21
healthcare rocks
I spend too long on these stacks. I was working on two other projects I wanted to complete before I got sucked into editing another stack to oblivion. Then I listened to this Hidden Brain podcast episode that explored the idea that it is almost impossible to care about something if it is an abstract idea and you don’t have a personal connection or know someone directly impacted by the abstract thing. We get angry at people who don’t care about something we care about when the science of it is that they are trying to live through their hard life and the thing we want them to care about is, yes, bad, but is also abstract. It’s a pretty simple idea. Of course I care because I have a personal connection. But it’s a nice, “duh,” to hear on a research-backed podcast.
I gave myself a week to write about how healthcare has been the dominating deciding factor in how I move through life. I’m not writing this to say my life sucks, feel bad for me. I have a good life, don’t feel bad for me. If you’re not impacted by the Affordable Care Act and the tax subsidies set to expire at the end of the year, this is my Hidden Brain effort.
WHAT HITS
I went to see Nation of Language with my friends Rebecca and Griffin the other day. NoL was great but a Gen Z band called Greet Death opened for them. We kept turning to each other during their set saying, “they rock,” because they did. They went for it so hard and were funny and awkward between songs. Nothing is cooler to me right now than this band.
A DRIP on healthcare
On November 1st, I looked up my new ACA health insurance premium estimate without the tax subsidies. It increased by $400, from $350 to $750/month. It’s a Silver Healthfirst plan. I am healthy enough I can drop down to a Bronze plan at $412/month and pull it off. I’ll be able to pull this off because I am healthy enough? Correct, it’s an insane thing to write. Bronze and Silver ACA plans are bad to mid. The copay sits around $50-75, the deductible is typically $10,000, you have to be referred to specialists by primary docs for half the plans, and it’s not a walk in the park to find a primary care doc that will take them. But they’ll save you from a surgery bill. I end up paying out of pocket for telehealth startups like Wisp and Honeydew even when I’m on ACA plans because paying $50-$150 for their telehealth options is a more cost effective route for some treatments. I’m single, no kids, and have an ethical employer that gives me a health insurance stipend. I don’t have anything that needs continuous treatment or medication. I saw this mom online who has a severe lung disease and their family premium increased to $4,500/month because they have to keep the highest tier coverage. I don’t know how you move through a day after that number.
I am not the first person to live a life. Not even the second. People have had to make major changes in their life because of money for forever. Let me kick off this writing with an “I’m good” sandwich. I’m good (bread). I’ll remind you at the end (other bread). I will take the life I have been given. I do not want another. But I’m not stupid enough to believe I need to work a little harder to succeed while Mike Johnson sends the House into an indefinite recess. If you need a personal story to connect you to an abstract idea, here is a timeline of how health insurance has fundamentally shaped my life (meat).
I am from a small town. I studied theatre at a state college. I got the degree in three years instead of four to save money. I moved to Chicago. I got a part time job at a bakery for 30 hrs/week at $13/hr and realized that wouldn’t work if I wanted to do anything other than pay rent and work at a bakery. I became a nanny. I worked 40-50 hours/week. I started taking improv classes and got placed on teams. I left the nanny family after a year and a half to try and pursue my acting career harder before I was kicked off my parent’s health insurance at 26. I got an after school job with the YMCA. I met a friend through improv who told me to get my group fitness degree and she’d hire me at her gym instead. It paid more than the YMCA but not enough. I picked up more work. For a stretch of about three years, I worked as a group fitness instructor, an after school nanny, and I’d wake up at 5am to clean a climbing gym two to three times a week. This was enough money to pay for classes and fly to weddings and buy PBR after shows. In 2018, towards the end of this chapter of jobs, I got an agent. Awesome. Sort of. Anytime I had an audition, I would have to ask off of work which would piss every boss off. Anytime I didn’t have time for an audition, I would piss my agency off. I performed at night. I went hard as I knew I had a limited time before I lost health insurance and a small window to cover as much ground as I could with the agent.
I turned 26 and lost health insurance in 2019. I’m grateful I got this window and could be on my parent’s health insurance. I lived without health insurance for about six months of that year. It’s dumb but it’s what any artist is doing basically all the time. You either have health insurance and are working too much and don’t have time to focus on getting your career moving. Or, you don’t have health insurance and have more time and money to focus on your career but you’re stressed about your health. These patches of not being on health insurance start to cut into your relationship with yourself, or they have with me. If I can’t afford health insurance despite working three jobs, I deem myself failure. If I fold and get a full-time job that doesn’t bend for my auditions, I deem myself failure. This mutates to shame. Any mind-body connection you have gets twisted and shoved through Chase Bank while you tell yourself it’s nothing and take store brand Nyquil again or search Reddit to see if anyone else has had this type of discharge. They have, they’re not on health insurance, but their cousin’s friend is an OB-GYN and here’s what she has to say. In late 2019, I got a much better agent. Awesome. I also had severe acne and knew I wouldn’t book because of it. I needed Accutane, a six to eight month treatment. I needed to take a full-time job for good health insurance.
Quick note on full-time versus part-time here. Multiple jobs are great as an artist because you only piss off one boss at a time if you have to take off for an audition or gig. Full time jobs are harder because you piss the same boss off every time. All bosses in the interview say, “of course we’re open to this, as long as you’re fully committed to the company and never plan on leaving.” They’re not open to it. It’s fine. They have to do their job too, which is to find someone who shows up and does the job. We’re all in the same machine.
I got an offer to be a full time fitness manager and accepted. I was on two improv teams, had an agent, was producing my own work, and was trying to have a social life. I was going too hard, a recurring theme. I did not have time to have a full-time job but I had no choice if I wanted to book (acne). The fitness job agreed that I could leave for auditions but any time I would need to leave they would get pissed off. So, I ended up saying no to more auditions and pissing off my newer, better agency. Then the pandemic struck. I lost my job and got into a theatre company that offered a health insurance stipend in the same week. All artists were cooked. Every artist I know had to make such drastic decisions at this time. Good job everyone. That sucked.
From 2020-2022, I nannied part-time and worked at the theatre company. Thanks to the stipend through the theatre company, I got an ACA plan. I had a $200 stipend so chose a plan around $400/month. It was a low tier plan and I tried my best to never use it. Thank God I had it. In late 2021, I had a deep pain in my gut after a session at the gym. I went to urgent care and my plan wouldn’t cover using a sonogram machine despite their being a sonogram machine onsite, so a physician’s assistant massaged my stomach and said, “I think you have an umbilical hernia?” Four weeks later, I met with a primary care doctor who felt my stomach and said, “You have an umbilical hernia.” Surgery a month after that. I paid $6,000 out of pocket in two installments. I don’t spend money. I don’t travel to Europe. I don’t eat out. In those days, as in ages 21-27, I’d only let myself go to Aldi and spend $40-50/week. If I didn’t take the bus, I let myself buy a snack for the walk home. I wish I could tell you I had saved $6,000 to spend on risk or experience but I was saving it for the inevitable - when something gave in my health. I’m grateful I did. I had it when I needed it and had no medical debt.
Surgery drained my savings but I was ok. Things were tight but I was pulling it off. I had to stop part-time nannying and get another full-time job to get off a bad ACA plan and start saving for what I’d lost. I couldn’t pull off an agency and the theatre company and a full-time job. I quit my agency. This was a sad day. But whatever. I got another full-time job in person at a gym and went full zombie. I worked seven days a week between the job and the theatre company. 40/hrs selling memberships at the gym, 25 hrs/week rehearsing and performing at the theatre. I convinced myself getting a remote full time job would solve all of this. After a year at the gym, I landed a remote job. A week later, my friend died. Same song, different verse. Working seven days a week, totally burnt, and now? Grieving. Rock on. But whatever. I couldn’t do another $6,000 surgery.
I lasted a year at that remote job. It was high pressure, demanded peak performance, and it turns out, working remotely from your studio apartment while in deep grief isn’t good for you. But I lasted a year. I had saved what I’d lost. I could afford to leave it. I found a part-time nanny job a month later. My nanny family rocked. They knew about my theatre company and respected my time and the kid I raised effectively saved my life. Every piece of that decision was worth it. It was enough money to get by, to catch my breath. That’s all I needed. After leaving the remote job, I didn’t apply for an ACA plan. This was a poor choice but I knew I’d be opting into a bad plan. I was just blitzed. I was so angry at this point, steeped in grief. Not having health insurance felt like some F YOU to the system even though it was just an F YOU to myself. I figured I’d give myself the summer without $600 going to another mid ACA plan (higher tier, as I’d learned my lesson from the surgery) and then find another full-time job.
I found a small lump under my arm in May. It grew. In July, I went to the doctor out of pocket. She felt the lump and then felt my thyroid and felt a mass there, too. She suggested a pap smear, too. This doctor had a heart-to-heart with me in that examination room about how messed up the healthcare system was but why I needed to take the financial hit to diagnose what was going on. For a two week span, there was a chance everything was connected. The pap smear came back irregular and I needed an Endometrial Biopsy. They couldn’t figure out what the lump under my arm was. A cyst? A tumor? A swollen lymph node? The fine needle biopsy from my thyroid came back at a four on the Bethseda scale which means “undetermined” which translates to “good idea to get this out because it could be pre-cancerous.” This was a challenging time. I imploded and walked through the world scotch taped together by a lot of people that read this stack. So now you’re thinking, surely you applied for an ACA plan at this point? I couldn’t. There’s an enrollment window for ACA from Nov 1st - January 15th. If you miss it, you can try to apply but they’ll say “you were supposed to apply in the enrollment window.” Ok. I found an out-of-pocket insurance plan through United. It covered nothing. I used it for one of the many appointments. They sent me an itemized bill and the plan covered no part of the appointment. Nothing to do but laugh.
I got the $100,000 estimate for my surgery and remember thinking, “Am I worth this much?” Terrible thought, right. But you have them. I remember where I was sitting when I got the estimate. I remember how the light hit my knee. I also remember where I was when Medicaid told me I was approved and the surgery would be covered. I was walking down Ravenswood, the day before surgery. I stopped and cried with the Medicaid rep on the phone and she was like, “Woah, woah, woah, you’re ok. This is what we’re here for.” I hung up the phone and sat on the curb with my head between my knees. A very gentle old man approached me like I was a hurt dog and said, “Are you ok?” I was ok. I had the surgery the next day. It was benign. The under arm lump was a cyst. The irregular spot on my uterus that flagged irregular was chilling, too. It was all ok. But I was spiritually and emotionally and physically shot. I didn’t want to leave Chicago but I didn’t know what else to do. I had racked up about $5,000 in medical bills before Medicaid saved the day. I went to live with my parents in Denver for a year and a half to fast track paying off the bill and collapse.
Are you dizzy? Yeah, me too. This is something I hate. When you look at my moves, at my resume, I look like a person that can’t make up their mind, a person that is career hoppy and non-committal. I really, really hate this aspect. Every pivot was because I’d either saved enough money to justify switching to ACA health insurance and going harder in art or because something happened and I needed to swing back to a full-time job that provides health insurance. I hate this for all artists. Our resumes are wild. But it’s not that we don’t work. Everyone’s working their tail off before they reach their line. Because there is a line when you know you can’t take this lifestyle anymore. Every day is fighting it.
Every pivotal decision I have had to make really would have been different if I had access to healthcare at a decent price point. I’m not saying if I had health insurance, I would be successful and happy and my life would be perfect. I’m saying, I would’ve been able to make different decisions. They wouldn’t have even been decisions, you feel me. Not even the third, man. I am not even the third person to live a life. Alright. Thus ends the meat. Bread time again.
I am privileged enough that my parents would’ve helped me if I would’ve asked. They hated finding out I wasn’t on health insurance. I had too much pride to ask for their help. For both surgeries in 2021 and 2023, my mom was able to travel and support me through recovery. She was incredible. My parents just let me stay at their place with free room and board for nearly two years. I knocked out that debt. I loved getting to know my parents better in Denver. I wouldn’t trade that for anything. In the medical Chicago crashout, I had friends that would take me to every appointment. The love was endless, I couldn’t believe it. Neil drove me to the suburbs for the sonogram. Abby drove me to Sonic after the first biopsy. Hannah drove my Mom and I to the ER. Allie talked me through so many stressful moments in our apartment. My siblings and college friends texted me off the ledge every day. Anna taught me how to negotiate lower bills with hospitals. A past nanny dad picked me and my mom up from surgery. A past nanny mom called her friend who was a gynecologist to help me write up a list of questions for my endometrial biopsy. My ex put me in conversation with another doctor friend so I had someone to text questions after appointments. He flew back to Chicago to be with me for a weekend just to support. My older brother and his wife are both in the medical field and fronted questions at all hours of the night. My grandma would call and pray with me on the phone. I had some of the best surgeons in Chicago for both surgeries. There’s fifty people I haven’t listed. And everything is good now. I have to watch my thyroid but I don’t have a chronic, untreatable illness. Everything is so, so ok. It’s a beautiful day, every day. I didn’t understand that before. Life had to absolutely crash and burn for me to learn that. I wouldn’t trade the ego death I had the day I listened to the meditation on “waiting for test results” that told me, hey, your body is nature. I remember where I was standing in Welles Park. I remember that light, too. It was one of those BLUE SKY, YELLOW LEAF, CRISP AIR days. All the masses were in my body and undiagnosed and everyone was telling me, “you’ll fight this, you’ll win this,” It was making me crazy. Fight the body I’m living in? Why? I might die. And that brief meditation gave me such clarity, for myself, for the loss of my friend. We’re nature. I may be a tree that got bit by the bug that will make me sick and die. No big deal. I was always a tree. This was always a risk. I am no more deserving of life than any other tree. It didn’t take hold immediately, but two years later I can point to it as a monumental change in how I move through life. The toolbox of wisdom and understanding I have gained, the tactics to endure that I now practice each day, I wouldn’t trade it. But I’m not stupid.
My story is anybody else’s. I moved to New York in May. Half of the artists I meet still live without health insurance. I was at a party the other day and someone was talking about how there is a good portion of their back that is numb but they don’t have health insurance right now. I pulled what the doctor did for me and told them to get it checked out, debt can be figured out later. If Congress continues to refuse to negotiate, the cost of health insurance will, once again, dictate the direction of at least thirty million people. Probably far more. I’m a case that can handle it. I am healthy. I have a job. My plan did not increase to $4500/month. I can justify pulling a Bronze plan off for a year. But I can’t do that for a life. That’s fine. I am lucky enough that there are things I could go back to school for and love to do every day. It won’t be a choice I make because I want the thing any less. That’s fine, too. The goal is to keep on. It’s a vague goal. In New York, I find myself being asked who I am and what I’m doing a lot. I’m pretty bad at it because I don’t care. The consequence of learning every day is all we have is your once freak like ambition turns to sand. When Georgia O’Keeffe’s eyesight grew so poor she couldn’t paint, she started to collect rocks. I learned that three years ago at her museum in Santa Fe and it’s the only goal I’ve got. If I can’t do the thing how I thought I would do the thing, so be it. I’ll look back for one blog but no longer. There are rocks to collect. I have a writer friend turning 26, about to be kicked off her parents’ health insurance. She texted me the other day and said, how do you do it. I said, beats me.
WHAT’S UP, _____?
Traditionally, this is where I ask a real human person to answer two questions about their life but I forgot about this portion in my self-imposed week to write time crunch. Here is an awesome picture I took the other day of someone whose responses I wish I could feature here.
See you either in three weeks or in 2026-2027. xo.
So beautiful Cat. Right there with you <3
really, really good