May 2, 2014 in City

Shawn Vestal: ACA saves former Spokane Symphony director from economic disaster

By The Spokesman-Review
 
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John Hancock, a former director of the Spokane Symphony, signed up for coverage under the Affordable Care Act not long before having chest pains that led to the discovery that he needed open-heart surgery. Several months later, he’s 98 percent recovered, he says, and the cost of the care didn’t bankrupt him.
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Timing, they say, is everything. For John Hancock, that’s been particularly true lately. After several years without health insurance, Hancock – the former director of the Spokane Symphony – signed up for coverage under Obamacare not long before being hit with chest pains announcing that he needed heart-valve surgery.

He showed up at a cardiologist’s office March 5 with a brand-new insurance plan.

“They said, we’ve got to fix this right away,” Hancock said.

One six-day hospital stay later, his heart is all fixed up – with a new valve grown from pig tissue – and he’s mostly recovered. Crucially, the cost didn’t bankrupt him.

As he puts it: “A government program saved the farm.”

Opponents of the Affordable Care Act are struggling to come to grips with the inescapable reality of the law’s mere existence: Witness the inane and vicious drubbing Cathy McMorris Rodgers took for her tepid acknowledgement that the law would probably not be repealed and her lame attempt to deny saying things she said in front of a bunch of people with notebooks. But Hancock’s experience is the kind of story that will make it harder and harder for deniers to deny. It’s also further testament, as if we needed it, to the ridiculously complex, inefficient and expensive system we have developed around health care in this country.

For Hancock, the ACA is not a solution, but a good step toward one.

“It’s far from over,” he said. “But I think we’re headed in the direction of less expensive, better quality care.”

The 61-year-old Hancock, who really does live on a farm north of Airway Heights, came to Spokane in 1999 as director of the symphony, after nearly 20 years with the Toledo symphony. He resigned in 2004 to take a job with the Milwaukee Symphony and later the Pasadena Pops Orchestra before returning to Spokane as a self-employed consultant to nonprofit organizations.

During his years of symphony work, he was covered the way most Americans are: through employer-provided insurance, for which he also paid a share. A tall, lean man, Hancock says he has enjoyed “excellent general health,” with an interest in natural, holistic alternatives to traditional, drug-based medicine. When he became his own boss, he discovered what many others in the same boat have long complained about.

“As a self-employed person, I found insurance to be too expensive,” he said.

So he went without. When the ACA passed, he hoped it might provide him a more affordable way to get health insurance. Last fall, he went to the Washington Healthplanfinder website; because he and his wife had different health care coverage – she’s enrolled in Medicare – but filed a joint tax return, he had a little trouble getting signed up.

“It took the intervention of my insurance agent,” he said, “to sort that out.”

He found that he had made little enough money in the previous year that he qualified for Medicaid. He enrolled around the end of November.

“And on January 11, I had what felt like a heart attack,” he said.

He went to his new family doctor. She told him it wasn’t a heart attack, but she didn’t know what it was. He saw a specialist and underwent some tests: Still no answer. Meanwhile, he was out of energy, sleeping poorly and sometimes feeling a fluttery heart.

“The most frightening part was: Is this what old age feels like? Is this what life will be like from now on? Have I just been diminished by age? I didn’t want that to be true,” he said.

At that point, he ran into the limits of his Medicaid coverage. If he wanted to see the cardiologist he needed, he would have to get better insurance. Through the state exchange, he found a Premera “silver” plan that would cost him $102 a month in premiums, with a $750 deductible. The government pays another $400 or so a month to cover the full cost.

He had to wait a month for the new policy to take effect before he visited the specialist, who scheduled his surgery immediately. One of his heart valves had failed and needed to be replaced.

“The valve was not holding and my blood pumping was diminished by 30 or 40 percent overall,” he said.

Hancock feels lucky to have gotten excellent care from his team at Providence Sacred Heart Medical Center. And because he was insured, he was fortunate to experience the health care system the way the luckiest of us do: at minimum personal cost. Apart from his deductible, his treatment was fully covered.

But in the bills he has received, you get a clear picture of the deep-rooted problems in the system that have nothing to do with Obamacare: a method of pricing and payment that is opaque, expensive and absurd.

The total cost for his care is still being tallied. But the bill for his six-day hospital stay alone came to $109,877. Like almost all health care costs, this figure is highly theoretical; at the end of the day, it would only apply to someone who didn’t have a negotiated discount with an insurance company.

Someone just like John Hancock before the ACA.

But the negotiated discount for Premera on Hancock’s bill was $58,147. That’s a discount of 53 percent. Premera paid $51,730.

It makes no sense. Which is not to say Hancock isn’t grateful. He’s “98 percent” recovered, and he’s back on the farm.

“I’m a really lucky guy,” he said.

Shawn Vestal can be reached at (509) 459-5431 or shawnv@spokesman.com. Follow him on Twitter at @vestal13.


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