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.
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.
Posted by: Amy | February 14, 2008 at 05:07 AM
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?
Posted by: Jenny, Bloggess | February 14, 2008 at 06:22 AM
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.
Posted by: InTheFastLane | February 14, 2008 at 07:07 AM
I Kayla I am glad you are talking about this. Something need to be done
Love you
Kim
Posted by: Kim | February 14, 2008 at 07:26 AM
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.
Posted by: PunditMom | February 14, 2008 at 07:27 AM
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
Posted by: Elizabeth | February 14, 2008 at 07:35 AM
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
Posted by: Erin | February 14, 2008 at 08:13 AM
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.
Posted by: Glennia | February 14, 2008 at 09:19 AM
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.
Posted by: LawyerMama | February 14, 2008 at 09:26 AM
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.)
Posted by: Julie Pippert | February 14, 2008 at 09:52 AM
Kyla, That is terrible. I hope and pray you are able to get something done.
Posted by: Missy | February 14, 2008 at 10:01 AM
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.
Posted by: lildb | February 14, 2008 at 10:15 AM
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.
Posted by: Aliki | February 14, 2008 at 10:17 AM
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.
Posted by: Mom101 | February 14, 2008 at 10:23 AM
"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.
Posted by: Katie | February 14, 2008 at 10:23 AM
That is so appalling and so heartbreaking.
I hope things work out, and soon.
Posted by: magpie | February 14, 2008 at 10:37 AM
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
Posted by: crazymumma | February 14, 2008 at 11:11 AM
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.
Posted by: jen | February 14, 2008 at 11:46 AM
Kyla~I am so sorry you and your little girl have fallen through the cracks of this countries healthcare system. Your story is heartbreaking.
Posted by: xoxo | February 14, 2008 at 01:00 PM
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.
Posted by: Hetha | February 14, 2008 at 01:06 PM
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.
Posted by: Izzy | February 14, 2008 at 01:50 PM
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.
Posted by: Dawn | February 14, 2008 at 02:44 PM
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.
Posted by: Chicky Chicky Baby | February 14, 2008 at 03:50 PM
Oh kyla---i have been following your struggle with this and it turns my stomach!
Hang in there--we deserve a change. NOW.
Posted by: christine | February 14, 2008 at 03:58 PM
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.
Posted by: xiaolinmama | February 14, 2008 at 03:58 PM
Kyla, I am so sorry. I wish there were a better option for your family. This is so sad. I will definitely vote carefully in the upcoming presidential election. In the meantime, I hope everything works out for your daughter.
Posted by: Kaley | February 14, 2008 at 05:02 PM
Your story, while sadly not unique, makes me furious. I am so sorry your family has to go through this. But nothing is going to change as long as people keep paying for insurance. They're making billions while causing endless pain and suffering. Insurance companies are nothing but blood sucking vampires and they need to be eliminated, plain and simple. We need to fight against any candidate whose health care plan involves insurance for all because only the insurance companies will benefit.
Posted by: Magpie Ima | February 14, 2008 at 06:44 PM
This is exactly why I went back to work (for the Feds)-- so that I would have adequate health insurance coverage for our son. He is "healthy" by most standards (only suffering from the normal ear infections, etc), but if something were to happen to anyone in our family prior to the past four months or so, we would have went bankrupt trying to pay the bills. Many of my friends are worse off. One had their insurance company cancel their coverage for no reason! The system is broken, and we need a President and a Congress willing to stand up to Insurance companies and the medical institutions in this country.
And what I would REALLY like answered-- how can the healthcare industry be for-profit. The idea of making money on someone's health (or lack there of) is sickening to me. Insurance, hospitals, etc, need to be not-for-profit entities, IMO.
Posted by: Maria | February 14, 2008 at 07:15 PM
you rock.
and you deserve to be taken care of by this country.
Posted by: Dawn | February 14, 2008 at 07:36 PM
I'm so glad you are sharing your story here, Kyla. Our system needs to change. It's outrageous what you need to go through to get coverage for your family, and that there are so many other families who must go through this.
Posted by: alejna | February 15, 2008 at 07:21 AM
Not only can I not afford insurance, I can't find a midwife! I live in a state that has more midwives than any other and leads the nation in midwife births, but I CANNOT find one that is is available for my pregnancy and birth. I am seriously having to face the possibility of going without prenatal care and having the baby by myself at home. It is truly that bad.
Posted by: Marie | February 15, 2008 at 11:07 AM
Kyla, you know from your own blog how I feel about this, but I will add my voice here, too. How Bush can look in the mirror every morning is completely beyond me. When I lived in the states for a few years, I only once went to see a doctor, and only to establish a primary care physician in case anything went wrong later. Nor did I see a dentist, as the rates covered by my union insurance were lower than what any dentist was charging. When my husband lost his job, and we had to get COBRA insurance for him, it cost a fortune. In the end, I luckily got a job here, but we were about to move him back to Canada to work any old job he could, because at least we wouldn't hve to pay his insurance. I would follow after a few months, because it would be cheaper to live in Canada with non-professional jobs while we looked for jobs in our fields than to live in the States any longer.
Here in Canada, what we hear are rumours that people are worried about long wait times and not enough beds, but I know of no one who has actually faced these situations. True, our health care does not cover medications, dental, eyeglasses, or extras like semi-private hospital rooms. Growing up, my parents were self-employed and paid these things out of pocket when needed, knowing that the big things would be covered by the government. Myself, I have a good drug and dental plan, that also covers those extras, and my empoyer pays for it because being supplementary insurance only, it is not so costly as american insurance is. That is the typical situation for people in full-time positions with decent companies. Even with no insurance, an illness or injury doesn't have to ruin a family here. Extra home care after the fact can be costly, time taken off work to care for and visit loved ones is tough, hotel stays and so on add up, but the actual care, the most ruinously expensive part of all of it, is teh duty of the province. As it should be, to look after its citizens up to a point of basic care.
Posted by: kittenpie | February 15, 2008 at 11:32 AM
So I told myself I wasn't going to respond to this, that it wasn't worth my blood pressure skyrocketing. On second thought, yes it is worth it.
Stories like Kyla's are everywhere. They are in your own neighborhood, your church, your workplace. We, as a society, have allowed it to happen. We are like sheep that just meekly accept what is being done to us and get through it the best we can. When is that going to stop? When are we, as a society, as citizens, as MOTHERS going to stand up and say enough is enough?
Yes, this election has brought the issue more or less to the forefront and using your vote is certainly important. But when are we going to stop putting our trust in politicians (any politician!)? I want to believe that the election will change things, too, but the way our political system is currently set up, the odds are very much against that happening.
So when are we going to take matters into our own hands? We're not just meek, obedient wives and mothers anymore. We are educated, professional women who have the power to enact change. Even those who are not a part of the traditional workforce are some pretty smart ladies with a lot of willpower and street savvy. So when are we going to band together and change what the government seems incapable of doing?
How, you might ask? By educating ourselves on how the system works and then beating them at their own game. It all starts with knowledge....all of us posting on here have access to the Internet and knowledge and we need to use it. We need to collectively band together and form action groups. We need to start filing class action lawsuits and hitting these insurance companies where it hurts...in the pocket. We need to vote out every single politician that accepts a dime from these entities. The list is endless.
But as long as everyone has the attitude that the above is just "too much effort," we have no right to complain. The brave men and women who founded this country (a country that, at one time, was FOR THE PEOPLE) didn't sit around and wait for politicians to enact change....they took charge of the situation themselves. How bad does it have to get before we do the same?
Apologies for the rant (okay, not really)...all I know is that insurance companies need to be stopped and I, for one, am tired of waiting for somebody else to come along and "rescue" us.
Posted by: Michele | February 15, 2008 at 12:06 PM
Kyla, thank you so much for sharing this. I feel very strongly too that a change MUST be made NOW!!! Healthcare in this country is just UNREAL and it really ENRAGES me!!!
Posted by: Kelly | February 15, 2008 at 08:17 PM
it's so unbelievable that you have to deal with this and have such crappy choices! I hope things work out for you and your family
Posted by: Amanda | February 15, 2008 at 08:55 PM
Like Kittenpie, I'm also Canadian. And I thank my lucky stars every day for Tommy Douglas: that I can walk into any hospital or clinic and get care; that any sudden illness or accident won't ruin us.
Both Barack Obama and Hillary Clinton need to read this story.
I don't know much about Bush's veto of SCHIP - but hasn't he heard of a line-item veto if all he's concerned about is the "extra garbage" put into it? Strike the parts you don't like - but keep the core. Bill Clinton did this all the time.
And stories like yours, Kyla, cuts me to the core. I find it appalling in this day and age, in a country as wealthy as the United States, that citizens can't get basic care and compassion when they need it most. It blows my mind that in order to get the care you need for your daughter, your husband has to take a pay cut. That's just WRONG on so many levels, I don't know where to start.
Posted by: Nicole | February 16, 2008 at 11:45 AM
Thanks for posting this. We have struggled with insurance issues ever since I became pregnant in 1997, it has been a never ending battle.
Posted by: Ginny | February 16, 2008 at 08:39 PM
This is such a terrible situation and what makes it even worse is knowing that you are not alone. I hate that you are having to struggle with this. I'm hoping it will somehow improve...soon!
Posted by: aj | February 17, 2008 at 03:51 PM
Holy hell.
Are you sending a copy of this story to every elected representative you know? Because I'm going to.
I hope you don't mind.
I have my own horror story, but compared to yours, mine was sunny day at the beach...without health insurance.
At one point, I was so discouraged, I seriously contemplated allowing a friend from Canada to adopt my children. Well...not really, but...really.
Posted by: jozet at Halushki | February 18, 2008 at 06:41 PM
Did you know there's another option?
You can have your 3-year-old daughter commit a crime (say, check fraud), be sentenced to jail for a few years, and they penile system will take care of her. She'll come out a hardened criminal, but she'll get free health insurance.
Just an option to consider.
Posted by: A Whole Lot of Nothing | March 03, 2008 at 06:34 AM