Yes, I live in a small town in north central Arizona named “Strawberry.” Look it up. Several times at an airport TSA checkpoint, upon handing over my driver’s license an agent has looked up, smiled, and asked, “Is that a real place?”

 

Location map of Strawberry, Arizona

Many people have an image of Arizona of the desert; that’s only half the state folks. Do you see that large swath of green? I am surrounded by hundreds of thousands of acres of National Forest land. If you follow the main road in Strawberry, Fossil Creek Road, out of town, well you end up at the head of an 1800 foot deep canyon with the perennial Fossil Creek at the bottom.

It’s a bit funny that this is my home, since I grew up in the suburbs outside of Baltimore, and lived 20 years in the metropolitan Phoenix area. But the place I love to be has no traffic lights, a commercial “center” of a bar, a small hotel, general store, and an auto  mechanic run by two guys named “Bob.” I have a view of the Milky Way at night and elk that wander the neighborhoods.

My work is online, I am a quote/unquote consultant in educational technology. Mostly I get to work on innovative projects that involve expanding people’s creativity, sometimes teaching a course in digital storytelling. I build web sites and tools, like the one called TRU Writer that powers this site.

“40+ Years on the Stick” flickr photo by cogdogblog https://flickr.com/photos/cogdog/5188432051 shared under a Creative Commons (BY) license

I also have been Type-1 diabetic since I was seven years old. I have never been hospitalized for anything, beyond my initial diagnosis- that’s how long ago it was.  In 1970 I spent 10 days in a hospital until they were sure I could give myself insulin injections. I have lived 47 years without any diabetic complications beyond a bout of retinopathy 24 years ago. That was my wake up call to start taking better care of myself.

My way of life that I enjoy would not be possible without ACA insurance. 

I would be classified before ACA as from (excuse the poor taste pun) a “basket of uninsurables.” Skipping health insurance is not even something I can consider. I left my last full time employment, and with its provided healthcare,  in August 2012. I was able to continue coverage from under COBRA until February 2013, when I was able to sign up for ACA, which I have had since.

Before then it would have been insanely expensive to find an individual health insurance plan that would accept someone with a pre-existing condition, as if it was something I brought on myself.
Here’s what I have paid per month for health insurance in that time, all 80/20 plans from Blue Cross Blue Shield (the name and details have changed every year). These rates were relatively consistent until this year.

My monthly costs for ACA coverage. Note the small spike for 2017

Besides a bureaucratic labyrinth I have never had any problems or complaints about my insurance. I like my doctor, and have been able to stay with him since 2013.

The Cost of Being Diabetic

As a diabetic my pancreas does not produce insulin, the hormone that converts the food eaten to energy the body can use. Until 2006 my treatment was multiple daily injections; that was the year I switched to an insulin pump. Boy was I lucky. My health insurance provided by my employer covered the entire cost. Those were the good old days.

When the warranty on that pump expired in 2010, under the insurance of a different employer, for a list price of $6000, with trade in of the old pump, my out of pocket cost was only $300.

The next one I got in 2015 under my ACA insurance; the list price was now almost $10000, the trade-in was a lot less, leaving me with an out of pocket cost of $900.

A new pump will be a financial bite every few years; but there are ongoing costs for the 3 day insulin reservoirs and the tubing/infusion set which connects the pump to my body. The list price for 3 month supply of both items is $1300; with insurance that costs me $420.

A three month supply of insulin, 8 vials, would cost me $500 without insurance (instead I pay $100).

The other key part of managing diabetes is regular blood testing. The scheme here is much like razors; the meters they give away, but they get you on the recurring cost of test strips.

My Medtronic insulin pump comes with a Bayer Contour test kit. What helps is that it wirelessly sends my readings to my pump, which then I can dial in how many carbohydrates I will eat at a meal, and the pump calculates a proper dose.

Sadly (or strangely) Blue Cross considers Bayer Contour test strips a Tier 3 item, which means my 3 month supply would cost nearly $300, while One Touch test strips (not compatible with my pump) are covered at Tier 1 and cost $20 for a three month supply. I gave up trying to find out why similar items are priced so radically differently.

Fortunately I found the test trips I needed on Amazon for $65 for a three month supply. So I do an end around my insurance company.

The other fun part of the insurance game is that for 2016 Blue Cross Blue Shield had separate $400 deductibles for prescriptions (insulin) and the insulin pump supplies (durable medical equipment). So last January, when I needed both refilled, I had to layout $800 just to reach the deductible. This year the deductibles went up to $450.

The first rounds of supply costs each year is a double dose on top of premiums. So I try to get as much ordered before the end of the year.

A definite problem with the ACA is the gearing towards people who need insurance against unexpected illness- when I get reminders for how much I can save by switching plans, it does not consider that the cheaper plans  (high deductible, no coverage on prescriptions until deductible met) are insufficient for those like diabetics with ongoing regular costs.

What I spent in 2015 on Healthcare

A lot.

  • Medical and Dental Insurance Premiums $7368 (13% of income)
  • Dr office visits and lab work copays $242
  • Prescriptions and supplies not covered by insurance $4197 (7% of income)

Because the year before I decided to roll the dice and skip dental insurance, I had some major work in January 2016 that cost me $3300 (a long story, and an example of the pitfall of trying to go “without” insurance).

My total out of pocket medical costs for 2016 was $14,865 or 25% of my income.

I won’t have that expensive dental wallup this year, but… the 58% jump in insurance is going to be even more than that ($4800).

Because of my income level, I get no tax credit for insurance.

I wonder if my Congressional representatives have to pay a quarter of their income for health care. We cannot even speculate about the incoming President since his finances are buried deep inside the center of the earth.

About My “Lavish” Lifestyle

My luxury ride is a 1998 Ford F-150 with 170,000 miles and dents that may never get fixed. I do not have penthouses or golf course homes; my mansion is a 960 square foot modest house built in 1977, complete with 1970s vintage wood paneling. I own nothing gold plated.

My fixed living costs- mortgage and utilities are about $1000 per month. I have $0 debt on credit cards.

I thought maybe I could make up the extra $380 per month for insurance premiums in 2017 by spending less on groceries. My average monthly food budget is $400. Diabetics don’t do well on $20 per month for food.

Or maybe I spend too much on designer clothes? No, I spent a whopping $535 on clothes… in the entire year., mostly jeans and t-shirts.

Here is my biggest expense for 2016:

I adopted Felix in April from the Payson Arizona Humane Society. The kibbles, vet fees, toys, kennel boarding cost me $2200 in 2016. Plus $1700 to extend my backyard fence.

Yes, that is disgustingly extravagant.

But Felix and I have walked over 5 miles per day since April. In that time I lost 22 pounds, bought those basic jeans in a smaller size, lowered my blood glucose levels, and stopped feeling the pain in my lower back I was feeling last year.

I think that this canine investment has been good for my health. While I won’t get a tax deduction, I get great company.

What to Expect for 2018

I try not to think too much about it. Stress is not healthy. Without access to ACA, I might have to look at finding employment that would provide insurance. There is not work like that anywhere near Strawberry, Arizona. I would have to consider moving to a metropolitan area, selling my house that I love, and adding more carbon with the necessary increase in driving.

Felix would have problems too living in a city! He loves the forest.

I would give up the volunteer work I do with a local group that is building hiking and biking trails, my participation and volunteering with the annual Fire on the Rim Bicycle Race (I design and run their web site as well, plus the one for the local Pine/Strawberry Fuel Reduction organization).

I would like to have some hope that the people making the decisions on the future of 30,000,000 people know what the impact is of a repeal without any plan in place. Each time I have contacted my Representative and Senators about my concerns, I get a form letter response telling me that they are concerned, and then a long rant about how terrible the law is.

They have yet to describe what they are going to put in place of the ACA that will continue to let me enjoy a quiet, peaceful life in a little town almost no one has heard of.


Part of this was published previously in more of a rant "Hey You! Don’t **** With My Unaffordable Healthcare" https://medium.com/@cogdog/hey-you-dont-with-my-unaffordable-healthcare-fe9086ddb82#.hqcz1vlps