A Preexisting Condition Makes Public Assistance the Only Option

Pre-existing condition clauses force Will, diagnosed with AIDS, out of his job and into low-income work so that he can qualify for public aid that covers what insurance companies will not.

“When President Obama mentioned the possibility of ending discrimination based on preexisting conditions, I started to cry,” recalls Will Wilson.  Will was diagnosed with AIDS in 2002.  Unable to obtain affordable coverage for treatment or prescriptions, Will has no option but to cap his earnings so that he can qualify for public assistance.

When diagnosed with AIDS, Will was insured by MEGA Life and Health Insurance Company.  He worked as a freelance graphic designer and found the coverage provided by MEGA to be adequate.  But as soon as he required consistent care, the insurance company failed him.  MEGA would not cover blood work and had an annual prescription cap of $1,500.  Will’s prescriptions cost him $3,000 a month, which meant he reached his annual cap in two weeks. Will was forced to pay for his care and the majority of his medication out of pocket.  He began living off his credit to cover rent, prescriptions, and utilities.  Unable to work because of the serious side effects of the new medications, Will quickly burned through his savings.

Today, Will works part time for a Chicago tour company as a tour guide.  This way, his income is low enough that he qualifies to receive benefits through the Ryan White CARE Act, which provides care, including prescription coverage, to the uninsured, underinsured and low-income victims of HIV/AIDS.  He is also able to receive care from the Howard Brown Health Center on a sliding scale.  Will is satisfied with his job, but he feels trapped; his choices are to remain poor or lose the care he needs.  If his income were to increase, he would no longer be eligible to receive assistance from the Ryan White Act.  And because of his preexisting condition, insurance companies can deny him coverage for anything from the flu to cancer, leaving him without any safety net. As a result, Will is forced to live paycheck to paycheck.  “I can’t contribute as much as I want to,” says Will, who would like to return to the work that he loves. “I’ve been on hold for seven years, and I hate it.”

The Ryan White CARE Act expires on October 30th, 2009 and is up for renewal, though the vote has been postponed.  Will wonders what happens to him and others who would suddenly lose the ability to get the prescriptions they need.

Eliminating discrimination based on pre-existing conditions and giving Will the choice of an affordable public insurance plan would return Will to freedom, giving him back the ability to work in the field he loves, save for the future, and contribute to society in the way he chooses.