Mar 23, 2010

What does healthcare reform mean to me?

Healthcare reform didn't come soon enough for me. Nevertheless, I am happy to see it. We are heading in the right direction....
By Angil Tarach_Ritchey
Alzheimer's Reading Room

I am a nurse and I am a patient. For those who don’t know, I wrote about my own difficult health care situation previously -- My story as a nurse and patient in the face of healthcare reform.

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I am a big proponent of healthcare reform. I say am, because I don’t think we’re there yet. This is a good start.

With the current reform, I think about what it would have meant for me when I needed it most, and what it now means. What does it mean for my aging parents, and my homecare clients?

I had health insurance for as long as I can remember. I was a healthy individual for 43 years before I became extremely sick. I thought I was covered. I thought my HMO was great. It covered my family for minor injuries, sickness, and a couple surgeries. Great, I thought.

What transpired after I became very ill was another story. A very long story. The short of it is, even though I had health insurance, I paid nearly $80,000 in 5 years out of pocket for my own healthcare.

During that time, I was worried, frustrated, and angry as I battled for a diagnosis to my illness. By the time I was diagnosed I was broke and paying for healthcare on credit. Part of that cost was the fact that there was not one physician in my “network” that was treating Chronic Fatigue Immune Deficiency Syndrome. As a result, my insurance company would not cover or reimburse my costs.

Health care reform doesn’t address forcing insurance companies to pay out of network when there are no viable in network solutions.

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Seven physicians wrote letters to my insurance company stating I needed to go to the Mayo or Cleveland Clinic because they were unable to diagnose me. My insurance company denied access to either clinic. I appealed and had to go in front of the board with my family and fight to get 2 visits approved. One for an evaluation and one for tests. I wasn’t granted a visit to go over the results or plan for additional tests. Although I see no language in the reform that prevents denial of treatment, it does have some rather subjective language that implies the appeal process will be easier.

During my illness I divorced and was forced to pay the high COBRA premiums to retain medical insurance. When COBRA was nearing its end, I had one choice of health insurance because of a pre-existing condition. This didn’t allow for price comparison or even the best insurance plan for me. Now that insurance companies cannot deny me on a pre-existing condition, I may be able to purchase a more suitable, or cost effective health insurance plan.

I also had a limit on prescription drugs which was $2,500. a year. This was a cause of worry when one January I was prescribed a medication that was $950-$1200 a month on top of my $1,500. deductible. I was forced to order my prescription from a Canadian pharmacy at less than half the cost of an American pharmacy. Does this make sense?

So what does reform means for my parents, clients, and millions of seniors?

Personally, my Mom ends up in the Medicare doughnut hole every year. She is just like hundreds of thousands in this country. The reform doesn’t remove the gap, it reduces it by 50%. A good start,

Drugs are expensive and many people cannot afford them. Seniors are forgoing medications once they hit the doughnut hole because they cannot afford the cost of the medications they need. This is more common that most people realize. People in my field understand this sad reality.

What happens when someone can’t take a needed medication because they can’t afford it? The result is often additional medical treatment and procedures that are more expensive then the drugs. The new reform contains a 50% reduction in the Medicare donut hole. It is better than no reduction at all, but if you must pay for supplemental insurance, shouldn’t that pick up the total cost, with a copay?

I am glad to see that preventative tests will now be covered for seniors! This will probably prevent much more costly treatments, and suffering. Too many are not obtaining recommended screening exams, such as colonoscopies, because of the cost. Disease is typically too far advanced when treatment is sought, brought about by symptoms.

Small businesses may now see tax credits for providing health insurance to their employees. Since I own a small business, this would be a very welcomed break! This country runs on the backs of small business. Most small businesses cannot afford to insure their employees, or have dropped health insurance because of the exorbitant costs that make it less and less affordable. The caps on rising premium costs are also good news.

So while there are many unaddressed issues in the Health Care Reform, it is a beginning. Yes I could’ve benefitted from this reform when I was at my sickest, but to some extent I should benefit now. Many will benefit when they face a life changing diagnosis, including those that opposed reform. Our battle is not over. We must continue to advocate for even further reform. I guess I’ll be happy with it when we have the same access to healthcare as the folks working on Capital Hill!

Original content Angil Tarach-Ritchey, the Alzheimer's Reading Room