The Robinson family of Dallas, Texas started out pretty excited about their new insurance plan under the Affordable Care Act.
Nick Robinson turned to Obamacare after he lost his job last summer. He had been working as a youth pastor, and the job included benefits that covered him, his two young daughters, and his wife Rachel, a wedding photographer.
Nick says he wasn鈥檛 too nervous at first, because everyone was healthy. Then, he recalls, they found out Rachel was pregnant.
鈥淚t鈥檚 one of those times where you hear the news and there鈥檚 this immediate sense of joy and excitement like 鈥榊ay, a new kid. That鈥檚 awesome!鈥 鈥 he says. Then he continues, after a long pause, 鈥淲hat are we going to do? How are we going to pay for this? This is intense.鈥
Nick and Rachel Robinson welcome their son Cash, who was born in a midwife鈥檚 birthing pool (Photo: Jessica Hooten/Courtesy of Nick Robinson).
Nick, 31, found a new job fairly soon, working as an account manager in retail sourcing. But the small firm did not offer health benefits.
The couple started looking around. They applied for Medicaid but didn鈥檛 qualify in Texas. They thought about paying for prenatal care and the delivery out of pocket, but the quotes they got scared them 鈥 up to $15,000 for a basic hospital birth.
Summer crept into fall, and Nick started hearing the buzz about the Affordable Care Act.
鈥淚 was like, 鈥極h, here鈥檚 the answer! This is simple!鈥 鈥 he says. 鈥 鈥業t鈥檚 a cheaper insurance plan, there鈥檚 no pre-existing condition stuff.鈥 鈥
Rachel was skeptical, but Nick went online and started shopping. He had trouble getting through the glitchy website at first, but eventually he picked a plan just for his wife. It was a gold plan HMO through Blue Cross Blue Shield for about $375 a month.
In January, as soon as the plan began, Nick printed out a list of obstetricians from the plan鈥檚 website. 鈥淚 handed it over to Rachel, fully confident, fully feeling like I had accomplished something for her, I had come through for my wife,鈥 he says. 鈥淭his whole Obamacare thing was going to work!鈥
Rachel, who is 30, recalls sitting down over two days in January and calling every doctor on the list of 28. According to her, most of the practices told her they didn鈥檛 take the plan, in one way or another.
鈥淪ome would just come right out and say, 鈥榃e don鈥檛 take Obamacare,鈥 鈥 she says. 鈥淥r the best one was, the doctor takes it here at the actual practice, but whatever hospital you use, that do all of our deliveries, does not take that insurance.鈥
She says there were other issues too 鈥 some of the doctors said they wouldn鈥檛 see her because she was too far along in her pregnancy 鈥 about 30 weeks. A few practices did take the HMO, but they operated as a rotating clinic and couldn鈥檛 guarantee she would see the same doctor every time. Rachel wanted to establish a relationship with her obstetrician.
鈥淚t was mind numbing,鈥 she says, 鈥渂ecause I was just sitting there thinking, 鈥業鈥檓 paying close to $400 a month just for me to have insurance that doesn鈥檛 even work. So what am I paying for?鈥 鈥
Nick got even more frustrated when he called Blue Cross and was told those doctors should take the plan.
鈥淗ow could this not be working?鈥 he says. 鈥淭he United States government has set this up. It鈥檚 this whole big deal; there鈥檚 commercials everywhere saying we need to use this. And they鈥檙e just saying, 鈥楴o, no, no,鈥 and that just made me so mad!鈥
Regulators in the Texas Department of Insurance are responsible for monitoring insurance plans to make sure they have adequate networks, what qualifies as adequate, however, is somewhat subjective.
Louis Adams, a spokesman for Blue Cross Blue Shield in Texas, says he went down that same list Rachel had checked. He says most of the 28 obstetricians do take the HMO鈥檚 members. Adams was checking the list in May, five months after Rachel made her calls, when Obamacare was brand new.
鈥淲e鈥檙e committed to helping our new members understand how to get the most from their coverage and also working with doctors and hospitals to inform them of the range of coverage options we have available,鈥 Adams says.
Even if it was a matter of miscommunication, the Robinsons felt lost. It was January and their baby was due in April. They started considering a midwife, an option friends had suggested but that they had previously rejected.
鈥淥ur answers to that were absolutely not,鈥 says Nick. 鈥淭hat鈥檚 insane. We鈥檙e not going to go to some crazy witch doctor lady, and make us get in a giant tub. Those are the crazy people. We鈥檙e the normal people. We want to have our birth 鈥 in a hospital!鈥
It was risky, too. Rachel had already had two c-sections but a home birth would mean trying to delivery vaginally. But gradually, the Robinsons changed their minds. Rachel met with a midwife and loved her. Out of pocket, a home birth would cost only $4,000.
And so they dropped their new plan. They just stopped paying the premium.
They signed on to be in the midwife鈥檚 care. Nick signed up for a nonprofit, cost-sharing plan. The Robinsons will pay cash to the midwife up front, and then request reimbursement later.
Nick says, 鈥淲e鈥檙e so happy with where we are now, but this is not okay. And I鈥檓 extremely confident that that鈥檚 not what the architects of this plan had in mind.鈥
On April 28, Rachel gave birth 鈥 at home, in the giant tub, with no pain medication.
It was a healthy baby boy, named Cash. Nick says that鈥檚 for Johnny Cash, whom they both love 鈥 and not the midwife鈥檚 fee.
This story is part of a reporting partnership between , and Kaiser Health News