The Democratic Party

of Hood County, Texas

Lifetime Caps

July 24, 2017


The editors of this blog received the following article from one of our local party’s members. It provides a powerful testimony to the effectiveness and humanity that Obama’s ACA provides to American families. Please share this post widely as Republicans remain determined to destroy this woman’s family and many others like hers. And no one knows who will be next; we only that it could be any one of us, at any time.


In 2007, a man from a pharmaceutical company came to my home to discuss health insurance with my husband and me. My husband is a very profitable patient to them. Each patient who depends on their particular drug costs the insurance companies, over a lifetime, hundreds of thousands of dollars a year, thus making the drug companies a lot of money.

The man said, “I am visiting patients who are about to reach their lifetime caps on their insurance. I have a top ten list from all over the country.”

I naively asked, “Is my husband on the list?”

His reply: “He’s Number One.”

He was weeks away from reaching his cap and losing his health coverage and we didn’t even know it.

This was before the Affordable Care Act, better known as Obamacare. There were lifetime caps on every policy back then. Typically, these caps were around $1-2 million, a “lifetime” amount that my husband could reach in as little as 2 years. The problem this time was that his policy was in the “State High Risk Pool,” the last line of coverage for those in high need. Yes, the Risk Pool policies for those that are medically desperate also had a lifetime cap. And no other individual policy will ever accept you once you have capped out of a Risk Pool.

“Okay, so what can we do?” I asked. The drug rep explained our options.

  1. We could move to New Mexico (where we had no jobs, no family, and no home) or…
  2. I could quit my career and get a job at a large employer where I would add him on my insurance and his high medical costs wouldn’t be noticed by the sheer numbers of people on the group plan. I had lots of questions. “How would this work? If I got another job, what if my insurance didn’t start for 90 days? What if we were rejected for a pre-existing condition?”

While my husband’s condition is manageable with medication, without it, his life could be very short and would be filled with incredible pain. He could become disabled and not be able to work. Ninety days without medication was not an option.

The rep explained that we could apply for help with multiple drug companies and, with our doctor’s help, receive samples of medication to get him through (which is not an easy process).

And that is exactly what we did. We got the samples, and I found a new job that would offer me group health insurance. I even explained to the owner of the small business what my husband and I were going through and he agreed to start our coverage on day one! Hallelujah!

I’ll never forget, about a year later, when I overheard the owner’s discussion with his HR manager. It seemed his new group health insurance quote had gone up by 50% “because of one very expensive patient.”

The next day, I was fired. A lesson learned: when you are medically costly, you never, ever tell your employer.

This was our life back then; a constant fear of being outed to employers. Fear of capping out. Fear of losing a job that is providing insurance. Fear of being able to afford insurance. Fear of being denied insurance because of a pre-existing condition. All this in addition to the stress and fear that comes with living with a catastrophic condition.

Then, everything changed.

The Affordable Care Act became law. Capping out of insurance would never happen again! No more denying of pre-existing conditions. Risk Pools… a thing of the past! Like Joe Biden said: it was a BFD.

A weight had been lifted off my family’s shoulders. No more making career decisions based on insurance. No more wondering if we would have to pick up and move out of state one day. No more worrying that becoming unemployed and not being able to find a new job within six months could make it impossible to get insurance ever again. What sounds impossible now was a real possibility then.

Since the start of the ACA, we haven’t thought about these things. We’ve been living our lives, working hard to build our careers. We added our son to our family. My daughter graduated and went off to college. We bought our dream home. We didn’t think about things like lifetime limits, caps, waiting periods, gaps in coverage. The phrase “pre-existing condition” was rarely heard. We had almost forgotten how much our insurance loomed over us in our early married life. I could never have imagined how these phrases would re-enter our world. Now all you have to do is turn on the news to hear them daily.

The fear is slowly seeping into our lives again. The phrase “pre-existing condition” is on every cable news pundit’s lips. With every politician’s promise to “Repeal! Repeal!” I feel as though a scab is slowly being pulled off. Anger wells up in my body as they casually talk about lifestyle choices and health savings accounts. Single-payer or a consumer-driven market? This amendment or that amendment. Debating if insurance is a right or a responsibility. Every politician has an opinion but none of them seem to understand—or maybe they just don’t care about—the number of people who could suffer. It feels as though they are deciding our future and we don’t even get to be part of the discussion.

I realize that Obamacare isn’t perfect. I do know that there are improvements to be made. But we can NOT go back to 2007. We cannot go back to when vulnerable people had their health dictated by insurance companies’ bottom lines. We, and families like us, don’t care about insurance company profits and politicians’ campaign promises.

Health insurance is life or death for us. It’s not an option. It’s not a choice. The Affordable Care Act means that we are able to get my husband the medication that his life depends on. It’s the freedom to start a business or change jobs. It means that we can live our lives and raise our family.

The Affordable Care Act means that I will never have a pharmaceutical rep show up at my door to tell us that we are weeks away from not having insurance. My husband is Number One to me but I never want him to be THAT Number One again.

Images: source