Obamacare: A promise betrayed

Natalie Powell (not her real name) is sitting across from me at a sushi restaurant. She’s just recovered from a 48-hour pain episode brought on by trouble afflicting her neck.

“I get them about every two to three weeks,” she says. “Treating them means lots of bed rest, ibuprofen, Tylenol, and sleeping pills.”

She’s contemplating having an operation, something that is, naturally, causing her anxiety.

But she’s anxious for another reason. By the end of the year she may lose her insurance, which she has had since 2008, and her primary-care physician whom she has been seeing since 2003.

The cause of this is, not surprisingly, Obamacare.

Natalie, a Washington, D.C., resident, first began experiencing neck pain after a truck rear-ended her car in July of last year. The whiplash she received herniated one of the discs and altered the bone structure in her neck.

“My neck was not in great shape before the accident, although I was largely asymptomatic. Since then not only do I have pain, but I’ve lost much of the curve in my neck. It’s much more straight up-and-down now,” Natalie said.

Her troubles worsened in October when the D.C. Health Benefit Exchange Authority, which runs the Obamacare insurance exchange in D.C., decided that individuals and small businesses with fewer than 50 employees would not be allowed to purchase insurance outside the exchange.

Natalie, who has had her current policy through Blue Cross, doesn’t know if her policy will be sold on the D.C. Exchange. She’s contacted Blue Cross and, thus far, they have not given her a definitive answer.

If it’s not, then she’ll have to purchase a different policy. And there’s the rub: her primary-care physician is no longer accepting new insurance.

“She’s a very popular doctor,” Natalie said. “She had all but stopped taking new HMO [health maintenance organization] policies when I managed to get my first appointment with her. Now, she’s booked. She’s not even taking any new patients.”

Natalie has an HMO policy from Blue Cross that is coupled with a $1,200 deductible. She likes it because it costs her about $150 per month in premiums. As it is in an HMO, the doctors she sees have to participate in the HMO’s network and her primary-care physician must approve any visits to a specialist. That’s not a problem for Natalie, though, since she has such a good relationship with her primary-care physician.

Natalie desperately wants to keep her policy, even if it means buying it off the exchange (that means she won’t qualify for any tax credits, but she earns too much to qualify for those anyway).

But the D.C. Exchange may take that option away. Mohammad N. Akhter, the exchange’s chair, reasons that if people can buy outside the exchange, not enough people will participate in the exchange to make it viable. “For the exchange to be sustainable, it has to have approximately 100,000 people,” Akhter said.