Affordable Care Act, healthcare, Obamacare — November 26, 2014 at 8:11 am

Why is the ACA so important? Just ask a doctor who treated the uninsured for free


She sees the benefits of Obamacare, both personally and professionally.

When Judy Stone, M.D., was in private practice as an infectious disease specialist, about one-third of her practice was made up of patients who could not afford to pay. But she never turned them away.

“I wasn’t raised to ask for payment,” Dr. Stone says. “I was raised to believe you help other people.”

When she parted ways a few years ago from the hospital employer that provided her health insurance, Dr. Stone found herself without coverage — and she struggled to buy insurance on her own. She was considered uninsurable because of pre-existing conditions like a back injury she was treated for in college 40 years ago.

Before the Affordable Care Act (ACA), Dr. Stone’s only option was to buy a group policy for her private healthcare practice. But it was expensive: $1,800 a month just for herself, with a $5,000 annual deductible.

It’s a completely different story now, thanks to the ACA. Dr. Stone found a Platinum plan through Maryland’s state-based exchange for $808 per month. Dr. Stone didn’t qualify for a tax credit, so that premium might sound expensive — until you look at the rest of the equation.

The plan features a $0 deductible — that’s right, zero dollars — so her benefits kick in right away. Her out-of-pocket maximum is $1,800 a year, which means her insurance picks up all out-of-pocket costs after that. She pays just $20 to see a primary care physician and $30 to see a specialist.

Dr. Stone admits that her prescription costs have increased dramatically with her new plan, but says the insurance agent who helped her pick the right plan did the math and she still comes out ahead financially compared to her previous plan.

Plus, you can’t put a dollar amount on peace of mind.

It has been a relief being able to get an individual policy for the first time ever. If you have ever had a health problem of any kind, you were uninsurable before.

Even before buying coverage for 2014, Dr. Stone personally experienced the benefits of the ACA, also known as Obamacare. Last year, her 25-year-old daughter broke both ankles in an accident, resulting in expensive treatment and recovery including physical therapy. Fortunately, Dr. Stone’s daughter was able to stay on her policy until she turned 26 thanks to the ACA.

If I had not been able to keep her on my policy at the time, it would have been a financial nightmare. And she would now be uninsurable without the ACA.

Dr. Stone’s daughter now gets insurance through work, but if she ever has to buy her own it won’t be a problem thanks to the ACA. And even with her insurer increasing her own premium for 2015, Dr. Stone remains happy with her coverage.

Looking beyond her own family, Dr. Stone recognizes the importance of making insurance more affordable for Americans — coverage that can be life-saving. She still practices part-time as an infectious disease physician, and has seen people develop serious infections and even die from something as simple as a lack of dental care.

Poor people can’t afford dental care, Dr. Stone says, so “a lousy cavity” that would have cost very little to treat can turn into an expensive stay in the ICU on a ventilator if an infection runs rampant.

We have an ethical and moral responsibility to care for others in our community. I’m delighted about the ACA because that’s how I was brought up — believing that healthcare should be a human right.

If your state created a state-based exchange, you can find it through — the one place every American can shop for insurance or renew their plan for 2015. Even if you want to keep your plan, it’s worth checking to make sure the benefits you like will remain in place next year.