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You're on your own, kid

Navigating the American healthcare system at age 26

Like all cultures, we in the United States must pass a series of milestones as we grow older. These coming-of-age rituals produce some of our most meaningful experiences. Learning to drive, participating in democracy as a voter, graduating from school, and drinking legally are some of the experiential stars in the firmament of modern American maturity. But young Americans face a milestone that’s unique in most of the developed world: getting booted from your parents’ insurance at 26.

I felt the coming of my 26th birthday with a sense of dread. My mother’s job at TU had afforded our family a fairly cushy plan through Blue Cross Blue Shield. As my birthday approached, I realized that the real source of my anxiety was a sense of helplessness. I was about to be cast adrift in a bureaucratic ocean that I was totally unprepared to navigate.

Blue Cross Blue Shield offered an early lead. A friend directed me to them, saying they had a program for people in my position. I visited the BCBS website, which informed me that I qualified for special enrollment because of my “qualifying life event,” turning 26.

Insurance plans are labyrinthine, bordering on nonsensical. Included with the overviews I looked at were lists of things not covered. I suspect this is done so coverage can be stratified to an ever greater degree and offered at a wider range of prices. One recommended plan charges $500 for an emergency room visit, but only if the patient is not admitted to the hospital from the ER.

Among things explicitly not covered by the plan: any injury or illness eligible for worker’s compensation, reverse sterilization, unprescribed female contraceptives, any male contraceptive, giving birth anywhere except a hospital, fertility treatment, infertility treatment, treatment for sexual dysfunction not caused by organic disease, treatment for obesity, horse-assisted therapy, elective abortion unless the patient’s life is in danger, drug and alcohol rehab, and anything else not specifically named a “Covered Service.”

I was going to need some help. My parents did what they could, but wanted to talk to an expert. I tried to call the BCBS office here in Tulsa, but that just patched me through to the national hotline. I tried the sales department, who referred me to customer service, which referred me back to sales. The sales associate gave me a local number to call, which turned out to be the number I was already calling. I called back and got a different local number, only to get the same national hotline.

My mother had more luck. She spoke with an actual insurance agent, albeit one out of state.

He even called me to get permission to speak to her. In the end, he gave her his personal phone number, but when I called that number the next day it went tothe main Illinois office.

It might be cliché to invoke Kafka when faced with a monstrous bureaucratic edifice, but  Kafkaesque is the only sufficient descriptor of my experience with BCBS. I would rather wake up as a giant insect than talk to Nathan from sales again.

What’s most striking about our healthcare system is its fundamental unfairness. The most egregious examples are world-famous. The average price of insulin increased 197 percent between 2002 and 2013, and is continuing to rise. “Pharma bro” Martin Shkreli raised the price of lifesaving medication by 5,000 percent, and it was totally legal. The major outrages cover a fundamental, underlying atrocity: Our country has prioritized the flow of capital over human health and wellbeing.

Healthcare is treated as a human right in every developed nation except ours. People in these countries don’t have to contend with private insurance companies and typically do not die of curable diseases because they cannot pay. 

The Affordable Care Act required plans and issuers to cover adult dependents until age 26, among a suite of regulations designed to bring us closer to universal healthcare coverage. But some states, including Oklahoma, have fought back. Oklahoma is one of 19 states refusing federal dollars to expand Medicaid programs, despite the fact that 14.2 percent of Oklahomans are uninsured, more than five points above the national average and the second highest rate in the country. As a result, Oklahoma has turned away roughly $3.6 billion in federal revenue over the seven years, tax money that has already been paid by Oklahomans. Perversely, many uninsured Oklahomans are already paying for healthcare they will never get.

Despite promises to the contrary, the Trump administration’s 2020 budget aims to cut Medicaid spending by $1.5 trillion, Medicare by $845 billion and Social Security by $25 billion.

I am lucky to be single, childless and gainfully employed. I have a family that is willing and able to help me, and I was fortunate enough to spend the first 26 years of my life with insurance. Although I will be uninsured as of Sept. 1, there is very little real chance of me being uninsured for very long. Nearly 600,000 Oklahomans do not share this privilege, and this number is poised to increase if the administration gets its way. 

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