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Julie Hagenbuch: Rhetoric is making America sick

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I am a 58-year-old small business owner and Colorado taxpayer. I have worked since I was 16.

Thirty-seven years ago I first purchased health insurance through my employer and have been continuously covered ever since. This is my first year on ACA.

Nine years ago I was diagnosed with an aggressive form of breast cancer. After eight surgeries, chemotherapy and radiation, I am left with many side effects. I have maxed out my deductible eight of the last nine years. Most recently, I have experienced recurrent life-threatening infections that cause me to be hospitalized.

My immune system is permanently compromised. I have worked very hard and have spent tens of thousands of dollars on supplements, integrated care and on experts not in my network to improve my health.

I spend extra money on grass-fed and organic food, maintain a full garden seasonally and exercise four times a week. Senators Gardner and Bennet, Congressman Tipton what else can I do to improve my health?

Most people wouldn’t fight to keep my high deductible ACA policy for my husband and I. It is good for us because my premium is low, and we are able to use our Health Savings Account that we have had for years for my medical expenses.

Should we lose the premium tax credit (subsidy), the premiums would go up $25,000 a year. Yes, $25,000 more for the same high deductible plan, twice as much as the Cobra plan I had previously. The insurance companies set the prices while the federal government sets the tax credits.

The so-called plans advanced by Congressman Tipton, Speaker Ryan, and others, all propose to give the subsidy money back to the richest Americans. Not only that, they do away with all the preventative care like mammograms, PSA, vaccines, physicals and more. Lifetime maximum limits will be restored, which a sick baby can use up in its first year.

Tell me Senator Gardner and Congressman Tipton, will I really get more for less? I don’t see how it is possible?

What would you do about health insurance if you were in my situation? What happens if you repeal ACA with 50 Senate votes using the reconciliation process? What happens if you cannot get the 60 votes with which to replace it? What then? How much will my insurance cost then in the so-called free market system?

I have to say all your rhetoric with basically no reasonable plan is making America sick. You’ve had eight years to come up with something. Time for you to put up or shut up.

I’m certainly willing to work hard to improve ACA, affordably getting more middle class people covered, containing costs and creating more competition. I think there is a solution that makes sense for taxpayers, insurers, medical providers and policyholders.  

Julie Hagenbuch

Steamboat Springs

Comments

Nancy Spillane 3 weeks, 2 days ago

Julie, thank you for sharing your personal history with us. I encourage everyone to contact Senator Gardner, Senator Bennet, and Scott Tipton with your worries and concerns regarding the repeal and replacement of the ACA. Right now, Julie, you are right in asserting that the proposals on the table will hurt the people who need the most help and it will make the rich richer. It's a shame that our country is so behind the times with health care for all citizens.

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Martha D Young 3 weeks, 2 days ago

Julie, What a horrible ordeal you are enduring, and now uncertainty about you healthcare coverage is added to your situation. Even though our most knowledgeable president has admitted that health care reform is "complicated", we still need to keep pressure on our senators and congressman. They make the ultimate decisions. Thanks, Julie.

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Dan Shores 3 weeks, 2 days ago

Thank you Julie for sharing your story. I am so sorry to hear of your continued struggle and I wish you all the best.

Ever since the ACA was enacted, republicans have refused to do anything to make improvements and have insisted on a complete repeal with no replacement plan. Our new president has apparently just realized that health care is really complicated, who knew?

We are the only advanced nation in the world that doesn't have a universal health care system in place. I have no idea what will happen with republicans running the show, all we can do is to keep speaking out, as you have done, and hope for the best. Let's just hope that in four years we can reverse this very disturbing trend and get back to helping all Americans.

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Ken Mauldin 3 weeks, 2 days ago

Many people have had terrible ACA experiences like our family; our premiums and deductible are multiples of what they were before the ACA was passed in the Senate on Christmas Eve through a strict party-line vote. We're paying more than twice what we were paying for insurance that we don't need or want, but are now forced to purchase.

President Trump and a GOP Congress were elected on a platform of repealing the ACA and I support repeal 100%.

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Julie Hagenbuch 3 weeks, 2 days ago

Trump was elected on a platform to give us something better for less.

I did address the costs in my letter.

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Erin Biggs 3 weeks, 2 days ago

Thank you for sharing your story, Julie. I appreciate your courage and bravery and wish you good health. Please continue to speak up. Republicans in Congress are paying attention.

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Fred Duckels 3 weeks, 2 days ago

For all those who envy our neighbors who have mostly subpar health care, albeit free, Trump is having a discussion about why they don't pay their defense bills. Maybe if they covered our bills we could be just like them. Obamacare was designed to fail and then they could pick up the pieces and proceed with a green light. One problem "Trump," and now we will try to develop a plan that works. One thing that will be a relief is the lack of theatrics, at least from those in power. One constant will be the omnipresent "guilt trip" that we read every day in the media trying to create an emotional stampede to massage the feelings of those with little else to hope for. Impeachment is the remedy when all else is lost.

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Julie Hagenbuch 3 weeks, 2 days ago

Good luck with that. You are on Medicare because of your age so why are you weighing in on this?

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Ken Mauldin 3 weeks, 2 days ago

The discussion of the impeachment of Donald Trump leads us to an interesting civics lesson:

If Donald Trump is impeached, Mike Pence becomes President.
If Mike Pence is impeached, Paul Ryan becomes President.
If Paul Ryan is impeached, Orrin Hatch becomes President
If Orrin Hatch is impeached, Rex Tillerson becomes President
If Rex Tillerson is impeached, Steve Mnuchin becomes President
If Steve Mnuchin is impeached, James Mattis becomes President
If James Mattis is impeached, Jeff Sessions becomes President.

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Scott Wedel 3 weeks, 2 days ago

If Trump is impeached then Republicans get creamed in 2018 election.

As was seen in Nixon's impeachment, when a President is seen as so corrupt and so unpopular then his party is in a real bad position. They are stuck either supporting a very unpopular President or are betraying those in their party that are still supporting their President. Democrats in Congress gained 49 seats in 1974.

Republicans are already facing a tough fight to keep the House in 2018. 23 Republican members of Congress won in seats carried by Hillary. And flipping 24 seats puts the Dems in control. While 12 Dems are in districts won by Trump, off year Congressional elections are nearly always bad for the President's party.

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Don Thayer 3 weeks, 1 day ago

Interesting bringing up the issue of impeachment due to improper behavior by our representatives. When Nixon was up, Republicans exercised integrity and sided against their President. When Clinton was up(impeached for perjury and obstruction of justice as the nation's top law enforcement official), Democrats gave us the finger.

And for the record, Democrats are losing at all levels of government nationwide. Their policies are NOT supported.

Governors - 33 R, 16 D, 1 Ind. Legislatures - 32 R, 12 D, 6 Split

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Scott Wedel 3 weeks, 1 day ago

Don,

Well, far from all Republicans voted against the President. Dems had a majority and there was still high drama what articles of impeachment would be approved. And Nixon's approval ratings was in 20s. The Dems gained 49 seats in the next Congressional election due to unpopular Reps losing from having protected the crook Nixon.

Meanwhile, the impeachment of Clinton was a failed partisan attack which lacked the support of the public The Dems gained 8 seats in 1998 in which the impeachment proceedings were a campaign issue.

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Don Thayer 3 weeks ago

Scott, you're always completely dishonest on this forum.

I didn't say ALL Republicans voted for Trump. Clever dishonesty without actually telling an ACTUAL lie.

Nixon approval ratings... seriously? And apparently Clinton was really just some very nice guy who really didn't do anything wrong, it was just mean ol' Republicans.

Address my statements. Did Republicans exercise integrity and plan to remove Nixon? Did Democrats vote overwhelmingly to excuse Clinton? Do you remember Clinton standing there looking into the cameras, pointing his finger, and stating "I did not have sexual relations with that woman"? And then he actually tried to use the argument of "Oh, I didn't know that was defined as sex"?

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Scott Wedel 3 weeks, 2 days ago

As Julie's letter demonstrates, for many people, their healthcare costs are high and ongoing. By any definition of insurance seeking to spread the risk among a larger pool, she is uninsurable because there is no randomness in her high annual medical bills.

As for Trump's campaign promises, he said it would be replaced with something much better. Though, now he has discovered that healthcare is complicated.

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Lou Coggia 3 weeks, 2 days ago

The biggest problem that Republicans have with the ACA is that it was Obama's program. From the beginning they wanted to repeal it at any cost. If it does goes as far as repeal some major themes of the ACA will still be in whatever replaced it. For that we will always have to give credit to Obama for breaking the ice on expanding medical insurance to as many people as possible. Because that is the right - no pun intended - to do.

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Nancy Spillane 3 weeks, 2 days ago

Beautifully said, Mr. Coggia. I agree wholeheartedly.

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Don Thayer 3 weeks, 1 day ago

I elected Republicans to repeal the ACA, primarily because it is an exercise of government control over the people. Geographically, the vast majority of America voted the same. Maybe you and the Democrat party should obey 'we the people' for once instead of lying (Obama, Democrats - about the ACA), manipulating, and bullying the rest of us.

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Chris Hadlock 3 weeks, 2 days ago

Thank you for your story Julie. Mine is older but the consequences follow me to this day. I have survived the dreaded cancer twice in my life, but it has now been over 15 years since the last treatment or diagnosis. I have been offered health insurance that would not pay for cancer of any flavor. I have been rejected by insurance companies and have had my employees forced to pay excessive premiums due to my personal health history(one of the reasons I no longer have employees, and yes that happened before the ACA). I have had insurance companies raise my rates to un-payable levels once they found out I had a cancer screening test to ensure I was still cancer free.

If you have been on the individual market in your lifetime with a pre-existing condition you know beyond a shadow of a doubt that the health insurance market was fundamentally broken. The ACA is not what I would have passed but it is light years ahead of the previous system.

If republicans manage to break the current health insurance market, they own the outcome and will manage to show everyone just how much they love the needs of big business instead of middle class America. Kicking something like 20 million of us from our existing healthcare plans is enough to sway the next election or two in my opinion.

To quote the famous Clint Eastwood line "Go ahead, Make my day"

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Julie Hagenbuch 3 weeks, 1 day ago

Thank you Chris. I hope the cancer is gone for good!

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Ken Mauldin 3 weeks, 2 days ago

Hi Lou - My biggest problem was that it increased my families premiums and deductibles by multiples through forcing me to buy coverage that I didn't need or want. I never cared who's idea it was, I dislike it because of the terrible impact it's had on my family.

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Erin Biggs 3 weeks, 2 days ago

Ken, I can appreciate how the impact on your family would cause you to feel the way you do. Can you appreciate how the impact on other families - such as Julie's story - make them feel the way they do? What are your suggestions for fixing the healthcare system? I'm genuinely curious, not being smart-alecky, though I admit it can be hard to tell the tone in typed communications online.

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Ken Mauldin 3 weeks, 2 days ago

Hi Erin - Yes, I can certainly appreciate that some people have had a positive experience with the ACA. Because scarcity exists in all markets, including healthcare, that requires difficult choices must be made that will directly and personally affect me. Because people aren't Angles with pure motive and heavenly guidance, I don't know any other person or group of people that should be allowed to determine what is in my or my family's best interests. The inherent inefficiencies of centrally planned economies (of scale, in this case) are aggravated by scarcity and what may seem sympathetic today, may not seem so sympathetic tomorrow. Be careful what you wish for.

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Fred Duckels 3 weeks, 2 days ago

On the other hand many later in life suffer poor health mostly due to poor choices. This makes it hard for those with foresight to understand why they should take up the slack. ACA did not address the inequity and it was DOA. If we continued we wouldn't have anyone willing to insure period. This is not easy, might look at the waiting lists in the single payer programs, no free lunch.

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Scott Wedel 3 weeks, 2 days ago

If the healthy families that used to pay lower premiums because their insurance pools excluded those with existing health problems then became a family with ongoing health problems, there might be a change of opinion on the ACA.

ACA has worked at two important levels. It has had a major impact at reducing the number of uninsured. It has also gotten more people to visit doctors instead of showing up at more costly emergency rooms.

It has failed at the important level of not having enough otherwise healthy people join and it is possible to get sign up just long enough to get a medical issue treated and then drop coverage.

There are a couple of ideas floated by Republicans that might actually work. One is to severely restrict healthcare for those previously uninsured and then signing up to get treatment. The other is to allow a higher deductible plans. Arguably, health insurance should all be high deductible plans to meet the definition of insurance of sharing the risk of calamities. And then there should be a health care subscription plan that covers the normal every day stuff.

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Robert Huron 3 weeks, 2 days ago

Every Western Civilized Country in the World has basic Healthcare for all it's citizens. If their citizens want something better than what their government offers they are free to buy something better as an add on. The US has chosen not to do this and instead we put the burden on the employers or individuals to buy insurance from profit orientated companies. The Administrative costs(Executive salaries and bonuses) at these companies are around 30% as compared to Medicare which is 3%. This is why the US spends 17% of GDP on Healthcare with poor results as compared to other Universal Healthcare Countries that spend 10% of their GDP on Healthcare with better results. The ACA was modeled after Republican Mitt Romney's Massachusetts Plan(Romneycare) which was successful however because so many States and healthy young people refused to participate the costs went up considerably. As a Country we have no problem spending Trillions of dollars on our Military Industrial Complex($6 Trillion alone in Iraq since 2003 which destabilized the entire Middle East) which no other country does but when it comes to Healthcare we are all told we can't afford it. Every survey taken shows the people who are most satisfied with their Healthcare in the US are those over 65 who are on Medicare. Trump has said he will repeal the ACA and what will replace it(Trumpcare) will be a lot cheaper and considerably better, be universal with no pre-existing condition exclusion. I wish him luck and I'm eager to see the details tonight.

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Julie Hagenbuch 3 weeks, 1 day ago

Thank you for the great perspective.

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Scott Wedel 3 weeks, 1 day ago

Single payer is not why other countries pay far less. We already have single payer Medicare that is nowhere as cost effective as other countries' cost per person under their single payer system.

We are unique across the board in having a system that costs more to provide medical care and do the least to have healthier citizens that require less medical needs.

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John Weibel 3 weeks, 1 day ago

For those with pre-existing conditions sorry that you do. Many of those conditions are caused by environmental factors, toxins which negatively impact health.

Fixing healthcare starts with fixing what causes the problems not treating the symptoms. Getting government out of food production, cheap food that is nutrient deficient and causing dead zones in our oceans.

As opposed to an EPA that sets maximum allowable limits for toxins/pollutants. Have one which penalizes companies which create them. Rewarding ones which help remove benign ones (co2) from the environment.

My issue with sick care is we are simply trying to treat symptoms of broader problems in many cases and not addressing the root causes.

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Larry Desjardin 3 weeks, 1 day ago

I am sympathetic to Julie Hagenbuch, who has a severe pre-existing condition, and those who expressed their dismay at the skyrocketing premiums of ACA. The two are critically linked, since when premiums grow too high, healthy people drop out, and the insurance exchange collapses. This is known as “adverse selection”, also known as a “death spiral”.

There is considerable evidence that the ACA is in an adverse selection cycle in many of the exchanges:

-ACA premiums skyrocketed by 22% this year. That is an average rate. Some districts, largely metro, had no increases, while many rural districts had 50% increases.

-2017 ACA enrollment nationwide dropped by 400K in face of these high rates, about 4%.

-ACA experts once predicted that 40% of the exchange enrollees needed to be young, under 35, to be stable. Last year the number was 28%. This year the number declined again to 26%.

-Two insurance carriers, after examining their 2017 ACA pools, have already pulled out for 2018: Molino and Humana.

-31% of the counties in the nation, mostly rural, have only one insurer. This is evidence that adverse selection has been already underway.

The poor results above are not evenly spread. The numbers above are an average of good results in metro districts, and terrible results in rural districts, such as Colorado’s District 9, which we belong to. Remember, ACA is not a single market. Colorado, for example, has nine ACA districts, with the boundaries defined defined by the Insurance Commissioner.

And there lies the critical ACA survival problem. While the markets reacted well to ACA mandates in lower cost metro districts, the combination of the ACA mandates combined with higher rural medical service costs have made rural districts unstable. They are collapsing first. That’s why my premiums, and those of others, have increased 100% in two years. Be thankful- the western slope, minus Grand Junction, may have no insurance options at all next year.

Colorado could have fixed this, by going to a single statewide ACA exchange. This was studied and rejected by the Insurance Commissioner, because it would have marginally increased premiums on the front range. Here is the Commissioner’s report on their decision to keep mountain communities out of a larger statewide pool. A better title would have been “Front Range to mountain communities: Drop dead”

https://drive.google.com/drive/folders/0BwguXutc4vbpZjg5a2hPUW0tbjg

We should be contacting our state representatives, the governor, and the Insurance Commissioner to fix this. However, the political reality is that votes on the Front Range drive Colorado politics. The decision was made to jettison mountain communities to keep low rates along the I-25 corridor.

I don’t know what is going to happen at the federal level. But if ACA collapses nationwide, much of the blame will go to the creation of these gerrymandered districts that caused the rural exchanges to go unstable.

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Lock McShane 3 weeks, 1 day ago

Larry You are totally correct about dividing up the state into smaller districts is causing the insurance market to collapse. Larger pools make health insurance work better. We would all be better off if the insurance pool included everyone in the country. It would reduce the paperwork required and would help negotiate our sky-high prices downward.

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Don Thayer 3 weeks ago

Seriously? Do you fail to understand that that is EXACTLY what the ACA does - force everyone into the system? Have you failed to see rates skyrocket - 50% plus in some states for 2017? Have you seen the paperwork load reduced since the ACA took effect?

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Larry Desjardin 3 weeks ago

Thanks Lock. I think larger pools by themselves bring some benefits, as a large pool is not subject to a few expensive cases triggering an adverse selection crisis- which is triggered by the price of premiums. My guess is that past a million participants makes that scenario exceedingly rare. Equally important, perhaps more, is the mix of participants. Ideally you have an even mix of healthy/sick expensive/low-cost patients. Splitting up that pool will make the more expensive pool more subject to adverse selection. To some extent, we've already done that by splitting the corporate group market from the individual market. The latter includes people who may be too sick to work. ACA has split the individual market even further, by a metro vs. rural split, making the individual rural market even more expensive. Throw the ACA mandates on top of that (they increase the premium price, so closer to the adverse selection threshold), and you can see why we specifically have a melt-down in the ACA rural markets. This is why I think combining metro+rural makes the system more stable. In fact, it is probably more stable to combine Colorado districts together than, let's say, combining all the rural counties in the US together, though the latter would be a larger pool.

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Lock McShane 2 weeks, 1 day ago

If everyone in the entire country was in One Pool, then your "even mix of healthy/sick expensive/low-cost patients" would be satisfied.

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Eric J. Bowman 2 days, 14 hours ago

"Seriously? Do you fail to understand that that is EXACTLY what the ACA does - force everyone into the system?"

I've got news for ya, if you think that. ACA penalizes me for not being part of a system I'm still precluded from joining. Yay. Senior citizens, by law under Obamacare, can't be charged more than what (I forget), 3-4 times as much as they charge me based on my preexisting conditions?

Which, when they were new, cost me my health insurance I've never been able to get back in the 16 years since, unless I agree to pay extortionate rates. Maybe I just need a GoFundMe page to cover that $2,500/month. My rent here in Yampa, as reference, is $850. Can I afford $30K/yr for health insurance? Maybe, but only if I get diagnosed with cancer... I'm pretty sure my end comes from jumping off China Wall up at the Flat Tops to keep from bankrupting my family if that happens. But I see it as my patriotic duty not to fork that over, but to resist. SINGLE PAYER, PLEASE!

It's amazing that I even have friends & neighbors who think it's MY FAULT that I lack health insurance. Trump voters. I don't hate all y'all, I just want (some of) you to admit you erred. Or just realize how lucky you are to have health insurance, so why do you care if the GOP repeal/replace plan, after SEVEN YEARS TO FIGURE OUT SOMETHING BETTER, would surely kick me off the rolls even if by some miracle Obamacare HAD would up insuring me.

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Eric J. Bowman 2 days, 14 hours ago

Sorry, Julie, it ain't political rhetoric making us sick. It's lack of single-payer healthcare which the rest of the world has. If some of our bought & paid-for politicians don't think that would be a workable system in AMERICA, I damn them as unpatriotic because this country can be exceptional, first and foremost if people quit going bankrupt & killing themselves in the face of untenable healthcare costs.

Hey, GOP? Before you kick more people out of health insurance than even before Obamacare, PLEASE address the problem of increasing healthcare costs, like $30 epi pens now retail (uninsured for those who most need them) for THOUSANDS OF DOLLARS. That's gonna bankrupt the country no matter how few of us you deem worthy of insurance. How many kids does that kill every year, when Mommy used to have one in her purse no problem?

Not part of the discussion in Washington, D.C. at this time. I don't know if anyone else has noticed, but "draining the swamp" hasn't happened... if, that is, you agree with me that un-insuring tens of millions of Americans in the name of profit-taking by health-insurance conglomerates ISN'T somehow part of that very swamp?

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