Affordable Care Act, ObamaCare, whatever you want to call it…my small work-at-home business needs it…desperately. My family needs it. And, as a newly pregnant woman, I definitely need it. As I have begun to face our own work-at-home health care crisis, I have discovered that this is not about politics. This is all about money. Our money, our business’ money and our family budget, especially in regards to health care costs.


Like a good business and family budget manager, I keep track of everything, every receipt, every invoice. So, I was able to run our family’s specific health care costs for the past six years. I went back this far because 2008 was the last full year that one of us had health coverage through an employer. 2009 and 2010 were COBRA years. 2011 was the first year of our current Aetna insurance plan that was independently obtained through a referral program from the NASE (National Association for the Self-Employed). To get an idea of the financial impact on our family, I summarized our costs as a percentage of that year’s net income.


(*Premiums annualized. **Includes bills just received as of 10/1/2013 but not yet paid.)

You can see the significant rise from 14% as an employee to an astounding 35% so far this year. I am sure you all agree that 35% of income spent in health care costs and insurance premiums is financially unsustainable. According to my records compared year-over-year, it has everything to do with declining coverage in plan benefits, rising deductibles and out-of-pocket maximums. Each year that we attempted to keep our plan premium manageable, it bought less and less actually costing us more and more out-of-pocket. Ironically, the benefits we have now are just as bad as the employer benefits we received in 2008 but our income is significantly lower because we are self-employed.




So, how do we stand with the exchanges? Much, much better. Because the Government Premium Assistance Benefit is calculated based on net income, specifically, 1040, line 37, running a home-based business has some benefits. We are allowed our business deductions from income which can include deduction credits for vehicle and home use. By the numbers, we qualify as a family of four for a premium assistance of $517 per month which makes a $849 PPO Silver Plan insurance an affordable $332. With the obviously better benefits, I was curious as to how much better it might be in total not just premium. So, I detailed out each bill from 2013 and recalculated as if they were paid under the new benefits. The same $25,163 in total out-of-pocket medical costs that we paid this year could have cost us only $12,296 in ACA Exchange benefits and premiums. (Note: the plan chosen for this study is the exact same type of plan we have now and allows access to the same hospitals and doctors we have now.)


Pregnancy = a pre-existing condition

Pregnancy = a pre-existing condition

But the real kicker for us is that I have been “diagnosed” as pregnant and our current provider, Aetna, has decided to no longer do business in California as of December 31, 2013. As of today, if I tried to change plans before January 1, 2014, I would likely be unable to obtain insurance I could afford because pregnancy is currently considered a pre-existing condition. For all intents and purposes calculating insurance premiums and risk assessments, pregnancy is a disease. Shocking, isn’t it? By insurance definitions, technically, that would make birth control disease prevention. Again, it all boils down to money, not politics. Birth control is cheaper than pregnancy, birth and adding children to a family health insurance policy. No wonder the insurance companies didn’t complain or push that requirement back until 2014 when that was mandated by the Affordable Care Act. This week I will be signing my family up for the exchange through CoveredCA and counting the days and dollars wasted until it takes effect January 1st. For us, this help is way past its due date!

photo credit: massdistraction via photopin cc

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