Most days, Joe Cato is confined to sitting in a chair or lying in bed, heavily medicated or asleep, debilitated by back pain that’s left the 41-year-old husband and father of four unable to work, attend seminary, or run his construction business. He has degenerative arthritis in his lower back and pelvis, a condition brought on after years of working on construction sites as a stonemason and hauling music gear as a worship leader in his church. Even riding in a car is painful, which he must do to get to his health-care provider 30 miles from his home in Waxhaw, North Carolina.
Joe is one of the many victims of Obamacare. His doctors say he needs surgery to repair the nerve damage in his lower back and pelvis, but his insurance company, Blue Cross Blue Shield, won’t cover it. In most of North Carolina, including Union County where Joe and his family live, Blue Cross is the only health insurer still offering coverage on the exchanges established by Obamacare. The only treatment Blue Cross will cover for Joe is pain medication—a battery of prescription drugs he must take daily, including what he calls “comatose-inducing” muscle-relaxers and opioids.
“When people call it being between a rock and a hard place I call it choosing between a firing squad and burning at the stake,” Joe says. If he doesn’t take the drugs, he’ll end up in the emergency room because of the pain. If he does take them, he’s useless as a functioning member of society. “I don’t want to pick either.”
He shouldn’t have to, but the collapse of Obamacare has left him with few choices. As the debate over health care reform rages in Washington DC, millions of American families who purchase health insurance on the individual market are struggling to get the care they need. Joe’s case is just one example of how federal health care policy has crippled the individual insurance market, limiting access to care and leaving families with no good options
How Obamacare Left Joe Cato With No Options
Last summer, when his chronic back pain became unmanageable, Joe was insured by Aetna, which worked with him to diagnose the problem. Aetna paid for CT scans, an MRI, nine spinal injections, visits to the emergency room, physical therapy, chiropractic care, and massage specialists. But last July Joe received a letter from Aetna saying it would be exiting the individual market at the end of the year. Given the company’s financial losses, there was no way for them to stay in the exchange.
Joe and his wife, Becky, tried to expedite the tests and treatments for his back, hoping to get a surgery scheduled before the end of the year. He needs a minimally invasive procedure called radio frequency ablation, which helps ease pain caused by the degeneration of joints from degenerative arthritis. The surgery involves burning the nerve out of the hip joint, easing inflammation and allowing it to move without causing pain. But it took too long to properly diagnose the problem and schedule surgery before the family’s coverage with Aetna ended.
When Joe went to buy new coverage in January, there was only one option on the exchange: Blue Cross. The company was offering a plan called “Blue Value,” created specifically for exchange customers. The plan is designed to provide general primary care, and little else. The idea is to prevent people from going to the ER for things like the flu but it does little for patients with more serious health concerns.
Under his new plan, Joe lost access to all of his regular doctors, including the specialists he had been working with to diagnose and treat his back pain, as well as the Carolina Medical Center (CMC), the major health-care system in Charlotte that runs 15 hospitals and nearly all the outpatient surgery centers in the area. CMC is the must-have provider network for all of North Carolina south of Raleigh, but his “Blue Value” plan didn’t include it.
What’s more, the new plan denies all radiofrequency ablation procedures, no matter what. Blue Cross deems the surgery “experimental,” even though it’s been around for a decade and Aetna was going to cover the procedure before it dropped out of the market. “The idea that it’s experimental is bogus, that’s not why Blue Cross is denying it,” Joe says. “It’s a business decision for them, plain and simple.”
Now, Joe’s only in-network provider is Novant Health, which stipulates that new enrollees can only see a Novant provider that’s accepting new patients. The closest provider that would accept Joe is 30 miles away. Joe says the Novant facility he goes to is “definitely lower quality” than the CMC clinics and hospitals he had access to under his Aetna plan. “It looks like Fallujah.”
Ironically, Joe and his wife pay more for their Blue Cross plan ($120 per month) than they did for their Aetna plan ($36 per month).
Millions Are Bearing The Brunt Of Obamacare
Joe’s story illustrates in a microcosm what’s been happening all over the country. Obamacare sought to transform the individual health insurance market by making two major changes: 1) forcing everyone to purchase coverage—the individual mandate provision—and 2) forcing insurance companies to cover everyone, even those with preexisting conditions. The idea was that the young and healthy would sign up, and their premiums would pay for the cost of older and sicker people, whose premiums wouldn’t actually cover the cost of their care.
It hasn’t worked out that way. Young people didn’t sign up for coverage on the exchanges in sufficient numbers, opting instead to pay the penalty. Insurers were forced either to raise premiums, which have skyrocketed in recent years, or simply exit the market in the face of huge financial losses.
This year, insurers fleeing the market left 21 percent of all Obamacare exchange customers with only one insurer in their area—including Joe Cato in North Carolina. Next year it might be even worse, with as many as 1,200 counties projected to have only one insurer and 47 counties with no Obamacare insurers at all.
That matters because of people like Joe, who are left with no choices and inferior coverage that won’t pay for necessary procedures—but will pay for opioids. That’s especially callous, given the ongoing opioid crisis. In North Carolina, a surge in drug addiction combined with inadequate resources has forced opioid addicts to seek ineffective care hospital emergency rooms, where they are “boarded” for a few days then released.
Obamacare’s destruction of the individual insurance market has inflicted real suffering on families like the Catos. Joe had to drop out of seminary this year, unable to continue his studies at Charlotte Christian College and Theological Seminary. He’s also increasingly unable to run his construction business. And although the powerful drugs he’s taking ease pain, he’s still destroying his back. Every time he walks, he exacerbates the underlying medical condition. The longer he waits to get surgery, the worse it gets. Surgery would cost him about $20,000 out of pocket, which he doesn’t have. Like many people in the era of Obamacare, he’s relying on a crowdfunding campaign set up by a friend to gather funds for the surgery.
Maybe Senate Republicans will find a way to pass some form of Obamacare repeal. Maybe they’ll try to salvage the collapsing exchanges. Maybe they’ll do nothing, and try to blame it all on Democrats. Meanwhile, Joe Cato and millions of Americans like him must bear the brunt of the failure of our political class.
“We wake up to this reality every day,” Joe says. “Once it hits home, you see the giant debacle that is the Affordable Care Act, and you realize that you hate it. Not because some pundit on TV says it’s bad, but because it’s hurting you and your family.”
From - The Federalist - by John Daniel Davidson
I am so disgusted with the Government in general, but the folks who promised to repeal Obamacare and then didn’t really do not deserve to be in any type of leadership position representing us Americans. We do not need the Government to be involved in Health Insurance any more than they are in my Auto Insurance. Maybe even less. I am so tiered of Jerks telling me what I need or want. Get out of my life…
“Maybe Senate Republicans will find a way to pass some form of Obamacare repeal. ” Well that option died in both the House and the Senate, so you can take that off the table AMAC. Clearly the Republicans we elected to Congress don’t want to do the will of the people (full repeal of Obamacare) that sent them there. “Maybe they’ll try to salvage the collapsing exchanges.” Oh goody. Throw more taxpayer money at propping up a fatally flawed federal take-over of the healthcare insurance market. Costs of both premiums and deductibles will continue to rise, but the American taxapayers, remember them AMAC, will continue to subsidize the convoluted system of Obamacare. All while having to pay those higher premiums and deuctibles themselves. Sounds like a plan…NOT!!!!!!! “Maybe they’ll do nothing, and try to blame it all on Democrats. ” BINGO!!!!! We have a winner! Yes, believe it or not,… Read more »
As Obama himself said, his goal was single payer (Socialized Medicine, think the VA), but couldn’t get there in one step, so the Dems created a system,designed to fail, to get there in steps.
THAT IS WHAT YOUR DEMOCRATIC LEADERS WANTED FOR THE PEOPLE, AND THEY REFUSE TO FIX IT, BECAUSE THEY WANT GOVERNMENT CONTROLLED HEALTH CARE. ANYTHING THE GOVERNMENT CONTROLS COSTS MORE AND IS MUCH LESS EFFICIENT. DON’T LIKE IT, THANK YOUR ELECTED OFFICIALS.
We now know 4 more traitors to the Republican party to join known liberal traitor John McCain, all need to be recalled and or voted out of office. They flat out lied in their political campaigns when they vowed to fight against Obamacare. When it came down to making good on their promise they showed their true colors.
Trump needs to wipe out their Obamacare exemption and make Congress and the Senate live under the same healthcare the American public does and pay their own premiums. Obama knew what he was doing or at least his staff did. They knew that if they exempted Congress the ACA would remain so now it is up to Trump to wipe out their perk so they have to live with what they have failed to do.
We will only give control of the government back to the people when the people themselves wake up and realize just how close we have come to Socialist control of the this great country of ours. The liberal Socialists have completely taken over the Democrats and most of the establishment Republicans are just Democrats in disguise. We got Mr. Trump by shear over whelming numbers of pissed off people, we can take back control, but we must more closely look at the people that we elect. Stop being so trusting, these people aren’t trust worthy for the most part. Stop voting for the guy that has been in office for ever just because he’s the guy who’s been office for ever, that doesn’t mean he’s doing good things for the people, keep track of what he’s doing, hold him accountable for the way he votes. Put more real conservatives in… Read more »
Has anyone heard of MediShare? You pay $300+ a month for your plan and its a faith based medical plan. Communities take care of each other thru this plan
Sen. McCain has his. Sucks to be Joe Cato. Our government, our country has become disgraceful.
The only person that I know that like Obumacare is the one who gets it free.
One more reason to make sure the politicians have to be covered by the same insurance. Instead, they have their own, excellent, “only we can have it insurance, because we are special”. But the people in this country are too stupid, and let this happen. Oh, and they get automatic raises every January, if you have a good paying job, do you get that? Let’s not even talk about the pensions!
Joe don’t do that radio ablation, I know others that are suffering from it, worse than before they had it done. Also, be very careful with your choice of physicians that would cut you and leave it worse than before in a few years. I made that mistake in ’02, and it took a year and half of repairs in ’06-7, of Dr. Koski in Northwestern medical university hospital to make my life safe. He called them “orthopedic cowboys, ” and did between 300 -500 repairs a year then. I’ve been where you are and went through the gamut of medical care of the spine. 36 screws, 1 plate, 2 rods and 2 bolts are part of my spine now. I also use subutex generic for pain, but part D, after six years of coverage, no longer includes the sublingual form in the formulary! ! Health care in America! Land… Read more »
Americans are just collateral damage. Congress doesn’t give a hoot about it’s constituents! They only want $$$$ put into their own bank accounts as do the insurance companies.
From now on when the republicans send you that letter saying please help buy sending money stop sending money to people not doing there job
It is a shame that RINOs (and scumbags) like John McCain lied to voters about repealing the monstrosity known as Obamacare. How many American’s must continue to suffer under this socialist nightmare because cowards like McCain are worried about stopping government handouts (Medicaid) to the lame and lazy? I am hoping that McCain will soon be dead, or at least out of the Senate, so we have a shot at getting a real conservative in his seat. I told the scumbag McCain as much in an email today.
Maybe Obama will pay the $20K for the needed surgery. Send a crowdfunidng invite to him — see what the response is from this all-noble, all-caring Father of Hope and Change. HMMM
Can Trump undo Obama’s decision to exempt federal workers (including House and Senate and their staffers) from Obamacare? Putting them under Obamacare might change their tune.
Cases like this persist while the military will fund million dollar protracted elective transgender “conversions” with the beneficiary out of commission but still receiving a paycheck. Ain’t global fascist Sec-Prog culture great?
One solution that might work is to have NO substitutions. NO special treatment for unions and All people in Government MUST participate like the rest of us. Why are they so special
How much would the nerve ablation procedure cost Joe if he paid for it out of his own pocket ? I have a relative who just had the same procedure done in Tennessee. He had to pay for it himself and I think it cost about $1600.00 . Although not inexpensive, curtainly a manangeable cost even if you had to borrow the money. Maybe Mr. Cato’s church family could help him because that is supposed to be what we are all about. Even though I don’t like Obamacare nor the way it was implemented, and no matter how you slice and dice it, insurance is still all about the well people , and society paying for “sick” individuals or persons less fortunate. SO SOMEONE HAS TO PAY. SO HOW DO WE CUT THE COST OF CARE? So how about we do some of the following: (1) Build more Federally financed… Read more »
This is an example of health insurance in name only, they cover only the basics. And what it leads too down the road is long waits to see a doctor or get surgery if approved as many will experience rationed care. It’s happened in every country that goes to single payer government managed care. The present populous ‘alternative’ is the recreational marijuana that is highly elevated in THC where the users just dream their lives away like the story of the opium eaters. In my youth I danced with Mary Jane and found her to be a whore. I found my thought processes degrading. All the wonderful experiences that others claimed I found deceptive. Some where but when I got away from the social experience I found my thinking was hampered. If I had done it in my teens instead of my 30’s I could have gotten hooked. So a… Read more »
Generally speaking, most of Government is despicable and needs to be replaced! Everyone knows Obamacare is and always has been a pack of lies and unaffordable. Remember Nancy Polosi’s comment, “We have to pass the bill so that you can find out what is in it.” Fortunately for us, since she was not born in the USA, she cannot hold the highest office in the land, but I’m sure the Democrats are trying to change that for themselves. Or have they, already? For the most part, politicians are a bunch of old dogs up to their usual dirty tricks and should be stopped. I believe the reason why so much is AFU in politics is because most people in politics are either attorneys or not real Americans who have helps to write/pass laws that benefit themselves, ALWAYS. Its time we threw all the bums out and got busy writing laws… Read more »