Heart Patient Learns Firsthand: The Affordable Care Act is NOT Affordable.

As a heart patient with a defibrillator and pacemaker due to life threatening arrhythmias, I must live with taking a certain amount of daily heart medications to survive. Months ago, I was hospitalized due to a shock by my defibrillator. The medications I take are supposed to control these deadly arrhythmias, but thankfully I have back-up when medications do not work.

While in the hospital, it came to my physician’s attention that I was being given the generic form of one of my heart medications. He asked me when this switch occurred and told me to tell the pharmacy that I was absolutely, under NO circumstances, to be taking the generic form of the drug! Apparently, many people with my condition have reported problems with the generic form, although it seems to work well in people with other conditions, and even though the active ingredient in generic brands is supposed to be the same as the brand-name drug.

It is important to note, however, that the FDA allows generic drugs to use different inactive ingredients such as binders and time-release agents than their original counterparts. I wondered if anyone else experienced problems with generic drugs and found that an alarming number have. So much so, that ABC Dateline did an investigation and reported in September 2014 that the FDA had actually lied about testing certain generic drugs for safety.

Yes, the FDA lied about the safety of generic drugs. In the face of everything else surrounding the current administration, it is of little wonder, but who else is talking about it? Who else is outraged?

The lie was discovered after a doctor took it upon himself to do an independent study of one extended-release drug that was not performing as the brand-named drug, thereby giving patients an initial jolt of the medication upon ingestion and subsequently leaving them without the medication in their systems throughout the rest of the day. ABC News reported the physician, Dr. Tod Cooperman as saying, “The FDA finally admitted that there actually had never been a study of this generic, and it had never been tested in humans, and that the information in that package insert was therefore, just made up.”

Made up?

The investigation also revealed that many doctors are concerned about the use of generics and have patients reporting numerous side-effects not found in the brand-named drugs originally prescribed. Heart medications, anti-depressants…medications that matter quite a bit to the patients involved.

This news was clearly upsetting to me, so I contacted the pharmacy and told them I did not appreciate being given the generic drug when my doctor prescribed the brand-named drug. I even found out that my doctor had written on the prescription, “No substitutions.” Here I was in the hospital, and it was possible that this was the reason why. This is a life and death situation for someone like me. I was not prepared for what I would discover next.

The pharmacist explained that my insurance company would not allow me to take anything but the generic form of the drug. “Allow” was the actual choice of words used. So the average consumer would probably stop there believing they had no other alternative.

Furiously, I questioned, “…even when my doctor is demanding that I take the brand name?!” The pharmacist was flippant and told to contact my health insurance provider to inquire. I found out that my insurance company would in fact “allow” me to take the brand-named drug my physician prescribed, but the caveat was that I had to pay for it myself. My insurance company (like most I presume) will only pay for brand-named prescription drugs now whenever the generic form is not available. No amount of arguing about it was going to change the situation.

So my choice: Pay the monthly out-of-pocket cost for the generic drug of $40 or pay the the brand-named cost of drug, a whopping $1200!

-Per month.

-For a mediation that I must have to survive.

That is on top of all the other prescription drug costs I pay (about $500) plus $500 a month for my monthly premium, and that does not include co-pays, deductibles, or my daughter’s health insurance costs. And of course, none of this includes other healthcare-related expenses like chiropractic, dental, and so forth.

The other day, my 17-year-old daughter needed some facial cream prescribed for a bacterial infection by the dermatologist. This infection was very serious and I was told she had to have the cream. The cost: $900. I almost fell over. Why so expensive? The pharmacy said no generic is available. So is that the choice now? Pay through the roof or get a generic?

When talking to others, I am astounded to discover how many people split their pills in half or take them every other day in order to lower costs. Sadly, many people forgo medications they need altogether. When choices have to be made, something has to give.

When I helped my fiance with his taxes last month, he told me he thought he would meet the threshold in order to qualify for a deductible due to medical expenses. I told him the threshold was fairly high, and I was sure he would not reach it, not really wanting to look for all the receipts for the year and calculate them all. But I agreed to do it, and I was absolutely shocked to discover that his out-of-pocket medical expenses were well over $10,000 for the year! That did not include any insurance premiums or deductibles he pays for himself or his two children.

Does anyone else wonder why Obamacare is called the “AFFORDABLE Care Act?”

Everyone I have spoken with has seen increases in their premiums, prescription costs, etc. since it’s implementation. More importantly, as I have also experienced, many physicians are no longer accepting certain plans or even taking insurance at all. As a person entering the mental health care profession, all I encounter now is the anger by therapists telling me they bill $100+ an hour for their time, but they can only collect around $30 from the insurance companies. After the time involved in handling paperwork, filings, phone calls, denials in coverage, and explaining coverage to clients, the average therapist is making less than minimum wage. As I pay thousands of dollars a semester to attend graduate school, I wonder why anyone goes into these professions any longer, and question my own sanity for doing it. It seems that every provider in the health care field is experiencing frustration with insurance companies, and presumably, many patients like me are, as well.

The good news is, if you can afford it, you can now go to boutique medical practices and have a whole new experience with doctors who have elected to get rid of the insurance hassles entirely. These physicians perform the tests they want, spend up to two hours with you in consultation, and even see you at your home. This personalized treatment means that the middleman is cut out. So while you must have health insurance by law, if you want to pay for this level of care, you will not be able to use it. More and more doctors are now offering this type of service, and do not be surprised to discover that your doctor is one of them very soon. Cash-only providers are likely to become the norm in many health care professions.

So the supposed point of Obamacare was to offer “affordable” care to everyone, and now only the wealthy will receive the best care. Everyone else will only get tests and prescriptions approved by insurance companies, and the care from providers who cannot afford to branch out on their own and refuse insurance altogether.

Another issue facing Americans today is the lack of accessibility of providers. Many people are struggling to find a doctor that is in their network, discovering that they have to drive hours away or even to other states to be seen. Often times, when a person signs up for an insurance provider, they only discover after-the-fact that the provider’s directory was outdated or their doctor changed networks, and the patient is left with the choice of paying out-of-pocket or out-of-network, or else they must see a new physician. For some this happens in the middle of serious care, such as cancer treatments. Who wants to see a new oncologist or find a new heart surgeon in the middle of treatment? It is happening folks, all over the place.

So while the average American has experienced stagnant wages, many are suffering greatly from the skyrocketing costs of housing, food and healthcare-related expenses. In fact, a Commonwealth Fund survey found that 4 in 10 people have forgone some kind of healthcare due to cost. As much as 10% of median household income now goes to pay healthcare premiums and deductibles, and as many as 46% of Americans are having trouble affording health care, which is up by 10% from last year alone.

“Affordable Care Act?” I think not. It is not affordable, and it does not provide the level of care that Americans deserve and should be demanding.