Alexander Demianchuk / Reuters

Being on Obamacare has, for me, been a first-rate education. Before I chose my own plan off of my state’s exchange, I had always been fortunate enough to receive quality health care through my employers, insurance that came with neither deductibles nor drama, and as a consequence I knew remarkably little about the realities of the health-care industry. I lived in a state of comfortable innocence when it came to real costs.

Much of the political inertia on health care in this country came from exactly that state of comfortable innocence. If a person likes his plan and his doctor, and if he himself has not yet been forced into bankruptcy because of ever-escalating bills, why then should that person believe the system at large needed work? And yet a system can be terrific for an individual and terrible for a country overall.

That’s what my experience of being pregnant on Obamacare for almost 24 weeks now have taught me. Well, one of the many things. I’ve learned what a storefront lab in Bensonhurst charges for an ultrasound ($500) and what a hospital in Park Slope charges for a test that determines one’s blood type, even when one is already on file at that very hospital as O-negative ($350). Most importantly, and this is something I was never taught in any classroom: Being on Obamacare has helped me learn that, as a patient, I have to be difficult. If I am respectful and deferential, the way my parents raised me to be around people in general but especially authority figures, I will end up broke. I cannot assume that authority figures will not take advantage of me. Not with any malice, either, only because it is what The System perversely incentivizes them to do.  

When specialists, for example, say, with causal authority, “Oh, and make sure to get that last test before you leave,” I have had to learn to reply, “Which test is that again?” and “I discussed it with my midwife and we don’t think I need that one.” Even when the specialist expresses surprise, and tries to coax, guilt, or bully, I have had to continually, firmly, say, “No, thank you.”

My instinct is to not cause friction, and I’m hardly alone in that: according to Psychology Today, “People want to please their doctors” and “People don’t know that they have options, especially when it comes to saying no.” When it costs excessive amounts of money, though—for procedures that are often either redundant or unnecessary—patients have to stand up for themselves, even when it means acting in ways that feel impolite. That’s not a lesson I would ever have learned if I were still on my old employer-provided plan.

A few days ago, I received a letter from Oscar, the insurance company which with I have been satisfied until now, letting me know that it was parting ways with my hospital system effective December 1st. My midwives are affiliated with that hospital system; they send patients to it to get tests done and, more importantly, deliver only in its birthing center. By breaking up with my hospital, my insurance company was throwing me into a kind of turmoil. Would I end up like the woman in Alabama who decided to change to a different hospital at the end of her fourth pregnancy and is now suing over the psychological and physical damage inflicted on her during labor?

No, I couldn’t switch hospitals or midwives. Midway through pregnancy, with all the hassle it would entail, I would have to switch insurers.

Or, perhaps, if I were difficult, I would not have to. I called Oscar and stated my case to the fellow who answered the phone. He put me on hold for about five minutes and then came back to say I seemed to qualify for what he called “Continuity of Care” coverage. “You’ve heard of that?” he asked. “Never,” I said. Why should I have heard of it? The phrase wasn’t mentioned anywhere in the letter or in any subsequent correspondence.

I was reminded of Health Savings Accounts, which are the “triple tax-advantaged” accounts set up to help people like me with high-deductible, usually Bronze-level plans, and which somehow go unmentioned on the Exchanges and by insurance companies alike. None of the bills I have received for my care have listed them as an option for how to pay, either. HSAs are the one perk, and in some cases the saving grace, of many Obamacare plans, and I only learned about them in detail while reporting a piece for The Billfold.

The Oscar rep promised to send me a Continuity of Care form to fill out, in conjunction with my health-care providers, and send back, after which the company will meditate for two to three weeks and then let me know if I am cleared to proceed as planned. Two to three weeks puts me right up against the New York State deadline for changing health insurance plans for 2016 (December 15th). If Oscar turns me down after all, I will have to scramble to find a new plan that I can afford that does cover my midwives and the only hospital where they deliver.

And so I’m left steeling myself to be sufficiently difficult in order to get this done.

We want to hear what you think about this article. Submit a letter to the editor or write to letters@theatlantic.com.