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The simple ways health insurance can change your life

The Affordable Care Act has been controversial -- but it's changing the many small health decisions that make up everyday life.

Janet Weilbrenner, left, and Stacy Benesh are surrounded by their animals at their farm in West Plains, Missouri. The couple recently received health insurance through the Affordable Care Act. (Photo by Nikki Kahn/The Washington Post)

The hospital was a short drive into town.  She intended to savor this moment by tending to her animals. Her colonoscopy was in an hour.

She walked through the kitchen and into the sprawling back yard, her new medical insurance card stowed in her pocket. Her silver rings and necklace sat in the house. She wasn’t looking forward to a camera poking around in her large intestine. But she was overdue for it. She was 54. Her stomach had hurt for months and she had avoided seeing a doctor for years. But now she had insurance.

The back yard came alive with bleats and squawks. Stacy Benesh counted the chickens, making sure the fox from the nearby woods hadn’t again raided overnight. “Come on, girls,” she said, coaxing out the skittish hens. A wild turkey scurried past. Tiny dogs ran underfoot. She greeted two llamas and a spotted saddle horse named Sedona. A goat named Gambler clanked his horns against a wire fence. Daylight washed higher over the Ozarkian hills.

“We should probably go get this over with,” Benesh said.

It was time. A colonoscopy is a common procedure. If Benesh’s visit had been covered by private insurance or even Medicare or Medicaid, it would be unremarkable. Ho hum. But her medical insurance was made possible by the Affordable Care Act. The federal law, especially in this part of the country, is often called “Obamacare” with a derisive twang.

Missouri’s Republican-led legislature has tried repeatedly to stop the legislation from taking root, including pushing back against an effort by Democratic Gov. Jay Nixon to expand Medicaid. So Benesh’s doctor’s visit felt like an act imbued with political motive, a simple hospital trip transformed into a journey through the nation’s caustic battle over health care. Floating above were big questions about the role of government and whether health care is a right.

Benesh was aware of all this. But she cared only about finding out what was wrong was her gut.

She drove. The battered Prius bounced along the gravel road. Her partner of 24 years, Janet Weilbrenner, sat in the passenger seat, sipping iced tea.

Weilbrenner asked Benesh if she remembered everything she needed. Benesh patted the pockets of her jean shorts. Yes.

These two were always together, side by side, in sickness and in health. They were known as “Janet and Stacy” or “the tie-dye girls,” for the shirts they favored. They were artists who traveled the country selling their handmade copper turtles. They sold real animals, too, with a specialty in Nigerian dwarf goats.

Weilbrenner and Benesh tended to stand out. “Just two gay women in the Bible Belt,” Weilbrenner said, laughing. But this rural town of 12,000 people, 30 miles from the Arkansas border, was home.

They’d moved to West Plains 15 years ago, leaving behind Des Moines, Iowa, for a place they knew little about, except they could afford a 12-acre spread and the cost of living was low. The central location meant they could jump in their red pickup and white trailer to reach art fairs in the Midwest or along either coast, blowing past the antiabortion billboard posted outside of town showing a gift box filled with babies under the headline, “God’s Stimulus Package.”

They loved that there was a hospital in town. Ozark Medical Center had its own emergency room and specialists. That was important for Weilbrenner, 58, who has high blood pressure, and Benesh, who has multiple sclerosis and fibromyalgia.

They always had health insurance, paying the $1,400-a-month premium, tolerating the $5,000 annual deductible. It was a big expense. They saved money where they could. Art fairs in the Southwest would turn into cross-border dashes, with Weilbrenner and Benesh loading up on cheaper prescriptions in Mexico for themselves and their animals.

Then the recession hit. Makers of “non-functional eye candy” did not fare well, Weilbrenner said. The market vanished for their $400 turtle sculptures and $1,000 longhorn skulls. Business stumbled and kept falling. They stopped buying the local newspaper. They cut back on cable. They stopped eating out at El Charro, where they had enjoyed Margarita Mondays.

And then, for the first time in their lives, they dropped their health insurance.

They tried to artfully manage their medical needs.

“For years,” Benesh recalled, “we almost never went to the doctor for fear they’d find something wrong.”

Coughs and fevers were medicated at home. When Benesh blew out her knee while moving a hay bale, she saw a doctor but didn’t go through with the referral to an orthopedic specialist. She found a $100 knee brace on eBay and lived with a limp, instead. And when a doctor pushed Benesh to get an MRI a couple of years ago, she did so, but regretted it because they’re still paying off the bill. They made friends with the staff at the local low-cost medical clinic, giving them fresh eggs from their hens. Weilbrenner was convinced the eggs were the reason the clinic offered her an unexpected opening for a free pre-diabetic eye exam.

“It was a little bit like egg insurance,” she said.

Then they traded egg insurance for ACA insurance.

They each pay $100 a month in premiums, with a $500 annual deductible. There’s a prescription benefit, too. Shortly after the insurance kicked in with the new year, Benesh made a doctor’s appointment. She was so proud that she danced into her doctor’s office, waving her insurance card. That’s when she complained to the doctor about her stomach. After a round of antibiotics and an ultrasound of her gall bladder, the doctor recommended she have a colonoscopy.

The hospital seemed asleep as Weilbrenner and Benesh walked past an empty front desk, down one hall and up another before running into a hospital worker.

“I’m supposed to have a colonoscopy this morning,” Benesh said.

“Oh,” the hospital worker said. “I can help you.”

They sat in a little cubicle.

“Blue Cross is your insurance, is that correct?”

“We just got insurance January 1,” Benesh replied, beaming.

Soon, Benesh disappeared behind swinging doors labelled “GI lab.” Weilbrenner sat in a seven-chair waiting room. Magazines lined one wall. A bulletin board advertised meetings for enrolling in the Missouri Health Insurance Marketplace.

A wave of publicity had swept across the state encouraging people to sign up. In the rural region served by the Ozark Medical Center, there were radio and newspaper ads, plus four health-care navigators to counsel residents on what to do. But the hospital never saw a hoped-for influx of new patients, despite only a quarter of its clients carrying private insurance. The problem was the county was too poor.

Because Missouri is among the states that have not expanded Medicaid eligibility under the Affordable Care Act, there’s a coverage gap. The working poor are the ones left out, said hospital spokeswoman Gay Watson. They either didn’t qualify for Medicaid or thought they couldn’t afford coverage under the Affordable Care Act, Watson said. The hospital, along with the Missouri Chamber of Commerce, has pushed for state lawmakers to expand Medicaid. A few weeks before Benesh’s visit, West Plains had served as the backdrop for Nixon to ask lawmakers to change their minds.

In the hospital waiting room, the minutes ticked by. Weilbrenner wondered how much the colonoscopy would cost, knowing they never would’ve gotten this far without insurance. Benesh would’ve just ridden out the pain at home. During the five years they were uninsured, every ache or pain was a threat. They imagined losing their home, their animals, their business.

“The fear of one of us getting sick was always there,” Weilbrenner said. “A huge stress.”

Now, they felt as though they could manage. Visits to the doctor and the hospital might still be expensive, but they had help. Medical calamities might still come, but they would not be financially devastating. And something was wrong with Benesh. They just didn’t know what.

“I don’t want anything bad for her, but I would like some kind of identification of what’s going on,” Weilbrenner said.

The procedure took less than an hour. At 8:20 a.m., a nurse came out to get Weilbrenner.

“So she survived?”

She did.

And then they were going home. Benesh sat in a wheelchair, talking about the weather and the need for rain with a hospital volunteer pushing her down the hall. Weilbrenner walked beside them. The hospital hummed with doctors and nurses.

Weilbrenner got the car.

“I think a nap’s in order,” Benesh said.

In the car, Benesh laid out the results. No polyps. No tumors. No signs of cancer. A biopsy was performed to look for colitis. But the doctor found no clear sign of what was causing her pain. The news was comforting, but also frustrating. At least it wasn’t cancer, Weilbrenner said. Benesh said her primary-care doctor probably would want to examine her right ovary to see if it was the culprit.

“But apparently I’m good to go,” Benesh said.

The car danced on the rutted road. Soon, Benesh, woozy and worn out, would head back to bed. Weilbrenner would sit at the computer to plan out the summer’s art fairs. The animals in the back yard would need tending. And weeks later, they would learn that their insurance company had been billed $5,583 for colonoscopy.

“See, you were basically okay,” Weilbrenner said now as they drove. “I’m glad.”

She patted her partner’s hand, wrapped in pink gauze.

“Now,” Weilbrenner added, “we just got to get your ovary checked out.”

That meant another trip to the doctor, another chance to use their insurance, another hunt for a diagnosis. More to come.

But their fear, at least, was gone.