With Reform, Health Insurance Will Cover You Even When Family, Health, and Economic Circumstances Change

Today, illness and disability can lead to financial ruin for a family.  Health reform will make health insurance coverage more secure and affordable even when a family’s income changes, improving economic security and reducing hardships on struggling families.

Cher worked hard to achieve her dream of becoming a dental hygienist.  Even when she was in school and it was hard to afford, she and her husband bought health insurance.  At age 31, Cher was diagnosed with a rare autoimmune disorder that led to kidney failure.  To treat the disease, she had to endure multiple hospitalizations, lab tests, medications, chemotherapy, and lots of doctors visits.

Cher’s insurance company immediately denied claims, insisting that her disorder was a pre-existing condition.  During her 10 months of dialysis, Cher wrangled with her insurer over her denied claims.  Ultimately, a financial coordinator working with Cher to help get her kidney transplant approved, helped her overcome the insurer objections to get the care she needed.  She received a kidney transplant from her brother in 1999 was able to resume work.

A few years later she was diagnosed with an antibiotic resistant staph infection and herniated discs.  Due to her previous kidney treatment and transplant, she was not a candidate for surgery.  The conditions were debilitating to the point that she could no longer work and was granted disability.

At this point she was paying premiums of $850 a month for her policy in the individual market. With her medical bills and just one income for the family, they would have had to declare bankruptcy if Cher’s parents had not let them move in and helped with bills.

They struggled financially, but worked hard to get to a place when they could buy their own home.  When Hurricane Ike hit Galveston in 2008, their home was seriously damaged.  They went $30,000 into debt reconstructing their home, but were still able to make their monthly payments until Cher’s husband got sick last year. At age 46, he was diagnosed with stage IV appendix cancer.  He has since also been diagnosed with type 2 diabetes.

He has good insurance through his work, but due to surgeries, hospitalizations, and chemotherapy, he is just about to exhaust all of the leave he can take from his job.  A bad reaction to his treatment led to his readmission to the hospital last week on the day he planned to return to work.  He has since returned to work; however, his absences have resulted in small paychecks.  If he misses more work, his job and benefits will be at risk.

With a diminished income, they now have medical and credit card bills piling up and creditors calling nonstop.  Cher doesn’t see any option other than bankruptcy this time. She thinks that she won’t lose her house in the bankruptcy, but doesn’t know how they will make their monthly payments if neither of them can work.

At a time when Cher wants to focus only on helping her husband get healthier, she is racked with worry about their financial future. She cannot believe with how hard they have worked and their focus on being responsible citizens that a series of really bad luck could result in the degrading position she is in.

How the Current System Fails People with Serious Health Needs like Cher

• Insurance companies can deny coverage for treatment related to pre-existing conditions.  Insurance companies can challenge a newly diagnosed condition as “pre-existing” long after people have enrolled in coverage and have been paying premiums each month.
• Having health insurance coverage does not protect people from having enormous and unaffordable out-of-pocket costs for health care. High deductibles, coinsurance, expensive prescription drug copays, etc., leave families with coverage exposed to significant out-of-pocket costs.
• Having insurance does not necessarily mean you have protection from financial ruin in the case of serious illness.  More than 60% of bankruptcies are due to medical problems, and of those, 75% had insurance when they got sick.

Health reform will end some of the worst insurance company abuses and make health coverage more secure and stable, reducing hardships on struggling families like Cher’s.

Top Three Ways Health Reform Will Help Cher:

1. Insurance companies will not be able to reject people with pre-existing conditions, charge them higher premiums, or deny their care once they are covered.
2. Health reform caps the amount of exposure families at every income level will have to out-of-pocket costs.  On top of that low- and moderate-income families—including families like Cher’s whose income drops due to illness and disability—will get sliding scale help with premiums and out-of-pocket costs in Exchange coverage.
3. Insurance companies cannot impose lifetime and annual dollar limits on coverage, keeping coverage from “running out” in cases of serious illness.