Dear Supreme Court, Please Don't Take Away My Healthcare Subsidies

Right now, 6.4 million Americans receive health insurance benefits under the Affordable Care Act, which was signed into law in 2010. But by the end of June, all of that could change. SCOTUS is expected to render a ruling on whether or not subsidies currently offered under the Affordable Care Act will continue to be offered for Americans in certain states. If SCOTUS decides to repeal the act, millions of Americans will lose the insurance subsidies they currently obtain through government marketplace exchange insurance. If repealed, the new health insurance reality would leave patients, doctors, and insurance companies in a bind. In essence, without the option to have subsidized health insurance, many Americans could be left uninsured and facing painful medical expenses. (Update: On Thursday, the Supreme Court ruled in favor of Obamacare.)

The Republican-dominated Congress would be charged with the task of creating a solution to the absence of the subsidies in the event that the ACA is repealed. As it stands now, Senate and House Republicans do not have a unified plan that could be quickly implemented if the ACA ceases to exist. Needless to say, the possibility of this very uncertain healthcare landscape has Americans concerned about what will happen to their ability to receive and afford necessary healthcare.

As it happens, I am one of those 6.4 million people who receives healthcare subsidies. Frankly, the whole business of insurance and healthcare confuses me. Selecting and enrolling in a plan involves a lot of legalese and jargon that I don't fully grasp, and ultimately, decisions about my healthcare are largely dictated by money. I am certain there are plenty of lovely plans out there, but they are irrelevant to me if they fall beyond what my finances can accommodate.

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When applying for new coverage during open enrollment early in 2015, I perused the details of several plans, selected a PPO (Preferred Provider Organization) from a popular provider that wasn't wildly out of my budget, and applied for coverage. I currently pay a premium of $145 a month for medical insurance (no vision or dental, sadly) and accrue the additional costs associated with maintaining my health. While it may be a good deal as far as insurance goes, $145 is not a small amount given my income, and the idea that these costs could become an unfeasible financial strain is very, very scary. I am fortunate enough not to need care for any chronic illnesses, for which the costs for treatment drives many patients into deep debt.

With this SCOTUS decision coming up any day, I thought it was time to crunch the numbers to see where I might find myself if the ACA is repealed and I lose my current coverage. Let's just say, the final numbers aren't reassuring. Here's a snapshot of what my medical life will look like without ACA subsidized insurance.

Birth Control

What I currently pay: $0

What it would cost without insurance: $32.99 per month

Fortunately, my insurance covers my birth control and hasn't asked me to switch brands (it's not in fact illegal for insurance companies to provide full coverage for all birth control). But without insurance, this prescription would cost me just about $33 each month.

Mental Healthcare

What I currently pay: $30 per month for psychiatry, $100 per month for therapy, $42.39 per month for anti-depressants

What it would cost without insurance: $451.98 per month for complete mental healthcare

This is the one that would really hurt me financially and frankly would not be manageable at all. Just the anti-depressants alone would cost $221.98 without insurance coverage (and yes, some people really need anti-depressant medication). Ouch. At over $220 per month, I would have to choose between therapy and medication. That's not a choice I'd be happy to make, and more importantly, a decision I shouldn't have to make based solely on financial considerations.

Emergency Room Visit


What I expect to pay: $40

What it would cost without insurance: approximately $200

I was diagnosed with Lyme's disease earlier in June, and when I woke up and saw the bulls-eye rash on my leg, I wanted to get treatment as soon as possible. The quickest way to do this was a trip to the nearest ER. I haven't yet received the bill for this, but most likely my visit to the ER will cost around $200. This was an exceptional incident, not a monthly recurring cost, but what if I didn't have insurance, and had already spent several hundred dollars on those other medications and office visits? I'm not sure where that $200 would come from.


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What I paid: $105.16

What it would cost without insurance: $117.29

Standard treatment for early stage Lyme's disease is two doses of antibiotics everyday for three weeks. That's a lot of medication, and a lot of money. For whatever reason my insurance barely covered this antibiotic, and I ended up shelling out over $100.

Total with insurance: $317.55

Total without insurance: $799.26

Adding all of this up, I would have had to cough up $799.26 in the month of June to be physically and mentally well. This is compared to the $317.55 that I will end up paying by the end of the month once I settle the ER bill. While $317.55 is no small chunk of change, and it certainly does cause financial strain, it is significantly more manageable than the $800 I'd be scrambling to come up with otherwise.

I am grateful to have the option for subsidized coverage, but I do want better and more affordable health insurance than is currently offered through the marketplace and privately from insurance providers. I want to make decisions on my health based on my well-being, not based on the balance in my bank account. The insurance system that we have currently is not good enough.

But because a massive overhaul of government healthcare is not on the table, what I need more than anything is to keep the subsidies offered under the Affordable Care Act. Instead of focusing on taking subsidies away, the current political conversation about healthcare should be about additional ways that costs can be alleviated for consumers, because I don't have $800 to spend on healthcare this month.

Images: Getty Images (3); Wikimedia Commons; Elizabeth King (2)