In the mid-2000s, Bob and Sarah Borgstede had 10 part-time jobs between the two of them and decided to buy health insurance on their own.
However, finding a plan was difficult for the couple in their mid-20s. Health insurance companies denied coverage to Bob and wanted to put him into a high-risk pool because of the acne he had as a teenager, which required he take Accutane.
“The plans that were available to us were catastrophic plans, not a make-good-decisions-for-your health kind of plans,” said Sarah Borgstede, of Belleville.
However Bob Borgestede began having stomach pain, which he ignored until it was so bad he had to go to an emergency room.
He was having gall stones, and eventually would need to have his gall bladder removed.
When he was eventually hired at Southwestern Illinois College to a full-time position in August 2006 at the age of 27, he had employer-based insurance so he could afford to get his gallbladder removed, but still put off the surgery. He didn’t want to take several weeks off from the job he just started.
“What he was weighing, is ‘I need to have this surgery, I need to do the right thing for my job, and our history with health insurance has been difficult,’” said Sarah Borgstede, now 36.
But in March 2007 Bob needed to go to an emergency room because of severe pain. During his six weeks in hospitals, Bob was diagnosed with pancreatitis and had part of his pancreas removed, before dying of sepsis.
Sarah Borgstede said if the Affordable Care Act, which was signed into law by President Barack Obama in 2010, was in place earlier, the outcome would have been different.
Under the ACA, among the provisions are the mandate to have health insurance, as well as allowing people to stay on their parents’ health insurance until age 26, and preventing people from being denied coverage because of pre-existing conditions.
Bob could have had his gall bladder removed while on his parents’ health insurance.
“If we hadn’t been forced into a catastrophic insurance plan because of his acne, then we would have made different decisions on when he was going to have his gall bladder out,” Sarah Borgstede said.
Now the Republican controlled-Congress, along with Republican President Donald Trump are looking to carry out a longstanding campaign promise to repeal and replace the health care law nicknamed “Obamacare.”
A vote is expected on the U.S. House floor on the American Health Care Act, the first in what Republicans say will be a three-step process to repealing and replacing the Affordable Care Act.
Subsequent steps include administrative changes by Health and Human Services Secretary Tom Price, and then other legislative steps that would have to be passed by Congress.
If this becomes which presidential administration gets credit for the best health care plan, that’s not enough. This needs to be about making sure Americans get good health care and not about whether it’s Obamacare or Trumpcare.
Sarah Borgstede, 36, of Belleville
Under the GOP plan, tax credits used to buy insurance would shrink for older people and it would increase their premiums because the bill allows insurers to charge more as people age and become more susceptible to health problems.
The provision that allows people to stay on their parents’ insurance until 26 would stay under the Republican proposal. When it comes to pre-existing conditions, the GOP bill would provide protection for people with health problems, but consumers who have not maintained continuous insurance coverage face a 30 percent premium penalty for a year. States can use federal funds to set up high-risk pools as insurers of last result.
The Republican proposal would overhaul the framework of Medicaid and end open-ended federal financing. Starting with the 2020 budget year, each state would receive a limited, per-beneficiary amount based on enrollment and costs. States would gain flexibility to cap enrollment and change benefits. Federal payments would be increased according to a measure of medical inflation.
There were changes made to the AHCA by Republican leadership in an effort to gain enough votes for the GOP health care bill.
George O’Connor, a spokesman for U.S. Rep. Mike Bost, said the Murphysboro Republican is reviewing changes that were released out of the rules committee and would not commit on how the second-term congressman expected to vote.
“He likes a lot of things in there, but there was new language added though, and he’s going over that right now,” O’Connor said.
He added Bost would issue a statement after the expected Thursday vote.
O’Connor reiterated that many of the counties in the Illinois 12th Congressional District only have one option through the exchange under the Affordable Care Act, and that premiums have increased by 70 percent.
O’Connor said the AHCA will “allow for more options and reduced costs.”
U.S. Senator Dick Durbin, D-Illinois, said the changes made by GOP leadership wouldn’t be helpful to the country.
“The last minute revisions made behind closed doors make a bad bill even worse,” Durbin said in a news release. “Larding Trumpcare up with political giveaways and kickbacks only means higher costs and less health care for seniors, hardworking families, and rural providers and communities.”
The last minute revisions made behind closed doors make a bad bill even worse. Larding Trumpcare up with political giveaways and kickbacks only means higher costs and less health care for seniors, hardworking families, and rural providers and communities.
U.S. Senator Dick Durbin, D-Illinois
U.S. Reps. John Shimkus, R-Collinsville, and Rodney Davis, R-Taylorville, both expressed strong support for the GOP health bill while attending a ribbon-cutting for a new clinic in Collinsville that, ironically, treats many patients who use the expanded Medicaid plans.
“We’re very excited about (the GOP plan),” Shimkus said. He said people cannot afford the ACA plans, particularly the high-deductible plans. “They’re being forced to pay for something they can’t use.”
Davis said he believes the GOP plan will add access and affordability, despite the Congressional Budget Office estimates that the plan could cost as many as 24 million Americans their coverage.
“The CBO is not infallible,” Davis said. “Our policy changes ... have the potential to do a lot more than what the CBO has (estimated).”
Shimkus said he believes that is an indictment on the ACA, that people are having to choose between plans they can’t afford and no insurance at all. “They don’t like the individual markets and exchanges, it’s costly, unaffordable and they can’t do it,” Shimkus said.
These are provisions that are must-haves for me to vote for a bill that is going to get rid of the Affordable Care Act. But we’ve got to have access for the millions who still choose not to buy insurance and the millions who can’t afford to use the coverage that they have.
U.S. Rep. Rodney Davis, R-Taylorville
Davis said he does not believe that many people will lose their coverage. He pointed out that the GOP plan keeps the provisions allowing pre-existing conditions and children remaining on their parents’ plans to age 26.
“These are provisions that are must-haves for me to vote for a bill that is going to get rid of the Affordable Care Act,” Davis said. “But we’ve got to have access for the millions who still choose not to buy insurance and the millions who can’t afford to use the coverage that they have. Just simply having a plan with a deductible of $6,000 means it’s unaffordable to use for many Americans, and that’s just unacceptable to me.”
Shimkus came under fire a few weeks ago after comments he made during a Congressional hearing, in which he questioned why men should have to pay for obstetric care.
“We weren’t talking about the group market or people who get their insurance from their employer,” Shimkus said. “People need to drill down and understand what we’re saying. It’s just like saying, a married couple in their 60s, should they be forced to purchase maternity care? Everybody says no, they’re not going to have kids in their 60s. It was part of the debate; it was 3 a.m. in the morning, but I think it went well.”
Following the debate
Now Sarah Borgstede has remarried and is closely watching the ongoing debate over repealing and replacing the ACA. She and her husband, Ed Jacobs, have four children between the two of them.
“What bothers me about it is I fear this is becoming a lot more about what happens between the two political parties and less about what’s happening to everyday people, because it is so complicated that it’s difficult to see how everyone is affected by these things and yet so much hangs in the balance. If this becomes which presidential administration gets credit for the best health care plan, that’s not enough,” Borgstede said. “This needs to be about making sure Americans get good health care and not about whether it’s Obamacare or Trumpcare. I don’t care whose care it is. … That’s not what’s important to me. What’s important to me is I could take my 12-year-old to the doctor and not be afraid to put him on Accutane that’s going to cause him to not be able to get health care as an adult. For me those dots are really easy for me to connect.”
Sarah Borgstede, the stay-at-home mom who is trained as an art therapist, said she understands the debate is complicated and costs are going up.
“It makes sense to me that they would be going up because our quality of care is going up and our technology is going up,” Borgstede said. “I don’t expect to not pay for that, but if our access to care is dependent on our income, I don’t see how that’s going to cause us to grow as a country. I’m not prepared to say I live in a country where you live or die based on how much money you make.”
Cheryl Sommer, 58, of O’Fallon, works two part-time jobs and had previously purchased her health insurance coverage through the marketplace exchange. She now qualifies for Medicaid coverage.
She had always had health insurance through an employer until she had lost her job.
Sommer said she did receive a subsidy the one year she bought insurance through the exchange, and ultimately only had to pay $100 a month.
“It allows me to have health care that is financially within reason for me,” Sommer said about the health insurance system set up through the ACA.
It allows me to have health care that is financially within reason for me.
Cheryl Sommer, of O’Fallon on the health insurance system set up through the Affordable Care Act
She said she is disappointed in the GOP proposal.
“It feels like putting they’re putting ideology ahead of people and reality,” Sommer said. “They’re not looking at the realities of real people’s situations.”
Sommer said she’s not sure how the Republican proposal would ultimately affect her if it became law.
“I don’t know if I will still qualify for Medicaid or I will be dropped from that,” Sommer said.
If she had to buy health insurance in market place, “I’m sure I’ll be paying more than half of my income for a health care plan,” Sommer said.
The Associated Press contributed to this article.