Here in the US, the Affordable Care Act is finally going into effect, with accompanying drama. I managed to get signed up today at healthcare.gov. After not having health insurance since 2000, I will finally be covered starting January 1 2014.

Since my income is mosty publically known anyway, I thought it might be helpful to blog about some details.

I was uninsured for 14 years due to a combination of three factors:

  1. Initially, youthful stupidity and/or a perfectly resonable cost/benefit analysis. (Take your pick.)
  2. Due to the US health insurance system being obviously broken, and my preference to avoid things that are broken. Especially when the breakage involved insurers refusing to cover me at any sane level due to a minor and easily controlled pre-existing condition.
  3. Since I'm not much motivated by income levels, and am very motivated to have time to work on things that are important to me, my income has been on average pretty low, and perhaps more importantly, I have intentionally avoided being a full-time employee of anyone at any point in the past 14 years (have rejected job offers), and so was not eligible for any employee plans which were the only reasonable way to be covered in the US. (See point #2.)

So, if you're stuck waiting in line on healthcare.gov (is this an entirely new online experience brought to us by the US government?), or have seen any of the dozen or so failure modes that I saw just trying to register for a login to the site, yeah, it's massively overloaded right now, and it's also quite broken on a number of technical levels. But you can eventually get though it.

Based on some of the bugs I saw, it may help to have an large number of email addresses and use a different one for each application attempt. It also wouldn't hurt to write some programs to automate the attempts, because otherwise you may have to fill out the same form dozens of times. And no, you can't use "you+foo@bar.com" for your email; despite funding the development of RFC-822 in the 80's, the US government is clueless about what consititutes a valid email address.

But my "favorite" misfeature of the site is that it refuses to let you enter any accented characters, or characters not in the latin alphabet when signing up. Even if they're, you know, part of your name. (Welcome back to Ellis Island..) I want to check the git repository to see if I can find the backstory for these and other interesting technical decisions, but they have forgotten to push anything to it for over 3 months.

The good news is that once you get past the initial signup process, and assuming you get the confirmation mail before the really short expiration period of apparently less than 1 hour (another interesting technical choice, given things like greylisting), the actual exchange is not badly overloaded, and nor is it very buggy (comparatively). I was able to complete an application in about an hour.

The irony is that after all that, I was only able to choose from one health insurer covering my area on the so-called "exchange". (Blue Cross/Blue Shield) I also signed up for dental insurance (it was a welcome surprise that the site offers this at all) and had a choice of two insurers for that.

The application process was made more uncertian for me since I have no idea what I'll end up doing for money once my current crowdsourced year of work is done. The site wants you to know how much income you'll have in 2014, and my guess is anywhere between $6000 (from a rental property) and about what I made this year (approx $25000 before taxes). Or up, if I say, answered the Google pings. The best choice seemed to be to answer what I made this year, which is also close to what I made last year.

So, I'll be paying around $200/month for a combination of not very good health insurance, and not very good dental insurance. There is around $750/year of financial aid to people at my guesstimated 2014 income level, which would drop that to $140/month, but I will let them refund me whatever that turns out to be in a lump sum later instead.

For comparison, I am lucky to spend rather less renting a three bedroom house situated in 25 acres of woods..

It's strange to think that all of this is an improvement to the system here in the US, especially given all the better options that could have been passed instead, but it seems that it probably is. Especially when I consider the many people around me who are less fortunate than myself. If you'd like a broader perspective on this, see Tobias Buckell's "American healthcare was already socialized by Reagan, we’re just fighting about how to pay for it".

Interesting!

I didn't realize your (relatively minor from the outside perspective at least) pre-existing condition was enough to prevent you from getting coverage. I tried to log on to the new site a couple of times over the last few days, but didn't care enough to wait in line. We'll see if it has any other options than what I currently have, the price of which increased by 37% in the last year so they could give me extra care I don't want (presumably so I'll be up to the legal minimum standard). Seems like catastrophic health insurance should still be legal at my age if you're healthy.... :-/

Anyhow, Mom will be thrilled you're now covered. :-)

Comment by Anna
Affordable Care Act

There are many problems with the Affordable Care Act. Most importantly, it is solving the wrong problems in healthcare: http://www.humanevents.com/2009/07/22/take-two-aspirin-and-call-me-when-your-cancer-is-stage-4/

There are many unintended consequences of this law already: http://nationalreview.com/node/359861/print

Comment by Keith
the market (shockingly) doesn't solve all problems

a recent article in the NY Times (silly paywalling rules may limit this to only an abstract) describes exactly the problems you ran into.

It's not surprising to me that the health care exchanges don't take care of everyone. The logic behind the health care exchanges seems dubious, at best: the idea that just unleashing market forces somehow will automatically result in healthy and reasonable social outcomes strikes me as magical thinking. If we want the healthy and reasonable social outcomes (like that people shouldn't be permanently crippled economically just because they get sick) we need to explicitly plan for those outcomes. Every study i've seen suggests that a nationalized single-payer approach (while still having lots of flaws) would result in overwhelmingly improved health outcomes for significantly less economic cost.

So why aren't we doing that?

Comment by dkg [id.mayfirst.org]