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March 2016
In this Issue
  • PAbanner

  • My Experience with Obamacare
    ISMS President
    Scott A. Cooper, MD

    Late last year I experienced one of those moments when policy turned personal.

    As a county medical society leader and ISMS Board member during the Affordable Care Act (ACA) debate, I had a front row seat to the legislative sausage making, legal challenges, and both the controversial and positive aspects of the law.

    As ISMS President since last April, I’ve met with many physicians who shared their perspective on the ACA – both good and bad.

    Just recently, I saw the new realities of our health care system from a perspective that many of our patients have experienced: as a consumer seeking to purchase health insurance. After a job switch, I am now an independent contractor. I bridged my health coverage using COBRA, which expired recently. Late last year I found myself responsible for purchasing my own health insurance for the first time in several decades. After considering my options, I sought to enroll in coverage through the ACA marketplace.

    I’m covered now and the coverage is still relatively new, so I can’t speak to its quality just yet. I do, however, have new insight into the enrollment process.

    A few months ago I wrote about how our health system has evolved to favor the insurer-patient relationship over the physician-patient relationship. During my enrollment I experienced a little of that first hand. In my search for a plan that would suit my needs, I had several criteria to consider:

    • First, I thought about network options and where I would seek treatment. I am healthy and don’t have many specific requirements, but as a physician there are doctors I know and trust, so maintaining the options currently available to me would be ideal. I would also like to be able to access certain academic health systems should I become sick, and since I do locum tenens work, I want to be sure my insurance offers good options throughout the state.
    • Another consideration is my family. I have three adult children, each of whom is still young enough to be on my plan if I choose.
    • I am fortunate that cost doesn’t have to be my first thought, but I certainly did consider it. I don’t mind spending more for quality and options, but as my own employer, the tax consequences of my selection were also important.

    I spent several hours sitting in front of the computer clicking, comparing and weighing the options available through the Get Covered Illinois portal. I must admit that several sessions in front of the computer were required. While there is a wealth of information available online, it is sometimes overwhelming. It was also sometimes difficult to compare networks offered by plans, and the information offered on drug formularies was a bit murky.

    As I understand it, the online portal has improved significantly since the ACA plans first launched, and I found it generally easy to use. That said, being able to ask questions and to ensure what is represented online is current and factual offered a certain peace of mind. I ended up seeking further assistance and purchasing coverage through a health insurance broker.

    I won’t be able to report to you on how my health plan is treating me, as my term as president draws to a close in a few short weeks. But my experience has prompted me to reflect on how difficult the process of buying health insurance must be for many of our patients, who generally have much less experience and confidence in navigating the health care system than a physician. While I can’t say I enjoyed the hours I spent shopping for health insurance, I am glad to have a new appreciation for the challenges our patients face before they ever set foot in our offices.




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