.
I have been in the workforce thirty seven years. The last time I had health insurance offered by my employer was 1989. I was a union worker and my monthly premiums were $25, with a $5 co-pay for doctor visits. I had to leave that job because they went out of business. All my other places of employment involved food service and none of them offered health insurance.
Fast forward to 2008 and the economy in Northern California tanked much like the rest of the nation. My hours were slashed and working as a food server that is not good, so we moved to Southern California on the recommendation of a friend. We were told that there were plenty of restaurants in Orange County and it would be easy to find a job.
It probably is easy but not for someone over the age of fifty. How many people do you see working in restaurants older than thirty? So I ended up working three part time jobs and my husband found a full time job. None of these places offered health insurance either and we could not afford to buy a policy on our own.
We were both lucky and hardly ever got sick until December 25th 2010. I hadn’t been feeling right for a few months, but was seeing a doctor who was treating me for hemorrhoids and IBS. I woke up that December morning and I knew there was something seriously wrong with me. We went to emergency and I worried the whole time how we would pay for the visit.
To make a long story short, I was diagnosed with cancer. I was hospitalized immediately and given blood transfusions. I stayed the first time ten days. I still have the hospital bill; $247,000. Luckily, I qualified for MediCal because I couldn’t work. My treatments lasted ten months, which is relatively short compared to a lot of cancer patients. I am cancer free and grateful that MediCal accepted me, however I still have ongoing complications from chemotherapy and radiation. I have a permanent colostomy bag. The monthly cost of ostomy supplies run me $150 a month — and that’s only if they last as long as they are supposed to.
I qualified for Social Security as well, not Social Security Disability because our assets were more than $3,000. Our car was worth $5,000 so I did not qualify for that. As soon as my Socially Security checks started my share of cost changed dramatically to $800 a month. Our gross income is $2500 a month and according to some chart (that has not been reviewed since 1997) that MediCal uses to determine eligibility, we are now middle class.
I would like to know whose great idea it was to determine eligibility on money that people do not have. Every month we lose about 35% of income to various taxes. We do not live off $2500 a month.
When someone is diagnosed with cancer they see specialists and specialists are expensive. A typical office visit averages around $300 and that’s if the doctor doesn’t do anything. I also have a port in my chest that needs to be flushed every six weeks. That costs $150 a visit. Any medications or doctor visits I need are not covered by MediCal until I reach my $800 monthly share of cost. Luckily, I do not receive cancer treatments anymore but I use my credit card to pay for my supplies, flushes, semi-annual scans and doctor checkups. The problem is coming up with the money to pay more than the minimum balance each month so I can continue getting medical services, and not max out my credit card.
Senator Lou Correa is my Representative, so I decided to pay him a visit to help me appeal the MediCal decision. I must have had a brain fart when I decided to ask him for help because he voted “no” to single payer healthcare, claiming that healthcare is not a priority in his district. That’s funny because 25% of his constituents don’t have health insurance. I met with two of his staff who seemed interested in helping me (I emphasize the word seemed) but after a couple of weeks they no longer returned my phone calls. But his staff member, Arthur Sandoval, was kind enough to remind me I am not the only one with health insurance issues. Thanks Art I feel better now! I am so glad to hear my representative, Lou Correa, doesn’t think healthcare is a priority.
I spent hours on the computer and the phone trying to find a better insurance. I was given the website California PCIP Insurance, http://www.pcip.ca.gov/Home/default.aspx and was told they had inexpensive health insurance for people with pre-existing conditions, so I checked them out. I don’t know who actually decides what qualifies as inexpensive or affordable health insurance; it must be the same guy that thinks people live off their gross incomes. The group I fell in too offers insurance premiums for $1250 a month, plus high deductibles and co-pays. The waiting list is at least a year. These policies are offered by the private insurance carriers. It works similar to a builder getting permission to build homes in an area but must allow 10% of the housing to be low income.
This brings me to the reason why I am writing about my personal experience with healthcare and insurance. The Supreme decided that mandating its citizens to buy health insurance is Constitutional. They conveniently changed the word penalty to tax so people would feel better when they were getting ripped off at the end of the year. I know another reason why they call it tax, because the IRS can garnish someone’s wages that refuses to pay this tax and for those who cannot afford the tax (which seems to be rising hourly since the decision from 1% to $1,000 a year) can make payments and get charged 30% interest rate.
Millions of people are out of work, with no end in sight, and many others are struggling to make rent or mortgage payments. Exactly where do they get the extra money to buy health insurance, or the new tax? This is clearly a tax on the working poor and middle class. The wealthy can afford the luxury of health insurance and yes, I am calling it a luxury. I visit cancer patients each week and you know the number one thing they worry most about? Bankruptcy! And these people have insurance, but when they got diagnosed their premiums went up. Insurance only covers 80% of medical expenses, so when someone is faced with a $247,000 hospital bill they have to come up with the remaining 20%. People with life threatening illnesses should not have to be worrying about losing their homes or life savings to pay for medical bills. Single payer is the only way to ensure everyone is covered, but because of this ruling it will not be part of the conversation anymore.
I turned off the news yesterday because of all the cheers from Democrats getting the Affordable Healthcare Act pushed through. The only winners I see are the insurance companies. They just got a big fat bonus from our friends in Washington. Today I heard a senator actually say that it is up to individuals to take care of their own healthcare needs, not government. Requiring everyone to buy insurance will take care of that. He had the nerve to say that the reason people don’t have health insurance is because they choose not to. Is he kidding? At $1250 a month it’s either insurance or sleeping indoors. I like sleeping indoors. But for now I do have insurance, it’s horrible but I have something. What about other people? I know darned well how those eligibility requirements work, but the average person doesn’t. They will be in for sticker shock! Yes, people with pre-existing conditions (there are at least 200 of them), http://www.vaughns-1-pagers.com/medicine/pre-existing-conditions.htm/ will get insurance, but at what cost? $1250 a month? $2,000 a month? There is nothing stopping the private/for profit insurance companies from raising rates astronomically. And you better believe they will. Their stockholders will demand it.
The Huffington Post even reported this morning that the new mandate does not mean insurance premiums will go down. I am betting they go up and up and up. The worst thing that will happen is that their customers will drop their policies and then the government gets more tax money.
This new healthcare plan is not what it appears to be. Insurance companies will pay attorneys big money to figure out loopholes around the new law. In the meantime people will continue to get sick and require expensive lifesaving treatments, and they won’t realize until it’s too late exactly what they got for their money because the language in the policy requires an expert in double-speak to decode the darn thing, just like the bill our representatives write to make our laws.
[Inge, who previously wrote for the Orange Juice Blog as “Mika Wallace,” will be reporting for us live from the World Trade Negotiations in San Diego next week! – ed]
wow, very powerful story, thank you for sharing.
I’ve heard people with serious illness refer to the rest of us as “TSA’s,” (Temporarily Able Bodied).
We should never forget how close many of us are to the edge.
Wishing you a continual and long-lasting recovery.
Take care
I think that this story points to how badly the health care law has been explained to the public, so that even a very sharp and motivated consumer like Inge misses out some of its aspects.
The first and most important thing to mention is that under PPACA, she’ll be covered by Medicare in 2014 up to 133% of the Federal Poverty Line — so long as California doesn’t opt out — regardless of whether she is raising children. (Allowing states to opt out without losing their eligibility for the expansion of Medicare is part of the mischief that the conservatives on the court played with a generally good ruling.) That will ease the burden on her and many others like her — and at a premium amount that doesn’t bankrupt her. (Society saves money, too, because now Inge will not need to go to the emergency room for basic treatment if she is uninsured.
The court actually considers the penalty a “tax penalty” — or a penalty under the taxation power. It’s pretty clear that Congress does have this power, whatever one thinks of the Commerce Clause. So it was an exercise in taxation either way, as tax or tax penalty, but I’m happy to call it a tax. Let’s take a look at the tax.
What proportion of the households in the country are expected to pay the tax, which is to be something like $695 the first year? Something like 1-3%. How can THAT be true, given what a big deal is being made of it? It’s simple: lots and lots of people are excluded — and even those people who aren’t excluded can’t be fined, etc., if they don’t pay the tax.
The reason most people don’t pay the tax penalty is that they’re either already paying the tax or they’re exempt from paying the tax. If you pay for your insurance, you’re exempt. If your employer pays for your insurance, you’re exempt. If you’re too poor to pay for insurance, you’re exempt. The mandate isn’t out to get people like Inge who are working class (also known as “lower middle class”) and ill; it’s out to get people who are putting off getting insurance until they’re sick or likely enough to get sick (due to age) for them to need it.
The new insurance system isn’t as good as single payer and it’s rotten that it doesn’t have a public option, but it’s going to make things much better for Inge, whose only recourse if, say, she breaks a leg or a hip is to go to the emergency room. It’s a stepping stone to an even better system as people get used to it.
The MAIN IDEA behind this bill is to end medical bankruptcies. That’s why it has so many exemptions for people who can’t afford insurance. Yes, they should probably be even greater, but people don’t yet realize how much will be saved when for the first time U.S. companies have to put 80-85% into patient care and when uninsured working-class people no longer have to use the emergency rooms for primary care.
(That 80-85% requirement — along with the requirement to cover kids up until age 26 and no more lifetime caps and no more recission of benefits and no more rejecting people with pre-existing conditions, etc. — is one reason why this isn’t as much of a windfall for insurers as it may seem. Yes, they’ll have a larger client base — but they’ll make considerably less from each of those clients. Why did they let it go through? First, they couldn’t stop it; second, because our system is really, really, really and truly broken — and they know it.)
Premiums will go up as a function of covering those with pre-existing conditions. As the husband of a cancer survivor — and I’d like to think I’d feel the same way even if I weren’t — I’m happy that we’ll be able to get coverage on our own even if my wife can no longer work.
Yes, insurers will continue to try to screw it up — but it’s going to be harder for them under the new system. It could hardly be easier for them than it is right now.
The California PCIP aka the Affordable Care Act California style is already available. Check out the link for yourself and see what affordable care looks like…
http://www.pcip.ca.gov/Publications/PCIP_MRMIB_Premiums.pdf
Like I mentioned in my article, the eligibility bar is so high in California that no one qualifies – if a couple earns more than $1500 a month gross. It will be the same in 2014. I see this as a tax on the poor and another way for our government to get more money, even if its a drop in the bucket. The tax has already gone up from 1% of income to $1,000 a year.
The law always ends up favoring the house. Remember what happened to the 3 strikes law we voted on? How many non-violent offenders are serving a life sentence because of it?
The bill is over 900 pages, there’s alot of mumbo jumbo hidden in there.
The income level below one will get Medicaid (including MediCal), set by the federal government in PPACA, will be 133% of the federal poverty level, The federal government pays 90% of it, so all states but those wanting to see people of that income level more desperate will go along with it with Medicaid expansion. California certainly will. It is not a tax on the poor.
If you believe that PPACA doesn’t contain such a provision, and that everything that the government can do is certainly cursed from the outset, then I don’t know what I can say to convince you otherwise — other than read the law, read the summaries of the law, etc.
The three strikes law was bullshit — and that has nothing to do with PPACA.
In your second comment, I don’t even have to read it to concede the point that health needs will still be unmet. This law was only enacted after having the crap kicked out of it — and even then by the thinnest of margins. That it couldn’t be even better than it is doesn’t mean that it’s not worthwhile.
http://www.pnhp.org/news/2012/june/%E2%80%98health-law-upheld-but-health-needs-still-unmet%E2%80%99-national-doctors-group
*Inge….your story sadly is not isolated.
However, the true answer to so-called affordable healthcare is certainly not letting the “free market” control the cost. Passing on whatever technology costs are to the first in and first out group of patients is awful. Lot’s of technology will be errant at times and still expensive. Look at the various knee replacement and hip replacement tech that has switched around five times to Sunday.
No, whether it is Electricity, Natural Gas or Water…….Healthcare needs to be under
Government Regulation….to ever be fair to all. The rich folks are always going to have the advantage….by being able to go to whomever they want. Dumping HMO’s is a very important part of bringing in Government Healthcare Pay Structures – for both Specialists and Technology.
Wow. A powerful story.
Followed by a most crass response
Inge, I wish you well.
I have redacted the rest of this out of courtesy.
Oh, please, don’t let courtesy stop you; do go ahead and tell me why my explaining how the widely misunderstood health care law can actually address her particular problem is “most crass.”
Won’t be long before we hear about similar stories about the elderly having no or grossly inadequate retirement income to live on because the nation’s retirement systems are being dismantled as unaffordable and excessive – private and public sysetms. People will probably write in to this post, as they do on posts about retirement plan adequacy, and tell this person this is what you get for not planning your own personal responsibility adequately. Our hearts go out to this person facing insurmountable health care costs and who turned to the taxpayer funded Medi-Cal for a safety net. Will our hearts be equally compassionate for the elderly who struggle to survive because they have no income safety net?
Here is the first loophole regarding pre-existing conditions:
“If you are getting insurance at your job, depending on your employer and the health plans offered, you may have a pre-existing exclusion period. However, the exclusion period is limited to 12 months (18 months if you enrolled late in the health plan) and only applies to health conditions for which you sought treatment in the 6 months before you enrolled in the health plan.”
http://healthinsurance.about.com/od/healthinsurancebasics/a/preexisting_conditions_overview.htm
That’s under the current system, Inge, which PPACA eliminates.
PPACA is not a perfect bill by any means. I would have preferred single-payer or at least a public option. But compared to the current system, it is worth celebrating in large part because it gets rid of provisions like this. From your link:
Emphasis added.
It is easy for someone to sing the praises of this healthcare plan who has not had to deal with a catastrophic illness and fight with insurance companies at the sametime. Words written on paper are not reality. I was watching NPR last night and they interviewed an insurance broker from Florida. He agreed that premiums will continue to rise because they can. Insurance companies are a business not a charity. They exist to make money. He also said that business owners will probably choose the penalty tax and drop the insurance they give to employees because the tax is far cheaper than paying the employees premium each month. That means the individual will have to buy their own policy and wait until they see that bill!
Good points about how PPACA is inferior to a plan that contained a public option (or had single-payer, which Obama said he would have favored had it been politically possible.) But the choice that we were given, after all of the effort that activists like me put into to pushing for single-payer or public option all through 2009 (and beyond), was between PPACA and the present system.
Under the current system, businesses are already dropping their insurance — and there is no penalty for their doing so. Under the current system, premiums are not just rising, but hurtling upwards — because insurers don’t have to worry that their abuse of consumers will lead to a successful political drive for a public option. Now, given PPACA, a public option is politically possible; had PPACA been rejected by the Supreme Court, it would not be.
Bill Clinton’s first term was ruined by the failure of health care in late 1994. Lots of Democrats were afraid to try it again in 2009 because they thought that it would once again be blocked and would ruin Obama’s presidency as well. If it had not passed this time, you would not have seen reform for decades — if even then.
Republicans are incapable of supporting reform other than the fake reform of boosting insurance companies’ ability to offer junk insurance. Democrats are sympathetic, but often too timid to try. Obama stuck with reform even when Republicans didn’t give him a single vote for it, giving conservative Democrats the power to demand that he cut out some of the best parts. Now, if private insurers show that they can’t act responsibly, we will see a big push for a public option — which was otherwise impossible. We could see single-payer in California, along the lines of what Vermont is doing. The reforms you want are now at least possible; had the decision gone the other way, they would not be.
*Somehow…our society and especially the Republican Leadership recently….has missed a very important concept: Actions or Lack of Actions have Consequences!
Inge – you are entirely right about the Insurance Companies. But don’t forget..who
are the Insurance Companies? Who are the AIG’s, the GMAC’s, the Hartford, United Health Care, Blue Cross Blue Shield…….they are the BANKS! They are fronted and funded by the Banks. Ever hear of Lloyds of London? Get the idea? This grand circle route will eventually have to be dealt with from the Regulation and Legislative sides of Government. It may happen as it many times does….State by State…..maybe
as Dr. D. suggests with a “Feet to the Fire” consequence. We will see.
Truly however, the Insurance Companies have tried to maintain a very low profile and have the Banks take most of the heat….by raising rates “for loans”, “for bonds”, for lending of all types…which ramps up the inflation rate while the “Prime Rate” remains at almost ZERO! The Credit Card companies of course are the blood brothers of the Global Banking Community. This is deep……but they can only hide out so long.
thank god for my concierge doctor
I find the most interesting things on the net….http://www.huffingtonpost.com/david-sirota/obama-hires-fmr-wellpoint_b_646874.html
So do I: http://www.dailykos.com/story/2012/07/01/1104849/-Why-Let-a-Perfectly-Constitutional-Health-Care-Law-Go-to-Waste. jpmassar is at it again, finding a life-saving provision of the law.
Greg…we shall see. I have been thinking about this alot and i came up with this possible scenerio and you should relate to this…Politicians are rich people who don’t want to lose their control so they act like lawyers do…in he courtroom attorneys argue with their opponent and its their job is to win. After the case is done the same two attorneys have lunch or whatever. Its just a game to them. I learned this in my ethics class.
How do we know that the insurance company lobbyist didn’t approach Obama before he became president and said “hey offer the people this great healthcare plan and we will help you win”. We don’t know but I think its an interesting thought. This politics stuff is a game to them and their goal is to win and keep the rich (themselves) in power. If Obama was on the up and up, he wouldn’t have hired a member of the private healthcare to put together his mandate. Its a win win for both. Oh and if Romney becomes president he will come up with some excuse as to why he can’t repeal the law. The real reason? Insurance companies aren’t about to give up all that extra cash they just paid for by lobbying for this mandate.
Let’s get real. Washington doesn’t care about us. They never have and never will. Sure there are a few who want to do the right thing, but the rest are having too much fun living the dream on our dime.
I find that unnecessarily demotivating. If we’re checkmated from the start, why engage in agitation at all? By your logic, they will always find a way to beat us — and the fact that they might have done so means that you justify inaction. To hell with that. Assume that you can do something real — like Gandhi did, like King did, like Mandela did, like Suu Kyi did, at greater personal cost and against worse odds. Rage, rage against the dying of the light.
If I remember, it was Justice William Douglas who was an accomplished antitrust lawyer before he came to the Supreme Court — and became accomplished at undercutting anti-trust law because he had been in the industry and knew all of the facts, the law, and the tricks.
The fact that you have worked for someone does not mean that you have permanent fealty to their positions. In my New York practice I worked for some banks (in cases where, by the way, I thought that they were right.) That doesn’t mean that they bought my soul. You managed restaurants and now you’re a healthy food activist; would it be fair to refer to you as “a former agent of [whatever] and therefore suspect?”
As for your scenario, I try to have courteous exchanges with my opposing counsel in cases where I’m able, but I am proud not to be on the side of employers defending discrimination and occasionally will tell them so. You can deal with people courteously on a human level and still reject what they do Lunch doesn’t change that.
Some amount of cynicism is necessary to good activism — but too much cynicism kills it. I will continue to believe in the possibility of success.
This was not a personal attack on you Greg. But from what I learned in my ethics class is that since we are a Capitalist society all this stuff is one big game. There are winners and losers. I am sure you had exchanges outside the courtroom with opposing council once case was over…friendly ones. I am saying it is what it is, and once we realize that we can move forward and not participate in a fairy tale. I wish yu could have gone with me to TPP. It was quite interesting and a bit depressing.
On a different note….can border patrol legally ask passengers on train if they are citizens? This happened yesterday and they questioned everyone. I had to work real hard to keep my mouth shut and not say its none of there business. If I didn’t have pets at home I would have challenged them and sat in jail because I refuse to pay any fines…Hey, then I will get my ostomy supplies free and a check up.
That’s true of any society, Inge, not just capitalist ones. And before you go to court you have a lot of negotiation with opposing counsel (some of it mandated by court rules) and one generally tries to maintain good relations. I’m not the only attorney you’ll find who resents it being called “one big game” — it sure isn’t a game to me.
Are you going back to TPP again before Saturday? I look forward to reading about your trip.
Yes the Border Patrol can do that — within, as I recall, 100 miles of the border. (That line falls in central OC.) This is extremely controversial and there’s a lot of argument about its abuse. It’s really intended, in my opinion, for areas like the unguarded Canadian border and shouldn’t apply here. The ability to involve Homeland Security may be one reason that conservative groups (like the Kochs) keep having their meetings in San Diego.
The TPPA event is secretive and ambiguous, on purpose; I won’t go back during the week. Press is not allowed. I want to go back Saturday to cover protestors. I am hoping to get on the bus and get a ride to Irvine. I am working on piece right now. I picked up lots of literature. The event was only 3 hours, not much time to get to talk to everyone. I was not allowed to talk to any people for TPPA except one, and thats because he had a booth setup the rest held meetings on another floor. Its amazing how people like to talk to the press….they go on and on…
*Inge…in answer to your “hire the handicapped” statement about Obama…..
Remember what the Godfather said: “Keep your friends close and enemies closer!”
We shall see ……both in the Banking and the Healthcare Sectors…soon enough!
Wow, what a saga you have had…I especially fell for the way you were treated by Corea’s office- no one likes to hear that kind of stuff. A few items on the details of your dealings with PCIP:
1. Is it possible you were trying to work with MRMIP instead of PCIP? I don’t believe that there is a waiting list for PCIP- there can be one for MRMIP.
2. Would you qualify for PCIP since you currently have creditable insurance? One will not qualify for PCIP unless they have not had coverage during the past 6 mos.
3. The highest premium amount for PCIP through Dec 2012 for someone living in OC is $481/mo (age 60 & above), so not sure where the $1250/mo is from.
4. The PCIP office co-pay is $25 (seems reasonable to me), deductible is $1500 (again, not outrageous), and max out of pocket under PCIP is $2500 per year (again, seems reasonable). All are for in network services.
I am thinking that maybe you were looking at MRMIP the more I think about it instead of PCIP. MRMIP definitely is more expensive but has similar out of pocket and co-pays I believe- around $990 (Blue Cross) and $600 (Kaiser) for someone under aged 50-54 and who lives in OC (not sure of your age, please no offense). I wish you the best as well as everyone who has the devastation of on-going medical issues coupled with dealing with insurance and bureaucracy.
Source for most of the above: http://www.pcip.ca.gov/PCIP_Program/FAQs.aspx
I’ve been wondering the same thing, TJ. I would have expected a legislative office to know the difference, though.
I appreciate your ideas TJ, but there are no cancer doctors in OC taking PCIP insurance. I checked all my options. For now MediCal is the best option, even with $800 mthly. share of cost (deductable). I have changed my diet to vegan which in my research is the best diet to remain cancer free. I met another woman whose mthly share of cost is $3,000 a mth and she is currently getting chemo. I want this story to get out in hopes that other people may get the care they need.
more information coming out about healthcare mandate…http://fdlaction.firedoglake.com/2010/03/19/fact-sheet-the-truth-about-the-health-care-bill/
FDL has been opposed to the health care bill since its inception. Jane Hamsher is so committed to her position now that she apparently can’t move. A lot of activists — including those like Noelle Bell and Eve Gittelson (who despite living in NY is on the board of California One Care), whom Jane hired to work against the bill — ended up leaving her employment and grudgingly supporting the bill. I recall complaints that Jane’s presentation and manipulation of facts was one-sided.
Rebutting that whole fact-sheet would take more time than I’m going to put into a comment, but we can make testing its assertions a joint project sometime. My sense of it generally is that it accuses PPACA of promising cake and delivering bread when it actually promised bread — and (largely thanks to Bernie Sanders) delivers it.
I agree with you on some points, I don’t much care for their website, but they do cite their sources and my professors always gave me credit for citing credible sources. I really really want to be wrong, but after talking to people at TPPA, credible people, I am not my usual positive self.
I find it funny that Shumlin fired the first insurance programming company only to hire yet another out of state company (Optum new office at 46A Main Street, Winooski VT). 80% of the workforce is flown in for Mon-Fri & put up in hotels.
I am not prejudice in anyway nor form, but 90% of the workforce seems to be from Pakistan & Asia. This does NOT seem to be “Hiring Local” in any way shape or form.
Just another smoke & mirrors from our elected official.