Cutting to the chase:

Yes, you read that right.

Thanks to Obamacare, I am eligible for a health insurance plan with a $.03 (that's 3 cents) per month premium, with a $500 deductible/$750 annual maximum out-of-pocket payment.



Ultimately (for reasons I will explain further below) I decided to enroll in a different plan, with a $20 per month premium and a $600 deductible/$600 annual maximum out-of-pocket payment. Which doesn't sound too bad either, does it?

Obamacare isn't perfect, but I can report from the front lines that it is in fact working. It is going to improve the lives of millions of people - and save the lives of many more.

My Obamacare enrollment story:

I'm a starving graduate student student, and am just a bit too old to be allowed on my parents plan. Although I do work part time, I am not eligible for employer provided insurance. Consequently I am in the individual health insurance market, and for the last year have been enrolled in a junk catastrophic insurance program with a $6000 deductible.

I am young and in good health. But you never know what can happen in life. And if, over the past year, I had gotten seriously ill or in a serious accident, I would have been in trouble. Not in as serious trouble as many others who do not have insurance at all, but still in pretty bad trouble... Come to think of it, if I am not quite out of the woods yet. If I get in a serious car accident or something like that over the next 31 days, I will still be in trouble... I guess had better drive safely...

So on October 1st, when the Obamacare exchanges first opened, I tried to make an account right away at healthcare.gov, and ran into the same sorts of problems that everyone else did.

Over the past couple of weeks, I periodically tried a few times again, made a few additionally accounts, got further through the process, but ran into additional errors at later stages. So I decided to wait a bit until the website was fixed.

On Saturday morning I tried again. Saturday was (drumroll) November 30th: the magical-fairy-deadline-day on which the site has to work, or else Obama's presidency will forever be a complete and unmitigated failure, according to our pundit overlords. After all, getting Bin Laden was unimportant child's play, which is why Dubya never bothered to do it. So, here's what happened when I went to the website on Saturday morning.

In the enrollment process, you have to verify your identity through a private credit rating agency (Experian). Because I am a young person without much credit history, I don't have ... much credit history. That meant I could not initially verify my identity on the healthcare.gov website. So I had to call Experian, and after 5 to 10 minutes on the phone my identity was verified, and poof, I could go forward with my application.

After that I had to enter in in a bit more information and estimate my income for 2014, which the website needed to evaluate my eligibility:



As expected, I am eligible to purchase insurance through the exchanges. I qualify for a premium subsidy of a bit under $200 a month, which comes out to a bit more than $2000 a year. I still have to send proof of my 2014 income by Feb 28, which I can do by sending in W-2s.

In addition, because I am a starving grad student, I qualify for a plan with "lower copayments, coinsurance, and deductibles." What that means is that I am eligible for "Cost-sharing reduction plans", which are a special type of silver plan. A standard silver plan covers

70% of the average costs of healthcare, but because I am a starving grad student, my "Cost-sharing reduction" silver plans cover 94% of the average costs of healthcare. This essentially converts a silver plan to the equivalent of a platinum plan.

So if I do get sick over the next year, I will genuinely be able to afford it, which would not really be the case if I had a multi-thousand dollar deductible, like my current catastrophic plan.

However, if my income were a bit lower, I would not be eligible for health insurance on the exchanges at all. People with incomes below 100% of the poverty level were supposed to be included in the Medicaid expansion. But unfortunately, thanks to the Supreme Court and many Republican governors/legislators across the country, who decided not to expand Medicaid in red states, millions of people will not be able to get the health care that they need, simply because they are too poor and live in the wrong states. And in fact, if earn even $1K less than anticipated in 2014, I will lose my Obamacare subsidies. So nothing had better go wrong. [EDIT --- thanks to the comment from guyeda, you don't lose subsidies in that situation, at least for 2014. But I'm not sure if it effects your eligibility for future subsidies. In the signup process you have to agree that the IRS can look at 5 years worth of taxes, presumably to see whether or not your estimated income matches your actual income.]

With my eligibility confirmed, I was ready to select an actual plan. I already knew basically what was available and basically what plan I was going to pick, because I had done a bit of research over the past month or two. Two really useful websites I found are Value Penguin and The Health Sherpa, which both have good estimators of the costs of Obamacare plans. They have pretty accurate estimates of premium subsidies (mine were off by about $10). But keep in mind that neither includes the Cost-sharing reduction plans, so if you are eligible for those that will substantially reduce your deductible/coinsurance/copays/out-of-pocket maximum. So if you are still having any trouble with healthcare.gov, you can look at those sites in the meantime to see what is available and to get a rough idea of what it might cost you.

There's a menu on the right where you can filter what plans you want to see. So I selected the Cost-sharing reduction plans.



And when I did, I was (pleasantly) shocked by the first Cost-sharing reduction plan that showed up on my screen.I knew enough to know that I was going to have lower premiums. And I knew that the premiums for some of the high-deductible bronze or catastrophic plans (similar to my current plan) would be essentially completely covered by the premium subsidies (what happens in that case is you pay a nominal premium of $.01 or $.03). And I knew that the combination of premium subsidies and Cost-sharing reduction plans would make a silver plan affordable for me. But you can't see the effects of the Cost-sharing reduction plans outside of the actual healthcare.gov website, before you enter in all your info. And so while I was expecting to see options that I could afford, I was not quite expecting to see a Silver plan with a $.03 monthly premium, a $500 deductible, and a $750 out-of-pocket maximum!!!I seriously considered taking the Silver plan from Humana with the $.03 monthly premium. That would probably be a pretty good choice for most people, and most likely would have been just fine for me as well. However, the network for the Humana plan only exists in Texas (and only in part of Texas, actually - so if you are from Dallas, better not get sick in Houston, and vice versa).

I mentioned earlier that I am a graduate student. But I didn't say that I am an out-of-state graduate student. That means I spend, or may spend, a significant amount of the year in different geographical locations. And unfortunately, there is no medicine that makes you immune to sickness and injury outside a specified geographical boundary. And so I ultimately decided to spend an additional $20 a month on a BC/BS plan with very similar benefits, but which includes the BC/BS national network. This plan has a similar $600 deductible with a $600 maximum out-of-pocket payment.

What if I were to get seriously sick when I was in the wrong geographical location? I could get stabilized in an ER, but then what if I needed more? If you are in the wrong place for a month, and you break your leg, should you just let it be broken until you are able to go back to place where you have coverage? This sort of thing could easily happen - and does and will happen - to anyone, even if you are just traveling for a week.

It's astounding that we live in a world in which I can type a diary and transport it electronically to computers on the other side of the world, where it can be read. But at the same time, if I transport myself to Arkansas, and if I have the wrong health insurance plan, I can't see a doctor? How anachronistic is that?

So then I hit the "enroll" button, went forward a few more pages, and confirmed that yes indeed I wanted to select the BC/BS plan.

Now my status is "initial enrollment." That means that my information is supposed to be sent to BC/BS off the back end of the website, and then BC/BS is supposed to contact me. I am not sure when exactly that will happen, but I am sure that it will happen eventually. However long that takes, it will be orders of magnitude less time than millions of people have already waited to obtain access to health care. I'll probably wait at least a week or so and then maybe follow up to make sure my info got through to BC/BS.

Then, after I make my first $20 premium payment and after January 1, my new Obamacare coverage will go into effect!

Other than that, all I have to do is send in some W2s, and ... CANCEL my current junk insurance plan for January 1st!!! And then, come January 1, I will sleep a little more soundly.

Obamacare is a good deal for me and a good deal for society:

I think it is pretty clear that Obamacare is a good deal for me. I can get much better health insurance than I had previously, for much less. If I get sick, it will cost me enough that I will definitely notice it, but it won't be an enormous irreparable setback.

But is my Obamacare also a good deal for society? Even if you are a committed Tea Party Randian totally devoid of simple human compassion for the sick and injured, I would think you would have to say yes.

It is a good investment for society to keep me alive and in good health. Society has already invested a lot in me to get me to where I am today. That's a sunk cost that society is not going to get back if I were just get sick and die due to lack of sufficient health insurance. I'm just at the point where, over the next 10 or so years, I am going to be able to start really contributing back to society. What goes around comes around. So if my arm were to fall off, I'd like to think that it is in society's best interest, and not just my own best interest, that it gets sewn back on.

How to improve Obamacare:

Like I said at the beginning, I don't think Obamacare is perfect. But it is definitely going to make life much better for a whole lot of people. The website is not going to work 100% of the time for 100% of the people, but it works well enough that you can most likely get through it if you try and if you are willing to pick up the phone if necessary. The website may go down for a bit again at some point in the future, and there may be a few other hitches here and there. But in the end, it is going to work.

Having gone through the process of signing up, here are what I would say are some of the things that need to be done to improve Obamacare. Most of them have little to do with the website, which seems to be more or less working at the moment, and which will continue to get better with time on its own accord.

Identity Verification - There is no legitimate reason why a private credit report company should be involved in verifying your identity on healthcare.gov.

Who ever thought that having a mortgage or a car loan was a prerequisite in order for a doctor to stick a light in your ear or to hit your knee tendons with a hammer? And no, placating some lobbyists does not count as a legitimate reason.

Medicaid - Like I said, if my income were a bit lower, I would not be eligible for the Obamacare exchange. I would be supposed to be eligible for Medicaid. Except it was not expanded, thanks to the efforts of people like John Roberts and Rick Perry. And if my 2014 income turns out lower than expected, who knows whether I will be eligible for 2015. It's possible that I might have no eligibility in 2015. And millions of other people have no eligibility right now. Medicaid HAS TO be expanded nationwide, or millions of people will continue suffer for absolutely no purpose, and incidentally it will cost more because the cost of visits by the uninsured to the ER end up being picked up in the premiums of the insured!

Dental Care - Adult dental care is not covered. Why? I have five orifices on my head. My mouth, my two ears, and my two nostrils. People are going to start getting into a car crashes, knocking out teeth, breaking noses, and detaching earlobes. What's going to happen? They are going to sew the earlobes back on, tend to the noses, and ... just leave the teeth be? After all, it's not like you need teeth to chew. How does that make any sense?

National Networks - One serious problem, and a problem which certainly predates Obamacare, is the fact that people travel. A health care system based on the idea that people spend the entirety of any given year in one metropolitan area, or in a single sate, was obsolete in the 20th century - much less in the 21st century. There exist things called cars, airplanes, telephones, and the internet, which allow us to move across and interact across space. It is true of course that you can get ER treatment basically anywhere. But if you are from California and are, for whatever reason, spending some time in New York, on many/most health insurance plans you have to travel 3000 miles to get basic covered medical treatment? Again, how does that make any sense?

Public Option - My greatest disappointment in signing up for Obamacare was my inability to enroll in a public option. I am being forced to support a parasitic private insurance industry, which violates my freedom of choice. If you can conscientiously object to war, you should be able to conscientiously object to private health insurance and enroll in a public health care.

Moreover, you would think Republicans would wholeheartedly support the public option. If "socialized medicine" is really as terrible as they say, then you would think they would be happy to watch all the progressives enrolled in the Public option get killed off by it. This would reduce democratic turnout and complement voter ID laws.

Simplification - I'm computer savvy, I'm a political junkie, I followed the debate and passage of the Affordable Care Act very closely, and have been waiting for the ACA to go into effect (hoping that I wouldn't get sick in the meantime). I am a college graduate, am in grad school, and have been fortunate to benefit from more educational opportunity than most people. But despite being relatively well informed and knowledgeable, I found the process of signing up for health insurance through Obamacare to be overly complicated and confusing. I can only imagine how much worse it must be for people who are not political junkies, are not computer savvy, and are not highly educated.

What is complicated is not even so much the website, but is all the different options, trying to understand the complexity of how precisely Obamacare effects you given your particular circumstances, and in understanding what exactly all of the insurance industry jargon means. In order to really make educated decisions about which health insurance plan to choose, you need to know almost as much as someone who is an insurance agent as a full-time job. The idea that every citizen can or should be an expert on the minutia of insurance is simply absurd. The same problem plagues all sorts of similar privatized public services, like privatized electricity markets and (may it never happen) privatized social security markets.

In Western culture, and particularly in America, we have this cultural idea that more choice is always better. In reality, as psychologists and behavioral economists have come to understand over the past few decades, that is not the case at all. If we have too many choices and if things are too complicated, we shut down, make less well-informed choices, and are less happy. If you eat 1000 pounds of ice cream you are not more happy than if you eat 1 cup, but are less happy. Likewise, if you have 100 choices you are not necessarily better off than if you have five choices (or only one!). At the very least, there need to be simple default options from which people automatically benefit if they simply do nothing (a public option would fit well here).

Single Payer - This follows fairly directly from simplification. more efficient. What is not to like? Nothing but vested interests and ideology. All we have to do to see that it works is open our eyes and observe it in action in other countries.

Bottom line:

The healthcare.gov website is working. Maybe not 100%, but it is definitely way better than it was in October. If you try, you can get through and sign up for health insurance. You might have to pick up the phone at some point or may have to create a second account if you run into an error somewhere, but if you give it a shot you should be able to get through. Obamacare is imperfect, but is a great improvement over what existed before. When people see what they are eligible for, if they see anything even remotely like what I saw, they will be happy that they signed up for Obamacare.