Hate to waste $30

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 options.

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.

Comments

[Amy]

If there's one issue that really gets me riled up, it's health care! I grew up with a mom who worked at what I like to call Generous Motors. Free medical, dental, and optical for everyone! I never had to worry about paying for anything.

Now, my husband and I are both small business owners and as such, have to purchase private insurance. We don't qualify for any state programs.

It was ever so much fun when the company that we'd been paying premiums to for two years decided to deny my emergency c-section. The hospital bill for me alone was $9,153.40. (That number will forever be engraved in my head due to the number of nights I spent crying over it.) Which, of course, doesn't include the ob/gyn, the pediatrician, the nursery, doula, or anesthesiologist.

Luckily, my husband is a lawyer and after the fourth denial, we threatened a colorful lawsuit and they changed their tune and picked up some of the tab. I can totally see how people without the resources I do could be forced into bankruptcy and more. How things like this could break up a family. It's an abomination.

I hate that when my kids get sick, I have to worry about whether they are sick enough to warrant a trip to the doctor. I don't want any more children, but after two emergency c-sections, there's not a doctor around who would let me try for another VBAC. An unplanned pregnancy could devastate us.

It's so not right.

[Jenny, Bloggess]

Amen. Posting this here is a good start but what's the best way to get this to the people who need to read this? Emailing politicians? Calling them?

[InTheFastLane]

Kyla - I am so glad to see you getting your story out. Keep talking about this, keep writing about this. Something needs to be done.

[Kim]

I Kayla I am glad you are talking about this. Something need to be done

Love you
Kim

[PunditMom]

We need only ask each candidate one question -- would you make sure that this child AND her family has health insurance. Whoever can say yes without qualification should be president.

[Elizabeth]

I am so sorry Kyla. You are correct that it is NOT right that this is happening to your family and something has GOT to be done. It is just unbelievable. Health care in this country has got to be revamped, though I don't know what the answer is. In all fairness, the reason the SCHIP bill was vetoed, was not because of SCHIP, it was because of numerous unrelated and unnecessary things that other politicians tacked on to the bill. Bush said he would not sign it with all that added garbage(my word not his). I believe he would have signed it--should have signed it--if it was just SCHIP. But that is neither here nor there, because the bottom line is, you need health insurance for your daughter, and you can pay for it, yet you can't get it. That is simply not right. I am racking my brain trying to think of any other options, and will let you know if I do. You will also be in my prayers.
Elizabeth

[Erin]

Kyla,

I am saddened and disgusted by your situation and by the way you have been treated. I'm glad you posted this and I hope you pursue other avenues (like the press!!)

Love you,
Erin

[Glennia]

I think people should forward this on to members of Congress, especially those who voted against the veto override. George Bush is a lost cause, but some of those people who voted against it ought to be out of work come November.

[LawyerMama]

Kyla, thank you so much for sharing your story. It just makes me sick that people go without health insurance and coverage (and therefore without care) in the richest nation on earth.

And with all due respect to Elizabeth, that's BS. Bush was quite clear that he was vetoing SCHIP because families with "too much money" would be covered. Families like Kyla's.

[Julie Pippert]

Kyla, babe, BRAVO to you for this amazing, moving, and so needed post.

You know putting a link to this on my blog was only the beginning. This is outrageous and I won't have it. I will do whatever I can to help you.

LM, you are so right about why Bush vetoed it. I remember his reason and I remember being floored. Oh well, I suppose he's thinking what's he got to lose.

Does everyone know how to see who voted for or against a bill? You can---and should---go to the government site and look at the voting record for this.

There were: 411 Ayes, 3 Nays, 18 Present/Not Voting.

You can get this info at:

1. govtrack.us http://www.govtrack.us/congress/bill.xpd?bill=s110-2499

2. Source Watch
Here are the 4 voting records beginning with 1st in August:

1st: http://www.opencongress.org/roll_call/show/1737
2nd: http://www.opencongress.org/roll_call/show/1919
3rd: http://www.opencongress.org/roll_call/show/2020
4th: http://www.opencongress.org/roll_call/show/2070

HTH!!!

(Note: People from red states like Texas...don't look. You'll feel depressed.)

[Missy]

Kyla, That is terrible. I hope and pray you are able to get something done.

[lildb]

What Glennia and LawyerMama said - because, dude. George Bush vetoed it and then went ahead and "asked for" (really, I ought to say deMANded) BILLIONS OF DOLLARS to fund his unnecessary non-war that ALSO kills people and maims them and then brings them back here to face severely lacking healthcare for their great, serious needs.

I cannot wait until Obama becomes our next pres.

[Aliki]

Kyla,

I am so sorry about all this--you know how I feel. I hope your sharing your story will accomplish something--I'm not sure what, but it must.

Our healthcare situation is horrible. We are covered, but we pay out almost $*800* monthly for our coverage! We can barely scrape by most months. It's sickening to pay so much, yet we have no other options.

I hope something is done--and soon.

[Mom101]

Kyla, my heart goes out to you. This is unconscionable.

And LawyerMama, you are correct. Bush vetoed the bill because it would jeopardize the insurers as people move off inadequate plans - like Kyla's husband's employer has - onto SCHIP. His quote: "“It is estimated that if this program were to become law, one out of every three persons that would subscribe to the new expanded Schip would leave private insurance." It's amazing that he flat out chose the welfare of companies over the welfare of children and yet, not suprising.

I truly hope things work out for you Kyla. And that in the long run, you will find a more suitable solution than a pay cut.

[Katie]

"In a world where patients are dollar signs, my daughter happens to have a negative next to her ..."

The even more devastating fact is that this isn't just with insurance, so many choose to see a negative when life just doesn't add up.

Hang in there, keep pushing your little girl's story out there, let others see the reality of life without benefits.

[magpie]

That is so appalling and so heartbreaking.

I hope things work out, and soon.

[crazymumma]

I am so glad you wrote this Kyla.

You know how I feel, but I don't want to start swearing and starting a ruckus.

xo

[jen]

This is where we stand, just like PunditMom said. We will ONLY VOTE FOR YOU IF YOU PROMISE TO ADDRESS THIS IN A COMPREHENSIVE WAY. Otherwise, you will lose.

And you need us to vote for you. It would be a mistake to underestimate our community coming together on this issue.

[xoxo]

Kyla~I am so sorry you and your little girl have fallen through the cracks of this countries healthcare system. Your story is heartbreaking.

[Hetha]

My husband is self-employed so we don't have the luxury of a nice group policy. We pay more each month for this coverage than for our home and yet they deny the majority of our claims! My son was born deaf and they claim it's a pre-existing condition! He was covered under a different policy in the same company (yeah YOU medical mutual) at the time of birth.

It's legalized organized crime. Plain. and. Simple.

[Izzy]

God, what a nightmare. I'm so sorry your family has had to become an example of how badly our health care system is broken.

One couple I know, as a last resort in order to secure medical coverage for their chronically ill child, got a divorce. Their child was instantly accepted into their state's Medicaid program. Extreme? Yes. Sad? Yes. But now their son has the care they couldn't get for him anywhere else.

For these thing to happen is shameful. America is supposed to be better than that.

[Dawn]

Kyla, I truly hope and pray that you and your story are able to effect some type of change through this battle. I see no other purpose for this struggle.

As a Canadian, who has always been blessed to just assume that if I need a doctor I can go and see one without worrying about the effect of that on my bank account, it truly boggles my mind that the US government and so many of it's citizens continue to CHOOSE this path of money versus a person's well-being.

The irony of this is many of the people who are so dead-set against universal health care are also pro-life, as am I. However, I fail to see how the two ideas work together.

[Chicky Chicky Baby]

Kyla, I had no idea. There is no excuse for this to happen to you or to anyone else.

I hope our next administration won't be so blatant in their desire to protect big business and will fight for the little guy. But what I hope more is that you don't have to go to such extremes to insure your little girl. A miracle, I guess, is what I'm wishing for you.

[christine]

Oh kyla---i have been following your struggle with this and it turns my stomach!

Hang in there--we deserve a change. NOW.

[xiaolinmama]

My husband and I are both freelancing now - that means no health care except for COBRA at a whopping $1200.00 a month for crappy services. I sit here looking at my two children on the sofa - one sick with flu and the other with an upcoming scheduled ear surgery. I can't help but wonder what we would have done without access to a doctor. Funds are limited are our house these days, so we've had to trade runs to Target, Costco and Starbucks for the luxury to pay for abysmal health care - where I still have to pay another $20.00 co-pay. Ugh!

I've researched other options and am floored by what purchasing it yourself costs- a minimum of $1000 per month for a family of four for a lame HMO. It's one thing to pay through the nose and then get something you are happy with - it's a whole other thing to pay through the nose and get crap. Though I am grateful for the horrible insurance because as you know it is better than none. It is just wrong isn't it? I am just hoping we have enough to pay next month's bill without having to give up things like, paying for pre-school.

Kyla, thanks for your moving post and inspiring us to get fired up. My prayers are with you and your family. I hope together we can make a difference.