PERRY BACKUS for the Ravalli Republic | Apr 9, 2017
Editor’s note: This is the first of an occasional series on how Ravalli County residents have been impacted by the Affordable Care Act.
Wendy Dutton spent years working to ensure that her family had health insurance.
As a para-educator at Hamilton’s Daly Elementary for years, most of the money she made went to pay the premiums.
From that job, she continued her love of working with young children with a position at Hamilton’s Head Start program. Once again most of her paycheck was gobbled up by health insurance premiums that always seemed on an upward trend.
But then, her sight began to fail.
“I had to quit working when I was unable to see very well,” Dutton said.
When she was forced to stop working, she and her self-employed husband looked into buying their own health insurance, but it was more than they could afford.
“For a whole year, we went without insurance,” she said. “It was a scary time for us.”
Her eyesight continued to grow worse as she was referred from one specialist to the next. After nearly two years, a physician ordered an MRI, which spotted the tumor that was growing in her brain.
“One day, I really noticed the difference,” she said. “I took all three grandkids to the duck pond. It scared me that I couldn’t see very well. And so, I stopped driving.”
She now carries a piece of paper in her purse with the name of her condition: craniopharyngioma. That variety of benign brain tumor develops near the pituitary gland and often impacts the optic nerve.
Two years ago, on Friday, March 13, Dutton had surgery to remove the tumor.
“I asked the surgeon, ‘what if I don’t do it?” Dutton remembers. “He said I would die.”
And she remembers that when the hospital employees began talking about the cost of the surgery, she could hardly comprehend it. The estimate ran between $150,000 and $200,000.
“They wanted me to sign something that said I would pay it off in a month,” Dutton said. “My husband and I had worked too hard for too long to build our home and our nest egg. I wanted him to have it. I told myself that I’ll just die.
“My kids and my husband made me sign the papers,” she said.
Dutton was one of the first in Ravalli County to sign up for health insurance through the network created under the Affordable Care Act.
Even though she had a pre-existing condition, it allowed her to buy health insurance.
“I was very excited when it came out,” Dutton said. “That was a scary time for us when we didn’t have insurance. We probably wouldn’t have had insurance when it came time for my surgery if that hadn’t been available.”
Today, Dutton can see shadows in one eye and has pinhole vision in the other. She’s considered legally blind.
“I’m still able to see my grandkids,” she said. “I’m not sure that I can even put into words how thankful I am that we were able to get insurance.”
After her surgery, Dutton wrote then-President Barack Obama to voice her thanks.
In a return letter dated Aug. 10, 2015, she received a reply from Obama, who said he was encouraged to hear from people who have benefited from the Affordable Care Act.
“This law has always been about freeing Americans for the fear that one illness or injury could cost you everything it took a lifetime to build,” Obama wrote. “We have more to do to get there and I am going to keep fighting every day to make sure this law works for everyone.
“Again, thank you for your thoughtful letter – your story pushes me to ensure every American knows the peace of mind that comes with quality, affordable health care,” Obama wrote.
Kate Duggan works as a certified application counselor at Hamilton’s Sapphire Community Health clinic. It’s her job to help people navigate the Affordable Care Act Health Insurance Exchanges, including Dutton.
Duggan said obtaining health insurance been a life-changing experience for many of those she’s helped.
“Many have come in here with significant health issues,” Duggan said. “For the first time, they are finally getting to go to a doctor to get lifesaving medications. It’s provided them with a financial piece of mind that they never had before.”
For the first time, many aren’t using the emergency room as their entry into health care. Instead, they are seeing a physician who can offer preventive health measures.
When the enrollment period opened in 2016, Duggan said there was a dramatic jump in people hoping to get insurance through the exchange.
“Oh man, that first week of November was busy,” she said. “It felt like people felt that there was an urgency to get it done quickly. My impression was they felt like if they had insurance, there was sense of security. They seemed to feel like they were at less risk of losing it.”
Duggan said the other factor driving the increase in people seeking her out this year was a significant rate increase by Blue Cross Blue Shield. Many people who had insurance through the exchange with that company saw an increase of 60 percent in their premiums.
The other two companies in the state exchange had increases ranging between 25 and 30 percent, Duggan said.
There are adjustments occurring with the insurance market. There are fewer plans to choose from and consumers are finding their options are more limited.
“The market is trying to stabilize,” Duggan said. “I think it’s going to take a while for that to happen. This was the fourth enrollment period. It’s hard for insurance companies not to react to what’s become a pretty politicized environment.”
Duggan said many people came into her office this year upset over the large increase in premiums they had received from Blue Cross Blue Shield.
“The majority of them came in and told me that they would not be able to afford their health insurance any more,” she said. “Most left with a better plan for less money…I had people come in so frustrated that they said they planned to pay the penalty rather than pay for expensive health insurance.”
“They ended up leaving with a health insurance plan that was cheaper than the penalty and they actually got something for their money,” Duggan said.
Duggan said there are some people who are not getting any benefit from the current version of the Affordable Care Act.
“There are definitely folks who don’t love the plans that are available to them,” she said. “They get no tax credits. They are just paying to have an insurance card because the plans have really high deductibles. I can feel their frustration.”
“Why wouldn’t they just pay the penalty?” Duggan said. “I can’t tell them which plan to pick. I can show them the different scenarios. It’s up to them to make the best decision for them. I have had people who say they are just going to pay the penalty.”
There’s not an easy solution to make it work for everyone.
“I think the situation is very complicated,” Duggan said. “Obviously prescription and medical costs are high in general. The ACA has a lot of different parts. They are all pretty necessary to make it work. Even the unpopular parts of the bill are there for a reason.”
"Most of the people I work with in the Bitterroot don't give a hoot about Washington DC politics," Duggan said. "They just want to be able to go see a doctor when they need to."