Another apology

Yesterday I had one of the worst migraines I’ve had in years. The Migranal nasal spray I took simply did not work, which has happened a few times in my life with it and with Zomig when I used that—I said to my husband that it was like they’d filled it with water instead. A little fake-out vial in the pack to keep you on your toes.

The pain was unbelievable. Around 2pm it got so bad that I was crawling around the bed, screeching and sobbing. Eventually I threw up the water I had drunk to make myself throw up, which was incredibly welcome, and I was able to sleep for about six hours, on and off, with Mystery Science Theater 3000 in the background. It’s very odd how the nausea/vomiting in a migraine is tied so inextricably to the head pain; it’s not like feeling queasy because you just ate too much chili or because you’re on a rocking boat. It doesn’t feel like it has anything to do with your stomach being a stomach. It’s more like it’s an agent of the demon in your head. It’s not pain, but it’s acting on pain’s behalf, and when you’re finally able to throw up the pain lessens. I can’t explain that.

I had my first infusion of Vyepti last week, and felt better for a few days after, for the first time in weeks. I can only hope this migraine goes away faster and stays away because of it, but I’m starting to lose hope. If this doesn’t work I don’t know what to do, really. I just checked my Migraine Buddy app and I’ve had a headache or a migraine on roughly 63% of days since I launched Sick Note. Like I said before, I’m comfortable with not being an impressive journalist or winning awards. I’m not comfortable with barely being able to keep up. But I don’t know what else to do. I’m already avoiding triggers and taking preventative medication, and I’m sick two thirds of the time. (Maybe I should try to get SSDI—haha!)

Anyway, not the best start for Daylight Savings Time here for me. This is why I didn’t send out a news roundup yesterday, and I am terribly sorry for that. I will have a new Sick Note interview for you on Wednesday, barring another return to Big Pain Country.

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Here’s something funny I had open in a tab, and was going to put in the news roundup. I clicked an ad from BlueCross in another healthcare newsletter—I won’t put it on blast, because it’s not the reporter’s fault, but remember there will never be health insurance companies sponsoring Sick Note!—and got this page.

It’s a little list of policy ‘recommendations’ from the Blue Cross Blue Shield Association, on one of those annoying Issues websites that big companies like this set up. It’s not really meant to look like a neutral news or policy website, but nor does it explicitly admit that this is an advocacy page set up by a health insurer to push for things that would increase their profits or, at the same time, to make it look like they’re neutrally interested in Good Public Policy. All sorts of firms do this, not just healthcare companies. You get all kinds of ridiculous ads for these kinds of annoying junk sites when your IP address is located in Washington, DC. Some associate at a public affairs firm in DC gets paid six figures to sit around updating these sites.

The page was published on February 10th, so right in the middle of negotiations over the big stimulus package—which, you’ll remember, included expanded subsidies for ACA plans and a plan to fully cover COBRA premiums for laid-off workers from April to September. That is, billions of dollars for health insurance companies.

Anyway, the page just made me laugh, in a dark way, because of how much insurance companies are getting what they want these days. For example, the page suggests capping premiums at 10 percent of a family’s income for those above 400% of the poverty line, via subsidies. Well, the bill caps premiums at 8.5 percent of a family’s income. Close enough! They also recommend financially incentivizing states to expand Medicaid, another thing that ended up in the bill. Most of their recommendations boil down to “increase private insurance coverage,” except for expanding Medicaid up to the level originally imagined in the ACA, which they’re fine with—they want Medicaid to cover poor, sick people anyway, since then they don’t have to absorb their high costs. They don’t want a public plan to start covering people who are better-off, of course.

They also want the government to automatically enroll people in not just Medicaid plans, if they’re eligible, but ACA plans: “Marketplaces should automatically enroll and renew individuals eligible for Medicaid and premium-free marketplace plans and should facilitate enrollment for any remaining uninsured, maximizing their financial assistance and simplifying enrollment and maintenance of coverage.” Again, they want this because they want ACA marketplaces to be the de facto ‘public’ option, instead of an actual public option—where the government will pay them for the huge premiums they charge, absorbing the risk without cutting into their market share. (This did not end up in the bill, of course, and it seems functionally quite impossible—how are you going to automatically enroll people without knowing their income in real-time, since that’s what determines their premium tax credit? Are you going to retroactively charge them for premiums, like Pete Buttigieg wanted to? You can read this Brookings report about automatic enrollment from 2019 to get a sense of how not-automatic any of this would actually be.)

I’ve gone on about this longer than I meant to and my head still hurts, so I’ll shut up now, but it’s worth looking at that page to get a sense of how closely aligned private insurance companies’ interests are with what the Democratic leadership in Washington wants to do. (Also remember while you read it that enrollment on the ACA marketplaces is comparatively tiny, like 3 percent of the country.) Best of luck to Joe Biden’s public option.

That’s all. My sincere apologies again for the missed post. See you on Wednesday, I hope.