Despite my frustration with my Madison doctors, I knew that for the rest of my life I would need a gastroenterologist. I had begun my search for a Portland GI doctor in July 2014, over six weeks before our arrival there, figuring that ought to ensure that I’d have someone lined up by the time I arrived…Right?
Not so. The process was turning out to be far more complicated than I had imagined.
The first step was arranging for health care in Oregon. Since neither Ron nor I had employer-based health care, for the previous year we had gotten Wisconsin insurance through the still-new federal Health Insurance Marketplace–a.k.a. Obamacare. Back when we’d signed onto our Wisconsin plan, we had logged onto the slick Healthcare.gov website, submitted our pertinent documents, shopped for plans, and signed up. It was pretty simple. So in July 2014, I’d had reason to believe we could smoothly switch to an Oregon plan using the same system.
If you happen to be a health-care historian (does that exist?), or anyone who worked in the industry in Oregon in 2014, you are now saying, and I quote:
That’s because in summer 2014, Oregon was the worst place in the country to attempt to enroll in individual health care. Good old Oregon, having decided (as it often does) to go its own unique way, had opted to create its own separate (and presumably better) website for enrollment in health coverage. Rather than participating in the oh-so-banal federal Healthcare.gov site, my home state had contracted with the software company Oracle to set up an alternative enrollment site, called Cover Oregon.
Googling “Cover Oregon debacle” now, you can find the following on Cover Oregon’s Wikipedia page:
As of mid-December 2013, the deadline for enrollment for coverage beginning January 1, the state had spent nearly $160 million and the site still could not process online enrollments. Governor John Kitzhaber informed Oregon residents that they should obtain a paper application and mail it in to obtain coverage. The state hired or reassigned nearly 500 people to process paper applications.
As of April 2014, the website was still not accepting online enrollments. 200,000 people had enrolled in Cover Oregon via paper applications, the majority through the Oregon Health Plan (Oregon’s implementation of Medicaid). Cover Oregon Executive Director Rocky King and Oregon Health Authority chief information officer Carolyn Lawson both resigned in the wake of the failure of the website. Interim executive director Bruce Goldberg stepped down in April 2014 and was replaced by Clyde Hamstreet, a consultant who specializes in corporate turnarounds.
Faced with millions to make Cover Oregon functional, the board of directors voted in April 2014 to scrap the website in favor of adopting the Federal HealthCare.gov website for 2015 enrollments. Existing subscribers will have to re-enroll with the Federal exchange…
In August 2014…the state of Oregon sued Oracle Corporation, in a civil complaint for breach of contract and “racketeering”.
In other words, the month Ron and I moved to Oregon, the state was suing Oracle over failing to create a functional health care enrollment website. (The state eventually won that suit.)
I didn’t know any of this at the time. All I knew was that we absolutely needed Oregon health care in place by the time we moved. I often shuddered to think what would have happened to us if Obamacare had not been implemented just a few years earlier, making it illegal to deny health care to people with preexisting conditions. With my new diagnosis and both of us in career transition, it would have been much harder for us to purchase insurance. Quite likely, without Obamacare, all of this year’s procedures, meds, and doctor appointments would have quickly drained our bank account…if I had been allowed to access those services at all.
So it was essential to find insurance as soon as possible in Portland. If my condition took a turn for the worse during the stressful move, I could end up with an expensive hospital stay. This had not happened to me yet, but I knew it was common for ulcerative colitis patients.
Six weeks should be plenty of time to get everything in order, I reasoned. I called Healthcare.gov to inquire about changing our coverage to an Oregon plan. The nice woman on the phone confirmed that our move was a “qualifying event”–open enrollment was in winter, but we now qualified to enroll in a new plan midyear. A few days later, after gathering our documentation together, I logged onto Healthcare.gov and submitted our W-2s and other required forms.
Within a few moments, the system gave me the go-ahead to shop for private insurance in Oregon, linking to the ill-fated Cover Oregon website. Innocent of the website’s problems, I picked a plan called Moda Health, which had the largest network of doctors to choose from.
My troubles began in the next step, when I attempted applying to Moda. Even though our background and income hadn’t changed in the last few minutes, the Cover Oregon website now told me our income was too low to purchase private insurance. We had to instead enroll in Care Oregon, a state Medicaid program.
I did not want to enroll in Care Oregon. On Medicaid, I knew my options would be dramatically limited, with far fewer clinics and doctors to choose from. Also, we would only be on it briefly. As soon as Ron got a teaching job, our income would bump us out of the Medicaid pool and we’d have to start all over again with a new Oregon health plan and, most likely, new doctors. I was anxious to find a long-term GI doctor, not just a stop gap.
I called the Cover Oregon website and asked if anything could be done. We could, I explained, afford to pay for a private plan. We didn’t actually need or want Medicaid. The state was firm. Regardless of our assets and preferences, if we wanted insurance in Oregon right now, we could only enroll in Medicaid.
What’s more, because of delays caused by the limping enrollment system, our new Oregon insurance wouldn’t kick in until the beginning of October. That was appalling, I said to the woman on the other end of the phone, who seemed nonplussed and quite used to hearing this complaint.
I next asked how I could at least schedule with a gastroenterologist in advance of October. “I have a serious GI condition,” I explained, desperation creeping into my voice. “I really need to see someone as soon as possible.”
This only met with more bad news: Once enrolled in Care Oregon, I would first have to see a primary care physician who would then refer me to a Care Oregon gastroenterologist…even though I already had a diagnosis and could get a referral from my Madison GI doctors.
I wished there was a way to slam down a smartphone. Resigned and angry, I thanked her then stabbed the phone with my finger to hang up. (FYI, it turns out stabbing the phone just hurts your finger, and sounds exactly the same to the person on the other end.)
I submitted all the paperwork to enroll us in Care Oregon, knowing I’d have to re-enroll in Moda within a month or two. Nothing to do but jump through hoops: I made a primary care appointment, the first one I could get, for October 7th. This would be more than six weeks after our arrival in Portland, and more than three months after beginning the enrollment process. And it would still be one step away from seeing a GI doctor.
What if I had moved to Oregon with cancer, or needed dialysis?
We arrived in Portland; I had my appointment with Dr. S, the naturopath; we moved into our new house; Ron started his new job. On October 7th, I drove to Northeast Portland, which was across town from our house but was the location of the closest available Care Oregon clinic, since there were indeed only a handful to choose from. The building was small and uninspiring, with a dingy waiting room (no plants), cheap plastic seats, an unsmiling woman behind the counter, and a tired, patient-looking woman seated in a corner.
The woman at the counter was young, with hair pulled back in a no-nonsense ponytail. When I gave her my name, she brusquely told me I had missed my appointment.
My heart plunged into my stomach. “What?” I sputtered. “But…my appointment’s at nine.” It was 8:45.
“You’re required to arrive by 8:30 for a 9:00 appointment,” she said, hardly looking up at me as she moved papers around her desk. “Since it’s your first appointment, there’s intake paperwork you needed to do first. You were told this on the phone when you made the appointment.”
“No, I wasn’t,” I protested. My hands and knees were beginning to shake. A cold spike of fear and outrage shot through me, mostly on my own behalf, but also out of the recognition that people who couldn’t afford other health care options would have no choice but to be on Medicaid and thus to be treated this way by this woman. I found myself mimicking her condescending tone. “I am certain that no one said that to me on the phone.”
“Well, it’s standard procedure for us to inform all patients that they need to arrive a half hour early, so I don’t know what to tell you.” She shrugged.
“Well, I am here, now.” I tried to keep my voice from shaking along with the rest of me. Somehow, from her position across the desk, this drab little woman suddenly held monumental power over my quality of life. “It’s not even nine yet. I can still fill out the paperwork.”
“I’m sorry,” she said, not sounding at all sorry, “This is standard procedure. You needed to be here by 8:30. You can fill out the paperwork, but you’ll have to come back another time for your appointment. Would you like to reschedule it now?” She looked up at me sweetly.
Aware of myself as a tall, slender, educated white woman looming over a shorter, rounder, less educated white woman who probably had a challenging job, I nevertheless opted to throw decorum to the wind. I couldn’t even help it–rage was boiling up within me.
“No,” I said, loudly. She looked up sharply this time, and I sensed someone pause unseen in a hallway over her shoulder. “I have to see a doctor. Today. I have a nine o’clock appointment, and I have a life-threatening medical condition, and I urgently need to see a doctor and I know the doctor is right here in the building and has the time to see me! I am not leaving until I see a doctor!” I think I might have stamped my foot. Who cared if I had slightly exaggerated my condition?
I sensed the patient-looking woman watching from the corner with bemusement.
Slowly, the woman at the desk spoke. “Well, after you fill out the paperwork, the doctor might have time for a short appointment.”
“Good,” I said, still shaking and trying to hide it.
She handed me the clipboard and I stalked over to a chair, tossing a self-conscious half-smile at the other waiting woman, not sure whether to be embarrassed or triumphant. I hunched over the clipboard, flew through its litany of questions, and stalked back up to the counter to turn it in by nine.
Well, after all that, the Care Oregon doctor was quite kind. She listened to my case history and quickly wrote me a referral to see a gastroenterologist. I left feeling relieved, and more proud than embarrassed about my little tantrum. At least I had my own back!
Soon afterwards, we received notice in the mail that we were no longer eligible for Care Oregon, because Ron had gotten a teaching job, and as I had expected, our new income nudged us back into the private insurance bracket. I shook my head and laughed bitterly at the letter. Soon I had enrolled us in Moda Health, three months after I had initially tried to.
But I got to keep my referral to the gastroenterologist.