What the Heck Happened to Healthcare on Sunday Night And Why I Care

This BIG HEALTHCARE BILL PASSED.  But before we get too confused, I’ll share a personal experience that I also sent to Congress and President Obama back in August.  It is certain not of the caliber of some of the horror stories that have circulated over the last year, but I’ve always had healthcare. I’ve only had glimpses through medical school and an experience in April into the seedy underbelly that is a lack of healthcare.  And I DID NOT LIKE IT ONE BIT.

 

An excerpt from the letter:

I have become more concerned over the state of healthcare and health insurance in our country.  I had an experience in this last year that has really encouraged me to support your efforts on healthcare reform with letters to Congress.  I gave birth to our second child in April 2009.  As you know with two children of your own, the first month of a having a newborn (and a toddler!) is hectic and we forgot to add our new daughter to our insurance within the allotted time period of 30 days from birth.  I only realized my mistake when I started receiving bills from the hospital that insurance wasn’t covering the $12,000 in medical bills.  I called them and was told that because it was outside the 30 day window (by two days), it was up to their discretion whether to cover our daughter.  I was very upset by this.  The policy of only giving 30 days to add a child who clearly was born alive and well since the doctor bills are arriving at our insurance’s office is not very consumer orientated.  I was post-cesarean and still hobbling down the stairs after my toddler at 30 days!  We did contact my husband’s human resources’ coordinator and she submitted our new daughter’s insurance form.  We were very blessed to be retroactively covered.  However, I still had to make multiple phone calls and have each claim resubmitted in order to have our insurance carrier pay.

I thought it was all over when I started getting new bills totaling over $1000.  I called my insurance company to ask why my claims were being denied again.  I was informed that those were my co-payments.  I was shocked.  Not only is that an exorbitant amount of money, but we had chosen to pay for our hospital room out-of-pocket and had left after two days instead of the average post-cesarean recover time of three days.  Had we stayed a third day our bill would have been closer to $1500 in co-payments.  All I did was have a baby!

I have had health insurance my entire life, but I have noticed that it is getting more and more expensive to see a doctor even with insurance.  We are blessed with enough money to still make every visit necessary to our health and the health of our children, but my heart goes out to the 47 million Americans who do not have health insurance.  I can’t even imagine how fearful I would be of failing ill if I did not have health insurance or a reasonable income. I thank you for thinking of those people and their families.

Good healthcare should be affordable and available to all Americans.  Please do the right thing by my family and the families of the 47 million Americans who are suffering under our current system.  Give them a meaningful option for healthcare from our government and please compel the health insurance companies to develop humane policies.

My family is willing to sacrifice our income and wait a little longer if it means that more people will be able to access quality healthcare in times of health as well as times of crisis.

And although the H.R. 3590, as passed by the Senate, also known as Patient Protection and Affordable Care Act, is not what I would have chosen, (i’m a universal healthcare kind of doctor, mother, Christian, liberal, human being), here are the benefits:

  • Children will not be denied for pre-existing conditions effective within 6 months of enactment.  And by 2014, no one will denied for a pre-existing condition (My two cents: so N would have been put on our insurance at any time with NO PROBLEM.)
  • Prohibition against health insurance companies from dropping people from coverage when they get sick within six months of enactment
  • Prohibition against health insurance companies from placing lifetime caps on coverage within six months after enactment
  • Prohibition against health insurance companies requiring prior approval for patients to see gynecologists or visit the emergency room
  • 32 million uninsured persons will be covered persons by 2019, a 59 percent reduction in the number of uninsured
  • Dependent coverage will be provided for children up to age 26 under all individual and group policies (My two cents: My kids can live with me FOREVER… Oh wait…)
  • Increased funding for the National Health Service Corps and the nation’s community health centers
  • Medicare Part D coverage gap for Medicare beneficiaries, who have surpassed their prescription drug coverage limit, will begin to close
  • Co-payments for preventive services will be eliminated and exempted from deductibles.  For Medicare patients starting Jan 1, for new private health insurance plans within six months of enactment, and for all insurance plans by 2018 (My two cents: It won’t cost $50 a pop to see my gynecologist.  And $25 for my PCP. Maybe I’ll be willing to go as many times as my health and doctor suggest.)
  • Individuals must carry health insurance or pay a penalty that would be the greater of $750 or 2 percent of income by 2016 (My two cents: Remember the people who don’t have health insurance cost taxpayers LOTS of money when they show up at the emergency room. Because even healthy people get sick.)
  • 50 state-administered insurance marketplaces will be established by 2014 to allow small businesses and people without employer sponsored coverage to buy insurance that meets new federal standards
  • Medicaid expands to cover everyone earning less than 133 percent of the federal poverty level, or $29,327 for a family of four.

And I chose not to include cost information.  Not because I believe that it will bankrupt us.  (I believe that the bill will reduce our deficit in the long run.  Check out the Congressional Budget Office’s blog.)  But because I’m unwilling to put a price tag on my friends, family, and poorer American lives.

I am grateful that over 30 million Americans have a chance to live longer and fuller lives.  We are one step closer to treating our most important commodity, our citizens, with the respect and dignity that we treat our businesses and gadgets.

The information above is a conglomeration of American Medical Association FAQ on HCR, and American Academy of Family Physicians.  I figured doctors know the most about the human cost of inadequate healthcare while standing to lose the most financially with an expansion of government aided healthcare; thereby making them the least biased.  Although in full-disclosure, the AMA and AAFP (eventually) supported the bill.

Here are two summaries of the bill (neither of which I used for this post. But hilarious that both parties had to create there own summaries of a bill that exists in BLACK AND WHITE): Democrats (website) and Republicans (pdf)

This cross-posted with minor changes at Late Enough.

 

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