Thanks To The Pre-existing Condition Plan, Some People (Including Me) Get Help

I read Nicole's post last week about Spike Dolomite Ward, a former Obama supporter who'd been very critical of the president. She's a true believer once again because she was recently diagnosed with breast cancer, and found out she was eligible

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I read Nicole's post last week about Spike Dolomite Ward, a former Obama supporter who'd been very critical of the president. She's a true believer once again because she was recently diagnosed with breast cancer, and found out she was eligible for the preexisting condition insurance under the Affordable Care Act.

This really rubbed me the wrong way.

I, too, frequently criticize President Obama's policies. And the mere fact that I will use that same preexisting condition plan to get the surgery I desperately need doesn't do a damned thing to help all the other people who aren't eligible, or who can't afford it. (By the way, there's a $1000 co-pay, which is a hardship. I couldn't afford it at all if not for a tiny nest egg left to me by my mother - one I was holding onto in case of car repairs or other emergencies. When that runs out, it's back to the land of the uninsured, and I will still owe $22,000 from my earlier hospital stay.)

Ward sounds like a nice middle-class lady, one who can afford to make a small monthly payment, even if it's a stretch. I, on the other hand, know far too many people my age who are now members of the long-term unemployed, people hanging by a suicide thread. For various reasons, they're not eligible for programs like Medicaid - but there's no way in hell they can afford a monthly premium.

Good for Ms. Ward that she can afford it. But her story annoyed me because it sounds like her disillusion with Obama's policies (and her subsequent reconversion experience after she got finally the help she needed) was rooted only in her own middle class experience. You know, as if it's now perfectly okay as long as it's "only" happening to other people. That bugs me.

Don't get me wrong: The preexisting condition option is an absolute lifesaver for those who can afford it. It's subsidized by the federal government to keep premiums low (mine will run slightly under $300 a month, as opposed to the $600+ a month I paid into COBRA while I was still collecting unemployment). The original version required you to prove you'd been turned down by an insurer, or to show documentation that the premium was so high, you couldn't afford it. When the enrollment numbers turned out to be rather low, they loosened those stricter requirements. (In Pennsylvania, I only had to list which pre-existing conditions I had.)

You still have to have been uninsured for at least six months to be eligible.

The numbers are still low, and the original reason I wanted to write about this was to urge readers to look into their own state's program. (Some are run by the state, others by the feds. Ask Mr. Google how to apply where you live.)

As some of you already know, I've been suffering with gall bladder disease since July, and last month was also diagnosed with a nasty case of diverticulitis. The latter was treated with major-league antibiotics and a liquid diet; the former hasn't been treated because, well, I don't have insurance.

It hasn't been fun, these late-night cab rides to the ER. (911 takes me to the local Medicaid mill, which misdiagnosed me the first time around. I'm not going back for more.) Rolling around on the floor for hours because you're in excruciating pain is never fun; knowing a simple outpatient surgery could fix the whole thing is just plain infuriating.

No, the hospital doesn't have to perform surgery - unless your condition is life-threatening.

Hospitals have a weird subset of the definition. There's "life threatening" as in "we're going to fix it even if you don't have the money" kind of life threatening (the kind I don't have - yet), and then there's "life threatening" as in the GI specialist frowning, patting your hand (never a good sign) and saying, "Your attacks are accelerating, you really need to take care of this now, this is a life-threatening condition. If anything changes or it gets worse, you must go to the ER."

You know, as if I'm stubbornly refusing to get the surgery because I don't take it seriously enough.

Having an inflamed gall bladder is like having an inflamed appendix. If it ruptures, the infection can kill you. I know that. So when I found out about this plan, I was just plain thrilled. Not so thrilled when they told me if accepted, it wouldn't start until Feb. 1st. I called my local (Republican) state representative's office and talked to the constituent services lady, who'd never heard of the program but promised to see if it could be expedited. I wasn't hopeful, but the next day she called me back with a contact number. I spoke to the caseworker, who got my start date moved up to January instead.

When I hung up, I sat there and cried tears of relief.

Now all I have to do is wait. Wait for the official acceptance letter (hoping there's no screw-up in the paperwork), and wait for Christmas to be over, because I can't go to any Christmas parties this year. I might eat something that sends me back to the ER, and I don't want to risk it. (Although if any of you want to send me Christmas cookies in January, I could always celebrate later.)

If everything works out, this very useful government program will solve my individual medical problem. But it won't solve everyone's, and if there's someone else writhing around on the floor late at night because they can't afford insurance, that's one too many and I do feel their pain.

And so should our president, and the cowardly politicians who cobbled together this Frankenstein's monster of medical "reform". We're the richest country in the world, but our priorities are very badly skewed. People shouldn't have to beggar themselves for the help they need. As I said to every single person who dealt with me in the hospital, "This system is insane." Every last one of them agreed with me.

I'm glad I'm getting the help I need. But I won't stop pushing our politicians until they fix it for everyone else.

About Susie Madrak

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