I'm at a point in my life where I have never met my insurance deductible or had to use my health insurance very much at all. It pays for my annual well visit (THANKS OBAMA!). And now that I don't have to pay for birth control, every time I see someone bitching about the ACA on facebook, I'm tempted to post "Thanks for my free commie whore pills, sucka!" But I don't. Because rude. I don't know how the ACA is going to fare over the next several years, especially considering states like mine (Mississippi) that didn't expand Medicaid, which is now causing an even greater access issue than we had before because our hospitals' disproportionate-share payments will be greatly reduced. Between access issues and rightfully anticipated higher costs, plus a near-monopoly on the insurance market (BCBS), we have seriously high premiums on the exchange. These problems were created by our state government, and I think the ACA is doing good in a lot of ways already (whore pills, wooo!!!).

My back though, y'all. For whatever reason, my lower spine and pelvis are prone to moving out of place and getting stuck that way. And my spine generally. I had terrible pain in my upper back last year on a work trip where we were moving all this presentation gear around over several days, and apparently I popped a rib head out of place. I don't know how that was even possible because I was not doing any kind of gymnastics or lifting anything at all heavy. I've always been fairly flexible—not dancer-flexible or anything, but I have to have a really severe injury to be so restricted that I can't touch the floor with my hands, for example. I do yoga, and for the most part, I'm able to prevent or even resolve a lot of my back shit. But when I can't get it done myself, I use chiropractic and massage therapy to put myself back together. There is nobody in my area that does ROLF-ing, but if we had one, I would be like "Mangle me until I'm well." I use either chiropractic or massage or both, depending on what seems to be the problem, about once every quarter.

According to my chiropractor, my insurance would be just great, if only I ever met my deductible so it could kick in. Massage would not be covered unless it was considered physical therapy and I was referred by a physician. If I went to my doctor for my well visit and said, "Jeez, I'm having intense back pain several times a year. I can't seem to get any relief," I could most likely walk away with a prescription that would probably ease the painful feeling, but would not put my body back into proper alignment, and therefore would actually allow the problem to get worse and worse over time, until I needed opiate painkillers and/or started getting recommended for surgery. If I asked for a referral to massage therapy, I could probably get it, but if I just left it open, I'm pretty sure I would walk out with a 'scrip for Flexeril. All I actually need is regular adjustments/release work, and I could never have to take more than a post-adjustment Aleve. I think as long as I can get chiropractic and massage, and as long as I don't have some kind of trauma like a car accident or slipped/ruptured disc, I will never need heavy pain medication or surgery. But all that therapy and prevention is out of pocket.

Is this not a big deal of a care gap in the way we view health care? If the whole idea of the ACA is to pay for preventative care and avoid more expensive care, how did these simple physical forms of relief get left out in the cold AGAIN? When we know that back surgery does not reliably alleviate pain, and painkillers are themselves debilitating, and can be debilitating in the long term? I think about the people with the kinds of jobs that REALLY do a number on your spine and muscles, and think about how much longer they could work—probably all the way to retirement in a lot of cases—if only they were getting some physical attention every month that their insurance covered. It seems like a lot of those folks don't even get started on chiropractic or massage until they're nearly disabled. It doesn't have to be that way.