Health Care Stories
Texas Voice for Health Reform is conducting a state-wide story bank project with consumers in Texas to collect health care stories. Our hope is that, by raising the voices of the people who deal with or have been denied access to health care systems, we can help Congress to enact health care reform that guarantees affordable, accessible health care to all. Stories from this project may be used for:
- Television, radio, and print media stories
- Legislative testimony for lawmakers
- Educational or informational purposes on the Texas Voice for Health Reform website
Andrea arrived home to an unwelcome surprise. Her insurance company sent her a letter explaining that the doctor who treated her son in the NICU was not a part of the provider network. Despite the urgency of her son’s condition and the fact that she was not given a choice of which doctor would treat her son in the NICU, the insurance provider refused to pay for the bulk of the NICU doctor’s charge of $1,145.
“I just couldn’t believe that something like this was allowed to happen in America, we spend close to 25 percent of our gross income on total medical expenses a year, and it’s just getting more and more expensive every year. At some point people aren’t going to be able to afford it.”
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.
The month after his open heart surgery, Mario applied for Social Security Disability benefits. Like many workers who become disabled as adults, Mario was certified for both SSI (income related) and SSDI (work history related) disability cash benefits. His SSI started right away, which automatically qualified him for Medicaid, too. This Medicaid coverage retroactively took care of his surgery bills. By federal law, work-related SSDI benefits do not begin until 5 months after you are found eligible. Very often, a worker’s SSDI benefits—based on their past earnings—are higher than the maximum income allowed for SSI, and this was the case for Mario. So, when his SSDI cash benefits began, he lost his SSI and Medicaid (health coverage for very low-income citizens). Then, he began waiting out the federally-required 24-month period before Medicare health coverage for people over age 65 and adults who become disabled) starts for SSDI beneficiaries. This left Mario uninsured for two more years as he faced high out-of-pocket costs for follow-up care, making it difficult for him to seek regular treatment with a primary care physician.
I have helped a lot of people to navigate the health care system, and I share what I’ve learned. We have to make our voices heard. There are people who have savings, who can draw upon an inheritance to defray medical coasts. But we need health reform for our children, so they can have health insurance.
Bruce is a 61-year old, self-employed communications and fundraising consultant. As he puts it, his body is “falling apart.” He has had several serious health problems including heart attacks and cancer. He relies on his high risk pool coverage to help him access the doctors and prescription drugs he needs to manage his chronic conditions and stay out of the hospital.
For nearly 30 years he had an individual health insurance policy his parents first bought for him in the 1960s. In the 1990s, his insurance company refused to renew his policy, he thinks because he’d had a heart attack. He applied for coverage with other insurance companies and was rejected because of his pre-existing conditions. Considered “uninsurable” by insurance companies, Bruce enrolled in risk pool coverage, the only source of coverage that cannot reject individual applicants in Texas.
Bruce’s risk pool coverage comes at a steep price. His premiums just to cover himself are $10,000 per year. By law, premiums in the Texas high risk pool cost twice as much as comparable policy in the private market.
In addition to steep premiums, Bruce pays significant out-of-pocket costs. His annual deducible is $2,500, and on top of that, he pays out-of-pocket for copays, coinsurance and health care services not covered by the high risk pool, like dental services. He estimates that he spends about $20,000 a year in out-of-pocket health care costs on top of his $10,000 annual premiums.
Sarah was covered through her father’s job-based insurance. The plan dropped her in early 2009 because she was 23 and no longer a full-time student. She did not find out that she’d lost coverage until she went to the pharmacy to pick up a prescription. While her parents scrambled to get Sarah enrolled in COBRA coverage, she had to pay for three months of medication out-of-pocket as her COBRA enrollment was getting sorted out, totaling around $1,000. After her COBRA was set up, it took more than six months for the health plan to partially reimburse her for those expenses. She now pays $300 a month for her COBRA coverage.