Welcome to "Healthcare Days" on MOMocrats. Because Thursday was also Valentine's Day and the MOMocrats were busy scraping our children off the ceiling from their candy highs, we've decided to extend our healthcare discussion.
In addition to our regular content for the next few days, we are going to be talking healthcare some more. All day long. Politicians take heed: First and foremost, we are mothers. If there is one issue that we live and breathe, especially while our children are little, it's healthcare. Our concerns aren't limited to our own families, however. Our fight is every mother's fight. Every family's fight. And this year, we will fight with our votes.
This post will again remain at the top of the blog for the whole day. Please scroll down for new content. Please also share your thoughts and your stories about healthcare; we love hearing from you. If you see a post you like, please Digg it, link to it from your blog, or otherwise love all over it. We appreciate you reading!
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MOMocrats asked Kyla to share her family's struggle to find affordable and adequate healthcare with all of us and we stand together in disbelief that any child or mother should have to fight this hard to get the care they need.
Politics are personal to all of us. Thank you Kyla, for sharing your story.
I'd like to start by saying, in spite of the title, this isn't about money. This is about insurance, about protection, about adequate medical care for those in all types of need, not limited to financial need.
My child is one of those people in need. She is two years old and she has a laundry list of symptoms, specialists, tests, therapies, and treatments. She has no solid umbrella diagnosis, just bits and pieces that make for a not quite healthy, not quite average child. She has developmental delays and sees four therapists; developmental, occupational, physical, and speech. She has hearing loss in her left ear and has biannual ABR tests to ensure her other ear is not failing and she wears a hearing aid. She has a feeding disorder that means roughly 75% of her nutrition comes through a bottle, mostly in the form of Pediasure. She has low tone and hypermobile joints. She has sensory processing disorder. She has behavioral quirks that fall into the autism spectrum. She has lesions in her brain. She suffers from chronic constipation. She sees a pediatrician, a geneticist, a neurologist, a gastroenterologist, an audiologist, and an ENT, and will soon be seeing an orthopedist to be fitted for orthotics to help her physical development. In her wee life, she has had 2 MRIs, 2 CT scans, 2 lumbar punctures, 3 ABRs (hearing tests), 3 EEGs, one of which required a hospital stay. She has been to the ER 6 times. She has been admitted twice. She also sees her pediatrician regularly for normal and not-so-normal issues. Suffice it to say, she has a higher than average need for medical coverage, and in two weeks, she will be without it.
The plan we are currently covered by is closing down the entire program. They have the highest rates (and the best coverage) in our state, but they stated they have not generated enough interest in the program to continue it. We were warned months ago and have been pursuing options and information. It came down to three choices, the high risk pool insurance offered by our state, a self-pay individual plan with sub-par benefits, or a pay cut to qualify us for CHIP. In the spirit of full disclosure, there was a fourth option, my husband's group plan. However, it is not viable for us because the cost is so high and the benefits are so few. We can't pay that much per month and then turn around and pay for the medical bills, too.
One by one these options have been taken away from us.
1. High Risk Pool.
I spoke with a representative and things sounded hopeful. She was all
set to send me the applications and then she asked, "Does your
husband's employer offer group coverage?" I answered honestly and
qualified it with, "But the benefits are terrible and the cost is so
high." She apologized and said that ANY available group plan, terrible
or not, disqualified us from eligibility. 2. Self-pay Individual Plan with sub-par benefits.
I decided on this option months ago. I spoke with our agent and she
said I just needed to apply in February. I assumed, wrongly, that
because my daughter had been insured for the previous 18 months, they
could not deny her based on pre-existing conditions. I thought HIPAA
offered that protection. It does not. HIPAA only protects pre-existing
conditions through group plans. I had to learn that the hard way this
week. I completed my application as best I could, disclosing as little
as possible, while still answering the questions honestly, and
submitted it to my agent for review. She emailed me and said, "I am not
hopeful for [your daughter]." I returned her email and asked, "Should I
even submit it? Is it worth the application fee?" And she replied and
in summation said, "Hate to waste $30." That's the clincher isn't it?
My child is uninsurable through standard channels. I am at a loss. Our
insurance is up at the end of this month. My girl will be without
insurance through no fault of ours, and that brings us to our final
3. Take a pay cut and qualify for SCHIP. Ironically, if Bush had not vetoed the bills put through by Congress in November, my children would both be covered automatically. There would be no need for a pay cut. The difference in our income and the qualifying SCHIP income is basically the amount we pay into taxes. But because of those vetoes, my husband will be requesting a pay cut so my children can have access to appropriate medical care.
We have to pursue this option not because we cannot or are not willing to pay for insurance; we have to pursue it because my child will not make the insurance companies any money and so she is uninsurable. The underwriting department reads her application, weighs whether the amount they will pay out on her will exceed the premiums we pay in, and if there is a risk of excess, they deny coverage. The insurance system does not serve the people who need it the most. It serves the people who have a high enough income and a low enough level of need. If you fall outside of those parameters, it is very difficult to ensure adequate medical care and coverage. This should not be.
It is all a series of unfortunate events. The current company is closing its program due to the bottom line; it is no longer making money. They did give us fair warning of the program's end and appropriate information on other options. My husband's employed offers terrible coverage that isn't worth the cost. That fact prevents us from acceptance into the state program that would cover a child like mine. And she is deemed uninsurable by the individual companies. In a world where patients are dollar signs, my daughter happens to have a negative next to her and very soon, too soon, she will be without coverage.
This isn't limited to my family, these sorts of situations happen all over our country. In the wealthiest nation in the world, roughly 46 million people are without coverage. I've heard stories about happily married couples contemplating divorce just so their child can qualify for insurance. We shouldn't have to divorce or take pay cuts to take care of our families, of our children. Many people who have access to insurance don't ever realize this happens. The general population believes that those uninsured millions represent people who are lazy or irresponsible or are waiting for a handout. This is not always the case. Many of those millions have just fallen through the cracks of our broken system, just as my family has. It is time for change. We can't accept a system that allows those in need to do without based on profit margins.
Those 46 million uninsured Americans are men, women, boys, and girls. They are mothers and fathers, sisters and brothers, children. They are friends and neighbors, co-workers, maybe even family. They are just like your family but have been dealt a different hand. They are my family. My children. Myself.