn't have died (yet - he's now only 55 years old) without the ACA, but the financial strain on our family just to keep him relatively functional and able to get out of bed would have certainly bankrupted us, reduced his life expectancy at least another 10 - 15 years and maybe torn us apart.
Without the ACA protections for pre-existing conditions I'm not even really sure he would have made it another two years, when I qualify to switch from Employee-provided insurance to Tricare, and he would have been able to go back onto an affordable, government provided health insurance system.
So, Employer provided insurance won't really protect anyone who has a major health issue. It never really did in the past; it only delayed the inevitable.
Haele
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