Broken systems

Our healthcare system is very broken and unless more people start talking about it, I’m afraid it’s going to get to the point where no one can afford to be insured.

I love being self-employed, but at least once or twice a year I consider going to work for a large company just to get health insurance benefits because it’s so expensive to buy insurance on my own as a self-employed business owner. And I know I'm not the only one who has this thought.

I want to take a moment to share a little about my individual experience. I was fortunate enough to qualify for the Oregon health plan after getting divorced in 2018 and thanks to loosened requirements during Covid, I just recently had to start shopping for my own coverage.

I am healthy, in my mid 40s, and don’t go to the doctor very often so to keep costs down, I opted for a high deductible health plan. I also wanted the option to contribute to a health savings account, which is a tax deferred savings account that you can use to pay your qualified medical expenses.

I was under the impression that all high deductible health plans qualified for the health savings account, after all that’s kind of the purpose if you’re going to have an extremely high deductible, to be able to put money into an account on your own and at least pay for those healthcare expenses with pre tax dollars.

However, I learned that not all high deductible health plans even qualify to have a health savings account with it. Talk about making it even more confusing for all of us consumers.

Now being in the tax industry for the last 20 years, I would think that would have been something I was aware of, but it was news to me. 

In fact, some of the high deductible health plans that did not qualify for the health savings account, were less expensive, so I see why some people would choose them, not realizing that they don't qualify.

I’m paying more money for an already expensive out of pocket plan, just to be able to contribute my own funds to a separate health savings account so that I have money available when I need to pay for all my own health insurance cost.

Because you see, with this high deductible health plan, I will have to pay for everything out of pocket. There are no co-pays, no prescription drug coverage, no dental. The only thing it covers that I’m aware of is preventative healthcare so maybe one yearly check up with my doctor and my annual mammogram.

And do you want to know what this plan is costing me? (I'm going to tell you either way.) Just to cover myself, none of my kids, I’m paying almost $500 a month. That’s $500 a month for really what feels like nothing in my opinion. I’m still going to have to pay for every doctors visit, every prescription, every surgery until I reach my annual deductible of $7000

Now you would think that if I would possibly have to pay at least $7000 for my healthcare expenses during the year that I should be able to put at least $7000 in my health savings account, but that’s not the case either. I’m only allowed to save $3750 a year into my health savings account so if I were to reach my deductible, only half of my medical expenses would even be able to be paid with the HSA funds

It’s a broken system. I don’t know if you all are aware of this, but one of the reasons that we went to Mexico back in 2016 is because that’s when the health care mandate was going into effect and at the time my husband and I were both self-employed and it was going to cost our family almost $2000 a month to buy our own health insurance on the marketplace. By leaving the country, we avoided the penalty and were able to go without insurance for a couple of years. In Mexico the amount that we were paying for full price doctor visits was similar to the co-pays that you pay here when you have insurance. 

I remember having to go to the pediatrician for one of the kids and the cost for the entire visit was $25. And that was the cost for everyone, that wasn’t some sort of sliding scale or discounted rate for expats. That was market rates for medical visits down there. In talking to our neighbor at the time when we lived there, the only type of insurance that they carry was some sort of catastrophic coverage in case something really bad happened, but the cost of that was nowhere near what we pay here in the states for insurance.

I also have been extremely disappointed with the lack of communication that I’ve received from the Oregon health plan. While I’m so thankful to have been covered for the last six years, this last summer I did not fill out the renewal paperwork because I knew that I no longer qualified based on my income, so instead of sending me paperwork on when my policy would be ending and what steps I needed to take in order to find other coverage, they decided to just automatically extend my coverage for another eight months and not notify me of that change either, so I was left wondering if I had coverage and what my next steps needed to be in order to make sure that I did not have a lapse.

Thankfully, I have a friend that is an expert in health insurance and marketplace plans here in Oregon and he has been able to help help guide me, and ultimately get me into my high deductible plan that took effect on 1-1-25.

It just makes me wonder how many other people they are just automatically extending coverage for that don’t actually qualify, but it’s more of a hassle to cancel the coverage than it is to just keep accepting the free insurance. I obviously didn’t feel comfortable doing that knowing that I was over the income limit, but I wonder how many other people either don’t pay attention to that, aren’t honest enough to report it, or don’t want to risk having to pay for their own insurance.

It really is so hard to get out of the system. It’s great that we have programs like Medicaid, food stamps, and childcare assistance, but there’s a huge gap when it comes to climbing out of the hole and earning enough money to start paying for those things on your own.

The system that we currently operate in rewarded me for not working to my full potential. When I didn’t try to grow my business, and just worked a few months out of the year, I was able to get free health insurance for myself and my three kids and was also able to get free lunches at school, discounted academic fees, sports scholarships, and even food stamps for a little while during Covid. 

To add insult to injury, the almost $500 health plan that I am now paying for didn't even send me my insurance card until yesterday (1/27/25) and when I try to go online to pick a "medical home", their website isn't working. Two hours on the phone with four different customer service agents to determine that - so frustrating. So someone finally gives me three offices over the phone that will qualify but it's up to me to call and see if they are accepting new patients. Then, once I find an office that is, I have to call them back and have them list that office as my medical home before I can make an appointment. So much time wasted! Why can't the office just tell Providence if they have room for new patients and avoid making us call multiple offices. And once we find an office that is accepting new patients, why not just let us schedule? We already established that they are a covered provider, so why make us take this extra step of calling Providence back to tell them which office we are going with? 

I’m sure you can sense my frustration.

I wrote this last January and I’m just now getting back around to sharing it here on the blog. My recent video on my Facebook page where I talked about my frustrations with the healthcare system inspired me to come back and publish this. It’s October and I still haven’t been able to get in to see a doctor, although I do have an appointment at the end of the month.

Our healthcare system is broken and is not serving the best interest of the majority of the population.