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Entrepreneur with preexisting condition relies on ACA protections

April 15, 2017

By BETSY TAYLOR

Ben Brammeier's offbeat business, Fish Eye Fun, puts a party twist on the old-style photo booth with props that include silly hats, accessories and signs.

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He and his 10 employees, all but one of them part-time, travel all over the country to work at family celebrations and corporate and community events. They snap lighthearted pictures through a fish-eye lens that makes the moment pop, and immediately deliver a high-quality print to everyone in the group shot.

Before Brammeier started the St. Louis-based photo business, he worked as a production assistant and assistant director on films. Having good health insurance remained a priority throughout his life.

That's because 40-year-old Brammeier has chronic granulomatous disease, a rare and potentially life-threatening immunodeficiency disease that increases his susceptibility to bacterial and fungal infections. His 36-year-old brother Joe is disabled by the genetic condition. Joe is covered by Medicare and a supplemental policy. Ben buys coverage on healthcare.gov, an insurance marketplace set up under the Affordable Care Act.

Ben pays a monthly premium of about $500 and co-pays of about $40 per prescription. (He earns enough that he doesn't qualify for tax subsidies.) He also pays out of pocket for some out-of-network health care costs. His health care costs vary quite a bit from year to year, depending on how much care he needs, but he says he knows his prescription costs alone would be over $12,000 annually without his coverage.

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Ben Brammeier, owner of a photo business called Fish Eye Fun, is at work in the company's St. Louis office. He has a serious genetic condition and relies on quality insurance coverage through the Affordable Care Act.

With a thriving business, he can afford his health insurance and out-of-pocket costs. Both he and his brother have been insured at times when they did not have employment-based coverage through a high-risk pool run by the state of Missouri. Their father says that coverage was twice the price of policies available in the regular insurance market, and the risk pool coverage had a lifetime cap of $1 million. (The ACA eliminated the need for high-risk pools by requiring insurers to cover people with preexisting medical conditions; it banned lifetime caps on coverage.)

Ben Brammeier has required a few serious hospitalizations in his life because of his disease. Ben said his brother, who resides in the St. Louis suburb of Creve Coeur, has experienced debilitating complications.

The siblings' father, Steve Brammeier, is Joe's primary caregiver. He says the cost of Joe's medical care easily has exceeded $1 million. The elder Brammeier made a YouTube video to tell his family's story. In it he implores others to flood the Internet with videos telling personal stories that support affordable health coverage for all.

Both Steve and Ben Brammeier ex–pressed relief that the Affordable Care Act is still the law of the land after House Republicans withdrew the American Health Care Act for lack of votes.

The Brammeiers support a single payer system in the U.S. However, in the short term, they'd like to see improvements to the ACA. Ben called on politicians and insurance companies to provide affordable health care coverage for all, focusing reform efforts especially in states and markets where people have limited and costly insurance options.

Copyright © 2017 by the Catholic Health Association of the United States
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