'Will I Lose My Health Insurance?': Practical Tips to Manage Uncertainty While ACA Repeal Looms

David Fawcett Ph.D., L.C.S.W.
David Fawcett Ph.D., L.C.S.W.

Scott sat in my office after experiencing a panic attack earlier that morning. He was responding to constant news coverage of the determined effort to eliminate the Affordable Care Act (ACA, also known as Obamacare). For Scott, this was a matter of life or death. For years, until the ACA eliminated pre-existing conditions clauses, he had been uninsurable. Having lived with HIV for over twenty years, he had met his lifetime maximum coverage "several lifetimes ago," he morbidly joked.

The looming repeal of the ACA, however, is certainly no joke. It has provided health care to millions who had previously been denied coverage based on the insurance industry's efforts to eliminate higher-risk individuals and maintain profitability. Although it appears that the ACA may be immediately repealed in a grand gesture driven by optics, actually dismantling it will take time (if it is possible at all).

I cannot imagine that over 20 million people could suddenly have no health insurance, but conditions and circumstances will certainly change. For individuals whose lives depend on medications costing thousands of dollars each month and who require specialty care, even the possibility of its repeal creates emotional reactions ranging from anxiety to full-blown trauma.

Although the apparently inevitable repeal of the ACA presents a formidable new challenge, people with HIV and other chronic conditions should know that they have already mastered survival skills that are transferable to this situation. People living with HIV/AIDS and other ongoing health challenges develop great expertise at living with ambiguity, whether about their longevity, their future or more immediate concerns such as blips or confusing information in lab reports or medical bills. Here are some practical tips for actively managing uncertainty and preserving emotional health.

1. Learn to Sit With Ambiguity

Living with HIV forces us to create an unsettling and uncomfortable peace with uncertainty. We may experience laboratory irregularities that require retesting and nervously waiting for the results. Many have also had more serious life-threatening infections involving a seemingly endless, step-by-step progression of various tests and scans before an accurate diagnosis could be made. Personally, I prefer the verdict, whether good or bad. But when anxiety or (often needless) worry takes hold, I have found that mindfulness is helpful: simply noticing my thoughts and fears, avoiding judgment on them and not attaching to them. The situation with ACA is no different. We don't know what will happen, but we can take care of ourselves in the meantime.

2. Stay in the Present Moment

That naturally leads me to the second point: the ability to stay present and avoid the pitfalls of creative imagination. For many of us, it is second nature to jump into the future and put our bodies through emotional reactions about things that haven't (and may not) happen. These reactions have adverse consequences for our health. Psychologists recognize thinking errors such as "jumping to conclusions" or "catastrophizing" through which our self-talk can truly become frightening. A reality check will help: How am I actually doing today? What are the facts? What options do I have?

The future isn't the only place we go when stressed: The past may be equally appealing in stressful times, as we think, "Look what happened before; it was a disaster and it's going to happen again."

Re-experiencing past negative experiences or traumas creates a negative emotional reaction that is painful and serves no purpose. The solution remains the same although it may be a struggle: Pull yourself back into the present. This process can sometimes be aided by a distraction: Play with your dog or cat, put your hands in some soil in your garden or just take a walk.

3. Breathe in the Serenity Prayer

Most people know the Serenity Prayer, a few elegant lines that remind of us of our ability to discern those moments when action is required or when we should practice acceptance. These words describe something that is simple but certainly not easy. When we feel anxious, our "fight or flight" responses engage automatically, making it extremely difficult to think clearly or to avoid reacting. During such times, I have found it useful to combine slow, steady and deep breathing while reciting the Serenity Prayer. Conscious breathing physiologically calms the body, allowing the brain to shift and be more receptive to these soothing words. Pay attention to the messages you receive, whether to practice acceptance or to take purposeful action, including advocating for yourself and others.

4. Connect With Others

After years of practice as a psychotherapist, and as a person living with HIV myself, I have come to believe that social connection is a nearly universal solution for many of the issues associated with HIV/AIDS, including shame, stigma, isolation and even addiction. When frightened, most of us pull inward and judge ourselves, feeling that we shouldn't be having these thoughts or feelings when, in fact, we really need to reach out and connect with others. This is supportive, normalizing and instructive, and it benefits everyone concerned. From the very first days of the HIV epidemic it was this power of connection that enabled us to deal with the struggles, the grief and the triumphs.

5. Try Therapy, Especially Cognitive Behavioral Therapy (CBT)

Finally, there are times in our lives when we can benefit from an impartial professional who can listen, provide empathy and teach powerful skills to address these fears. A particular kind of treatment called "cognitive behavioral therapy" (CBT) is especially effective at combating the automatic thoughts and negative self-talk that can bring down the strongest among us.

Most, if not all, people living with HIV have experienced trauma (or multiple traumas). When something frightening occurs, such as the repeal of the ACA, it triggers strong emotional reactions in a part of our brain that feels as if we are being traumatized again. This can lead not only to mental health concerns but also to addiction. If this is happening to you, it is especially important that you speak with a mental health provider who can guide you and help you work through those painful feelings.

We have a long ride ahead of us, full of uncertainty and challenges. These skills will help you stay focused and healthy as we walk together toward the next bend in the road.

David Fawcett Ph.D., LCSW, was diagnosed with HIV in 1988, and has worked with HIV and co-occurring mental health and addiction concerns among men and women for over 25 years. Along with his clinical practice and workshops, he writes for TheBody.com and is an advisor for the SAMHSA-funded HIV/AIDS and Mental Health Training & Resource Center. His book, Lust, Men, and Meth: A Gay Man's Guide to Sex and Recovery (Healing Path Press 2015) explores the intersection of drug use and high-risk sexual behavior.