Wednesday, November 9, 2016

Insurance Coverage....

When I was a kid I didn't think about insurance coverage.  My dad worked for Ford, a decent factory job.  His union negotiated things like a 40 hour work week, paid sick and vacation time, health care coverage and retirement.  Until he died last summer he was still on Ford's health care plan, and he'd been retired for over 20 years.  So when I was hospitalized with kidney disease as a child and needed what was essentially experimental treatment to avoid major surgery, we were covered.  And as a result, I still have healthy kidneys.

When I was 18, my coverage under my dad's plan ended.  I paid a nominal fee for campus insurance for the next three years, and then got a job with excellent health and dental benefits (my teeth still have many of the fillings paid for by that insurance - I'd likely be close to toothless without it).  During medical school I was covered at the school clinic, but not for dental (I lost a tooth during that time). Since then, I've been lucky enough to be employed in jobs that provided reasonably affordable group health insurance.

I am very lucky.  I never had any substantial gaps in coverage, and never had any significant illnesses when I did.

Let's move down a generation.

Before Affordable Healthcare, kids could be covered under their parent's insurance if they were full-time students up to (I think) age 26.  That was fine, but as everyone knows, college costs have skyrocketed, so for lower middle class kids (or anyone!) there are gaps where they take a year off to work for money for the next year.  This is what happened to my nephew.  At the ripe old age of about 20 he was diagnosed with high blood pressure (it's a family thing. It sucks, but it is what it is, you know?).  During a gap year, he was working at Walmart for just under full time. He had no coverage, and didn't have the $75 to pay for a doctor visit he needed to keep his prescription going.  That's 10 hours of work at minimum wage, right? BEFORE taxes. So he ran out of his $4 medication.  And then his pressure when up.  And then he suddenly lost the vision in part of one eye, ended up in the ER ($500) with a CT scan ($300), with follow up with an ophthomologist ($200) and so on and so on and so on.  (At minimum wage this is over 130 hours of labor, more than a month's work at a less-than-full-time no-benefits job.) This is medical care for the poor without health care.  It is endlessly costly, and they can't pay it, and the hospitals and doctors end up eating the costs and charging everybody else more to make up for it.

One of the benefits of the Affordable Healthcare Act is that kids can stay on their parents' insurance to age 26 whether or not they are attending school.  Another is that pre-existing conditions and gender cannot be held against you. For Ana, this is EVERYTHING.  As it stands now, she can stay on my insurance until she is 26, and by then I was hoping that the Affordable Healthcare Act would offer some truly affordable options.

As it was before, her insurance would have ended when she finished school.  We are barely able to manage high school, and she is enrolled on line at this point.  She is not going to graduate at 18, so we have a little more time than my head usually screams, but by 20 at the latest she'll be done.  And then....

If Affordable Healthcare is repealed in its entirety, she will have no healthcare coverage.

She is a kidney transplant patient.

Her transplant medications alone run over $7000/month.  Add in her headache medications.  Add in quarterly doctor visits ($600).  Add in quarterly Botox injections ($1500).  Add in quarterly labs ($1000 - $10000 depending on what they need).  She hasn't been hospitalized this year, but we just finished paying off what we owed from 2015.

Here's the bottom line:  We can sell our home and try to find a cheap two bedroom appartment (and if we do it will be in PA where the insurance coverage is better!) and we can cash in our retirement.  The sum total of that plus my salary would keep her going for about two years.  Maybe a bit longer. We would, of course, use some of that money to purchase a health care plan for her, but there would be a pre-existing condition clause that would exclude ALL of what is wrong with her for the first year or two, so we'd essentially be paying a lot of money for nothing for a while because that is how it used to work.

If we're lucky, we'd bridge the gap somehow and survive retirement on Social Security and part time work.  If not....the transplanted kidney would fail.  She has already said she will refuse further dialysis, so....she will die.

I am incredibly grateful for insurance coverage.  I am more than a little afraid, this morning, that we won't always have it.


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