Teresa Bross pays through the nose for ICHIP insurance. She looks forward to 2014 and the elimination of exclusionary pre-existing condition clauses.
When health care reform passed, Teresa picked up the phone and immediately began looking into her new options for insurance. Diagnosed with asthma and severe allergies, she has been excluded from the private insurance market since 2002. Health care reform will go a long way in helping Teresa get the care she needs come 2014 by restoring her access to the insurance market and making health insurance more affordable. However, her phone calls also revealed that she is falling through the cracks when it comes to more immediate reforms, such as the establishment of a federally subsidized high-risk pool.
Today, Teresa buys insurance through Illinois’ high-risk pool, the Illinois Comprehensive Health Insurance Program (ICHIP), which provides costly insurance to those with pre-existing conditions who are otherwise excluded from the insurance market. Teresa paid $13,016.55 last year in medical expenses on ICHIP. This number represents a combination of her monthly premiums, prescription costs, co-pays and her $500 deductible. “I spent 80.5% of my small dividend income on medical and dental expenses in 2009!” says Teresa. The high cost of insurance for those with pre-existing conditions is often unmanageable. This year, Teresa finds herself making tough choices about which bills to pay, and which ones to hold off on.
Health care reform will help solve Teresa’s insurance problem in the long run, and she looks forward to accessing a competitive insurance market that cannot deny her coverage for pre-existing conditions. However, when it comes to more immediate needs, Teresa will not be able to access the new federally subsided high-risk pool because she is technically insured already.
The federal government is providing 194 million dollars to Illinois to set up this new high-risk pool and provide subsidies to new enrollees. In order to avoid burning through the new funds, there are certain pre-requisites for joining the high-risk pool, one of them being that you have to have been without insurance for the past six months. “The new health care bill was originally designed to help people who are denied insurance coverage because of pre-existing conditions. That’s me! I should be allowed to enroll in this new high-risk pool!” says Teresa. Reform may not benefit Teresa this year, but in the long run the new measures will save her money and worry.
This florist looks forward to a rosier future in health care costs.
Dennis runs a small business, Geier Florist, in West Peoria. In 2005 his wife Lisa was diagnosed with breast cancer for which she received surgery, chemotherapy, and radiation. At that time the couple’s annual deductible was $5,000 and their monthly premium $250. However, over the course of the next few years their premium increased nearly three-fold to $705 in January 2008. That same month Dennis was diagnosed with colon cancer. His treatment consisted of three operations and over a month of hospitalization. Hoping to keep their monthly premium below $800, Dennis changed the annual deductible on the policy to $10,000, however, in 2009 their monthly premium increased again—to $875. This year, literally a week before the Health Care Bill passed, the couple’s monthly premium increased again—to $962. This means that the couple spends nearly $22,000 annually in out-of-pocket expenses for their health insurance. Dennis refers to rising premiums and deductibles as ridiculous.
Dennis and his wife are looking forward to retiring at some point, but the astronomical amount they are spending on health care makes this seem like an impossible dream.
The recently passed health care reform bill, which, beginning in 2014, will require that 80% of monthly premiums go toward health care costs should reduce skyrocketing premium rates. This, along with the fact that insurance companies will no longer be able deny coverage to individuals with preexisting conditions, should foster competition among insurers and provide consumers with more choice when purchasing insurance. Although Dennis supports the Health Care legislation, he feels it does not go far enough; he supports a public option under which all Americans have access to affordable and quality health care.
The Dill Pickle Food Co-op is a small, locally owned and operated cooperative, which offers local and organically grown foods. For Vinnie Hernandez, the general manager, covering the co-op’s employees is a priority. However, the experience of finding and establishing insurance for the co-op employees was bureaucratic and time consuming. Vinnie had trouble finding adequate coverage at a reasonable cost and with premium rates skyrocketing each year, he worried about the future.
Now some of his worries can be put to rest. The health care bill recently signed by President Obama will allow The Dill Pickle a tax credit worth 35% of their health care costs. This credit will increase to 50% in 2014. Also, small businesses will soon be able to ban together to buy insurance as a group through Small Business Health Options Programs. These measures will help keep Illinois’ small businesses, like the Dill Pickle, strong and their employees healthy.
Health care reform may help this doctor finally afford health insurance and increase her patients’ ability to get care.
Dr. Mercedes Martinez is a child and adolescent psychiatrist who has no health insurance. She works at three different community health centers caring for underserved youth and volunteers her time in the community providing education on mental health topics. These jobs are all part-time and as such she does not qualify for employee-sponsored health insurance. Her monthly income is just above the maximum allowance to qualify for Medicaid, but she cannot afford to buy health insurance for herself on the individual market because of her high mortgage and student loan payments. Thankfully, her college-aged children are covered by their father’s insurance and will be able to stay on his insurance through age 26 because of health care reform. Dr. Martinez has thus far relied on self-diagnosis, community clinics and/or alternative medicine to treat her medical problems.
Dr. Martinez is a part of a growing cohort of doctors, who don’t have health insurance for a number of reasons including, student loan debt and high malpractice fees and choosing to work predominantly with low-income Medicaid and Medicare patients, which provide lower reimbursement rates. Finishing medical school literally hundreds of thousands of dollars in debt, some doctors simply cannot afford to purchase private medical insurance. It is a bitter irony that those working within the medical community can be uninsured.
Dr. Martinez believes that doctors in her position should have more choice when it comes to buying insurance. With the recent health care reform legislation, more funding will be allocated to community centers, and coverage for mental health patients will increase, which will, hopefully, allow hospitals and community centers to employ more doctors such as Dr. Martinez (full or part-time) and provide them with health care benefits. Dr. Martinez would also like to see lower insurance premiums for doctors that work predominantly with Medicaid and Medicare patients. Moreover, increased competition among insurance companies and new accountability measures will hopefully lower premium rates, making it more economically feasible for doctors to purchase private insurance. Finally, Medicare and Medicaid payments for primary care providers will increase—a policy which will hopefully be extended to include specialty doctors such as Dr. Martinez that continue to dedicate themselves to working in underserved communities.
Terry and her husband have struggled to keep their insurance and get coverage for their health issues.
Teresa Zduncyk of Brookfield is over 50 and has been unemployed for 18 months. With continuing job cuts in the banking industry, it has become increasingly hard for her to find work in her field.
In 2003, Teresa had insurance through her employer. Yet when she required emergency gallbladder surgery, her insurance company refused to pay. Since then, she has been hospitalized twice for atrial fibrillation. Without adequate coverage, her bills are high. Without a job, she struggles to make payments.
Her husband also struggles with the health care system. He was born with anhidrotic ectodermal dysplasia, a condition that weakens the skin, teeth, and hair, and diminishes their functions. In 2006 he was diagnosed with bladder cancer. In the hospital, he contracted pneumonia and developed a large hernia from coughing. As a result, he lost his job as manager of a convenience store. Without consistent work or health coverage, it has been impossible for the Zduncyks to pay for treatment.
Teresa and her husband’s struggles to receive the care they need are indicative of the need for change within our health care system. We need to hold insurance companies accountable by eliminating discriminatory pre-existing condition clauses and making sure people get the coverage they paid for.
