One Mom’s Perspective on Why the New Health Care Reform is Vital

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The Affordable Care Act (aka “Obamacare”) has undoubtedly been on the minds of many this week, as Republicans angle to defund the newly instituted program with a government shutdown.

In an ultimate display of irony, their latest ploy is using children with cancer who are currently being denied their treatment in clinical trials during the shutdown as a means to get their way. “Their way” being to dismantle the very bill that would ensure that those children with cancer are provided with the health coverage they need in the future. These maneuvers seem to be distracting Americans from the issue at hand, which is whether or not we need the health care reform included in The Affordable Care Act that the Republicans are “working” (by not working) tirelessly to eliminate.

I think there is an important aspect of this debate that is often overlooked, and I wanted to share my story to shed some light on it. In my opinion, those who are seeking help from the government are often characterized as lazy, unemployed people looking for handouts, who simply refuse to get a job to take care of themselves or their families like the rest of us hard working Americans. It is a convenient way to make a case against something, when you act as though the only people who will use it are society’s miscreants who are simply out to get a free ride from Uncle Sam. While I hate to speak in such broad generalizations, our political discourse is dominated by talking points rooted in sweeping statements like these, and few consider the possibility that perhaps it is not just the very small percentage of people taking advantage of the system that need help.

During my pregnancy I was working in a very busy coffee shop doing a physically demanding job into my seventh month, until a preterm labor scare made my doctor force me to call it quits immediately. When my daughter was born nearly four years after we started down our challenging path of trying to conceive, we decided that since what I could earn working was not much more than childcare would cost us, I would stay home and relish every moment with the child I worked so hard to bring onto this earth. Eventually my COBRA ran out, and we were forced to purchase an individual plan. However, we could only afford a plan for me and my daughter. My husband, who worked as a carpenter to provide for us, doing the types of things that really take a toll on the body, could not be covered.

For years we paid around $700/mo in premiums for this individual plan. This came to nearly ¼ of my husband’s net income, not including co-pays and bills for services that weren’t covered. It was the best plan we could possibly get for the money, and the next one up was $1200/mo for the two of us.  Unfortunately, we quickly discovered that the plan we had from Horizon Blue Cross Blue Shield was virtually useless.

In a devious layout on the plan description, under “diagnostic tests” the reader is directed to another section. I was so concerned about comparing deductibles, co-pays, etc … that it never even occurred to me that tests wouldn’t be covered. I’ve had so many ovarian cyst ruptures in my life that I’ve lost count, and every plan I had always covered ultrasounds.

It turns out that this plan, at $700/mo for a mother and daughter, only covered $500 per YEAR in diagnostic tests. This meant blood tests, ultrasounds, x-rays, and more. I discovered this after using up my annual allotment getting the initial blood work done for diagnosing arthritis, and receiving a bill for $6000 from radiology for 6 x-rays on my hands. I thought $1000 per x-ray was already steep, yet received another bill months later from the hospital itself for over $2000 “to cover hospital expenses.”

A month after this debacle, I got pregnant with our second child. We discovered that even in pregnancy, ultrasounds were not covered, including the one traditionally given at 20 weeks. Since I’d had 5 losses prior to this pregnancy and have a whole host of issues in my pelvic region, my doctor wanted to watch things closely. Out of the kindness of his heart, he didn’t bill me for any of my ultrasounds, knowing I’d be paying out of pocket if he did. I was unable to monitor my HCG levels in the beginning for the same reason, and he was infuriated when he thought that surely they must pay for the required prenatal testing, but his office double checked and determined that they didn’t.

At 16 weeks I showed up for a routine appointment, no pain, no bleeding, and no idea that anything was wrong. For the first time, he omitted the ultrasound and instead tried to listen for the heartbeat. My heart began to race as he couldn’t find it. They rushed me into another room for yet another free ultrasound. There I learned that my baby was dead, and based on the size, it must’ve just happened.

As I lay there weeping, he presented me with two options – I could be induced into labor, which could potentially take days since my body still thought it was pregnant, and I could birth the baby in a maternity ward. My other option was to find a specialist that would be willing to perform a D&E that far along in the pregnancy to take it out. The first words out of my mouth were, “Which one will be covered by my insurance?”

At such an abysmal moment of grief, my decision had to be dictated by my insurance coverage. I opted to go with the D&E, as I did not think I had it in me emotionally to go into labor, but also feared all the “testing” that could potentially be involved in that. It took a week to find someone to perform the procedure — a week of walking around with my dead baby inside my already large belly. In that time I had to call both doctor’s offices and my insurance company, trying to straighten out what would and would not be covered.

I was told that I would only be responsible for paying for the mandatory blood tests that were required before using general anesthesia, which when all was said and done came to about $700. Nurses from both my OB-GYN’s office and the specialist’s office called on my behalf and confirmed. Unfortunately, I would have to forego any and all testing that could determine why this late miscarriage may have happened. All of my previous losses were very early, so we had thought being in the second trimester we were out of the woods. These same tests would’ve told us the sex of our baby, which definitely would’ve given me more closure in the grieving process by helping to provide more of an identity to my baby. Thanks to my insurance, we’ll never know why this happened or whether it was a boy or girl. The only thing I have left of my baby is a pathology report describing the dismembered remains and a measurement of its tiny foot.

In the months following this traumatic procedure, the bills unexpectedly began to pour in, and to add to the confusion, they all came from different places. There were bills from the hospital, the specialist’s office, the anesthesia department, pathology and the lab that did the blood tests. It seems that since the word “ultrasound” appeared on the bill for the procedure, my insurance was trying to get out of paying for that portion of it, despite my doctor’s office informing them that it was used intraoperatively to guide them through the procedure, and NOT as a “diagnostic test.” In addition, neither nurse from either office informed me that it is typical for anesthesia to not be covered, and that basic pathology of the fetal remains was required.

I spent countless hours amidst my grief on the phone trying to straighten it all out, while chasing my 2 year old daughter around and trying to keep her quiet. None of my appeals worked. In the end, we were saddled with over $6,000 in medical bills for our dead baby. Between the bills for my x-rays and testing prior to this pregnancy, the insurance premiums, co-pays and bills for the miscarriage, we were at well over half of my husband’s take home pay for the year.

My husband and I are not people who are trying to take advantage of the government or seeking handouts. We are hard working people, who have had a bad run of luck. The sad thing is, as awful as this whole ordeal was for us, I can only think of the other stories that have long term consequences and are far, far worse. The parent having to watch their dying child and make decisions based on what is or isn’t covered, while going bankrupt from insurmountable hospital bills. The terminally ill who are unable to work, and require round the clock care. When my husband used to take on odd jobs on the weekends without health insurance, I would be terrified that he’d fall off a ladder and permanently injure himself, rendering him unable to work. The horrific scenarios are endless with the health care system in its current state.

I implore those who are so steadfast against any reform to consider these situations. The fact of the matter is the system is undeniably flawed in every sense of the word. Something needs to change — something HAS to change. How can the health of our citizens be dictated by greed? Isn’t everyone, including the hard working Americans who simply can’t afford it, entitled to care when they need it?

This bill is aimed at people who are uninsured like my husband was, or who only had the option of individual plans like we had. Plans that are likely overpriced and cover very little. In my years of surgeries, ER visits and countless doctors, I never had a problem with coverage (with the exception of my birth control pills).  It was a matter of a co-pay and a minimal premium by comparison, because they were GROUP PLANS.  It wasn’t until we were forced to buy an individual plan that we faced all of these issues.

If you have a group plan?  Great!  Those who are happy with their insurance need not make a change. And regarding small business owners, remind me why they don’t have a responsibility to take care of the employees who make their business possible? For years I worked as a waitress, and it goes without saying when you work in that industry that you will not receive insurance, no matter how many hours you work. Are the restaurant employees, who are some of the hardest working people I know, not entitled to the same care as the rest of Americans?

It just so happens that during that period of time I was waiting tables in my mid twenties, I had no health insurance. I know for a fact that all of the issues that would later have a detrimental impact on my fertility had already started back then. I can remember going to Planned Parenthood, the only place I could afford to go without insurance, doubled over in pain and begging them to help me. Unfortunately, aside from giving me birth control pills in an attempt to control the things that were no doubt growing inside of me, there wasn’t much more they could do. On a related side note, I would later have to battle a different insurance provider for coverage of my birth control pills, because they were a medical necessity and not for family planning, but our attempts were unsuccessful and we were forced to pay for them.

I will never know if my life would’ve been different had I been able to have health insurance in my 20s and get the proper care. Would my husband and I have been able to have as many children as we would’ve liked? Would I have had to have so many surgeries or endured so many pregnancy losses?  Would I have had a hysterectomy recommended to me at the age of 33 as a solution to my daily pain? If uninsured people who are forced to use the emergency room as their doctor’s office drive up the cost of health insurance for everyone, why is it a bad thing for them to have access to what so many take for granted?

About two months after my miscarriage when I was finally recovered, I had another ovarian cyst rupture at around midnight. Again, I was faced with two unappealing options. I could go to the ER and rack up even more bills for my out of pocket totals, or I could HOPE that I was right in my assumption based on past experience that it was a cyst, and take a few painkillers that I had left over from my D&E. Then I could hope for the best and go to bed, waiting until my OG-GYN’s office opened in the morning, where I would have to swallow my pride and beg my kind doctor for one last free ultrasound. I chose the latter, and while I tried to convince myself of the certainty of my condition, solely based on experiences I’d had most recently 4 years prior, it was terrifying to be in that much internal pain and not do anything about it. I was paying $700 a month for this — to lie there in excrutiating, indescribable pain and be unable to find out what was wrong.

The people who need The Affordable Care Act are not looking for handouts. We’re just trying to get through life and have our basic needs met, like the rest of Americans — basic needs like prenatal care.  For those who argue that choice may be limited under government plans, I would’ve taken just about any doctor, if they would’ve been able to give me the prenatal care I needed and deserved.  While the ACA may not be perfect, it’s a big step in a much needed right direction.  I urge you to call your congressman, tell them to get back to work, and that there are hard working Americans out there that NEED this Affordable Care Act.

 

Image courtesy of Ambro at FreeDigitalPhotos.net

 

 

About Amy Serotkin

Amy Serotkin is dedicated to sustainable living and finding ways to eliminate toxins in her home.  She is an avid organic gardener and cook, and is always looking for more ways to challenge herself to lessen her family’s ecological imprint.

Her website, The Mindful Home, shares with consumers the information she’s found on toxins and eco friendly products that help eliminate disposables or toxin exposure.  She also hopes to highlight smaller retailers, crafters and manufacturers.