My Obamacare Plan is Failing Me

Member Group : Commonwealth Foundation

Tuesday is the last day to sign up for health insurance on the Obamacare exchange. Luckily, I’ve already purchased an exchange plan. But barely one month into my new health care coverage, I’ve started running into serious roadblocks.
I battle fibromyalgia, a chronic pain condition that forces me to work from home many days. My need to see specialists and try expensive prescriptions makes affordable health insurance crucial to softening the financial sting. This longtime uninsured, sickly gal ought to be happy.

Plaster my picture on now, right?

But this victim—who knows intimately the pressures of no health coverage—can’t get over how damaging the Affordable Care Act is across the nation. Must we really destroy jobs, inflate others’ health costs, and enact countless new taxes and fees just to help people like me?

Worse yet, Obamacare isn’t even keeping its promise to provide quality health insurance to people with pre-existing conditions. On top of higher premiums or deductibles, critical drugs may not be covered at all, and the costs patients incur by buying them with cash won’t count against out-of-pocket caps or deductibles.

As Pennsylvania moves to shift 6,960 people from its high-risk pool to Obamacare, more people will discover how limited their new coverage really is.
Information about covered drugs on Obamacare exchange plans is hard to find and in some cases doesn’t appear to be available at all. Restrictions on covered drugs are nothing new, but the limits are more widespread in exchange plans to keep premiums low.

Only one brand-name drug that works on the nervous system has helped me keep the pain at bay over the years. Getting it on my Obamacare plan has proven a challenge.

Without insurance or discounts, the drug costs $400 per month. But I couldn’t simply refill my regular prescription—my new insurance company required pre-authorization for the drug. Just last week, my exchange plan insurer told me they will not cover the drug. For now, I’m surviving by driving 50 miles to pick up free samples from my doctor’s office. This isn’t the affordable, quality care I was promised.

Many Americans sicker than me are doing much worse. Take Lupus patient Emilie Lamb. Her state-subsidized plan was cancelled because it didn’t provide enough coverage—a "junk" plan according to President Obama. Lamb’s premium jumped from $52 to $373 a month, forcing her to get a second job so she can still see her doctors and buy medicine.

Fifteen-year-old Michigan twins Austin and Micheala Davert, suffer from a bone disease called osteogenesis imperfecta. They lost their primary insurance due to Obamacare’s mandates. Their parents, after failing to resolve technical issues on, purchased an exchange plan directly from an insurer with a similar premium plus a nearly $8,000 deductible increase.

Their mother noted, "The only other plan that had a lower out of pocket maximum was a plan that’s not accepted by their doctors."

With the health conditions I face, my $176 per month premium for a silver exchange plan is almost inconceivable. Before, all I could get in Pennsylvania after multiple denials was a $476 per month premium with a high deductible.
Don’t get me wrong: I know the country desperately needed health care reform—and still does. But millions of canceled plans, special exemptions, and countless extensions show that Obamacare is incapable of ensuring all Americans can access quality and affordable care.

However, real health care reform could reduce skyrocketing costs on everything from doctor visits to MRIs. It could promote visible pricing, which would allow people to plan and pay for much more of their own routine health care.
For people with pre-existing conditions, like me, who couldn’t get individual health insurance, expanding state high-risk pools would have been a better option. They give the "uninsurable" an affordable option by offering subsidized coverage comparable to private plans, rather than restructuring the entire insurance marketplace.

It’s the states, not Washington, that have the real solutions to our health care crisis. There was—there is—a better way than Obamacare. Even on my most pain-filled days, I know that.

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Priya Abraham is a senior policy analyst for the Commonwealth Foundation (, Pennsylvania’s free market think tank.