For West Philly mom, Obamacare is about freedom - and saving hundreds a month

Naomi Fiordimondo had to do a little sleuthing to discover why her health insurance applications kept getting rejected. It turned out she had a pre-existing condition — waiting to adopt a baby.

The West Philadelphia woman and her husband had already undergone three years of infertility treatments, paid for largely with donations cobbled together from family. They had no choice in 2012 but to buy coverage on the individual market for $1,350 a month even though adoption agencies might not call for years.

"If you don't have insurance at the moment they call they'll take the baby back," Fiordimondo said in a hallway interview after testifying before a Philadelphia City Council committee about the potential impact of congressional efforts to repeal and replace the Affordable Care Act, also known as Obamacare.

Testimony from academics, advocates and other experts dominated the meeting, which was called to talk about what losing the ACA could mean in Pennsylvania and Philadelphia. Though President Trump campaigned vigorously against the ACA, he and other Republican opponents of President Obama's signature legislation are finding it much tougher than predicted to come up with a replacement that can win enough support to be approved in Congress.  Details began emerging late Monday in Washington for an approach — income-based aid to make coverage affordable — that they have long rejected.

Monday's hearing before Council's Committee on Public Health and Human Services began on a light note a few hours earlier, replaying a Jimmy Kimmel Live video that asked people which they preferred, the Affordable Care Act or Obamacare. Many had a clear preference, not realizing that they were the same thing. Everybody laughed, but a more scientific survey came up with a similar result.

The experts offered sobering statistics. More than 160,000 Philadelphians gained health insurance through the ACA's Medicaid expansion, city health commissioner Thomas Farley said, and 60,000 purchased private coverage through the law's online exchange — combined, they make up one in six city residents.

David Grande, a physician at the University of Pennsylvania, said one of the hardest things a doctor does is tell a patient about a devastating diagnosis — "but a very close second is to sit with a patient struggling to afford health care when you try to explain there is nothing you can do that would help them get health insurance, and that without health insurance, they may not be able to get the care they need." That was reality before the ACA, Grande said, and is part of why a study he recently published in the New England Journal of Medicine found that just 15 percent of primary-care physicians supported repealing the law.

Others testified about patients who suffered without insurance or have benefited from gaining it.

Fiordimondo and her husband adopted Eli in July 2012. Two years later, Obamacare banned discrimination based on preexisting conditions. It also offered subsidized coverage for people who met income eligibility guidelines and purchased insurance on the ACA exchanges. Fiordimondo was able to buy a policy for $350 a month.

The family's costs have since risen substantially. Fiordimondo, who tracked her insurance options on detailed spreadsheets, determined that the most affordable combination now is three separate policies — two different types of exchange policies for her husband and herself (because of how copays are calculated for medications that she now needs but he does not), and the Children's Health Insurance Program (CHIP) for their 3½-year-old son.

Still, the $700 total is about half what the family paid before Obamacare took effect.

And it allows the West Philadelphia couple to do work that they want — he as a baker and she, ironically, handling insurance for a solo dental practice —  rather than seeking corporate jobs in order to get health insurance.

To her, Obamacare is about freedom. "If this country is about promoting small businesses" and pursuing the work of your dreams, she said, it must "offer health insurance."