ME, GO. HALEY, SEN. CRUZ, MEDICAID, THE POOR, THE COST OF HEALTH CARE AND THE AFFORDABLE CARE ACT Just recently, I got an answer I diligently, yet fruitlessly sought for months: $11,071.11. That’s how much it cost for one day of treatment in the hospital for my auto-immune disorder, chronic inflammatory demyelinating polyneuropathy (CIDP). I received the first round of treatment in early January – five days-worth – but was only made aware of the exact cost two weeks ago in a letter from Aetna, my health insurance company. I wanted to know the cost to do the type of comparison shopping free enterprise advocates insist can work even for health care. But the number wasn’t available, even though I am in a state that legally mandates health officials to tell patients about costs when they ask. But there’s a catch. They only have to tell you “if they can.” The best my doctor could do was say it would be “very expensive.” I had a second round of the five days of the infusions in February. I know what my deductible and annual out-of-pocket costs are supposed to be, but we are still in limbo over just what we will have to pay. Though the treatment was pre-approved, Aetna has most of the costs for it in a pending status, meaning Aetna could pay for it as scheduled after a further review or could claim some type of exception we didn’t read in the fine print of our policy and claim my wife and I are responsible for the cost of the treatment. It could be the difference between a bill in the low five-figures and one in the low six-figures. I have no reason, though, to believe Aetna would deny the treatment costs – the company made my getting the treatment smooth – but that doesn’t make it any easier, in the meantime, to figure out what we have to pay and how to make it fit into our budget. While Aetna and Mt. Auburn Hospital work out their agreement on what is covered, we are in constant touch with the hospital. Despite that, we have been sent automated telephone messages about unpaid bills and small bills sent to collection. That’s happening even as we are working with hospital officials to figure out just what we are supposed to pay – something they don’t even have a handle on. My wife has spoken several times with people who deal with the bills for the hospitals, who seem more astonished by the amount of bills every time they talk. She didn’t realize until recently she had to speak to someone else about the billing by the doctors, which is collected separately from the hospital, and which also includes a long list of charges, ranging from $61.16 to a few thousand dollars for a single test to a $23,000 charge. It was impossible to get a cost before treatment began and not much easier to get a total afterwards. Given that I have at least another five or six months of treatment, the billing issue is unlikely to be resolved any time soon, though one bill has. Seems we overpaid for a visit several weeks ago and got a call out of the blue telling us the doctor’s office wanted to return $14 to us. Fortunately, my new treatments, the next round of which begins tomorrow morning and lasts until Saturday, are less expensive than the initial rounds. How do we know? Our doctor said they are “very cheap.” (My body rejected the initial IVIG treatments, so now I’m on steroids.) Even with the uncertainty – and the billing-induced headaches to come – my view hasn’t changed. For a middle-class American, my situation couldn’t be more fortunate. I have comprehensive health insurance, not the ‘insurance-in-name-only’ type that leaves thousands of Americans bankrupt every year. I have family and friends who have eagerly pinched in to help in a variety of ways. I have access to top specialists who were able to diagnosis my disorder in fairly short order. Without all of that, my prospects for returning to work full time would be dim. Without the treatment, I’d be in a wheelchair and likely unable to use my hands and arms, either. While we have to use money we had earmarked for savings and paying down debt – and have to find other resources to ward of bill collectors – my life has been dramatically improved because I had an Aetna card and was living near a quality hospital the insurance company had contracted with. That’s why it pains me to watch what’s going on in my native state of South Carolina, which is one of the 20 or so to refuse Medicaid expansion through the Affordable Care. That decision has left more than 300,000 poor residents in one of the poorest states in the union without health insurance they otherwise would be eligible to receive. It means that when they are hit with a sudden, chronic illness like I was, they are less likely to receive adequate treatment – if they get treated at all. It means those poor people who are so often accused of being lazy and dependent won’t have a second chance, like the one I am receiving, to be a productive, fully active member of the work world. It means that they will end up in a wheelchair like I almost did, that when the strength in their hands and fingers and legs leave them, it is less likely to return, making them less desirable as job candidates. And that doesn’t include the personal struggles such chronic illnesses create. I’m fully aware that Medicaid in its current state isn’t perfect and doesn’t always lead to better health outcomes. Medicaid needs to be reformed and reimbursement rates need to be improved to attract a greater number of doctors and specialists the way Medicare does. But studies show Medicaid reduces the chances to near zero that a family blessed with it would go bankrupt because of a medical emergency, as well as providing a peace of mind – a real health benefit – that comes with simply having insurance. Medicaid guarantees nothing but provides the poor a fighting chance. Despite those facts, Gov. Haley’s administration has turned down the expansion, usually claiming that the state can’t afford the increased costs. A few weeks ago, Rep. Tracy Edge told me he agreed with Haley because Medicaid in South Carolina has not been managed well enough. Those claims don’t hold up well under scrutiny. S.C. taxpayers will be on the hook for an additional $130 million or so this fiscal year to contend with the growth of Medicaid – in large part because we are refusing ACA money. When critics of the ACA and other anti-poverty programs spy a poor person buying a $10 steak at Walmart with food stamps, they howl, but remain silent when the state wastes tens of millions of taxpayer dollars for nakedly political purposes. Under the ACA, the federal government would pay the entire cost of the expansion for the first three years and no less than 90 percent thereafter. But because Gov. Haley refused the expansion, the state is instead on the hook for 33 percent of the increased annual cost of Medicaid – compared to the zero percent to 10 percent under the ACA. Yes, state residents are paying more for the right to cover fewer poor people under Medicaid. (Haley also set up a committee under the pretenses of studying the viability of running a state exchange. At the outset, though, she was determined to deny the insurance exchange, no matter the outcome of the deliberations, according to emails uncovered and published in state newspapers, thereby wasting even more taxpayer money.) The negative economic impact of our ACA expansion refusal also includes the ongoing cost to pay for the un- and underinsured in the state, which is putting more pressure on rural hospitals throughout the South and has already forced some to shut their doors. It includes the thousands of jobs the new federal funds would have created through increased economic activity. Haley and other state officials used that type of economic argument to justify a one-billion dollar package of state goodies to lure Boeing and maybe 20,000 direct and indirect jobs to North Charleston, but ignore such analysis when the same logic applies to bringing health insurance to hundreds of thousands of poor residents, which would create even more jobs than Boeing has. To Rep. Edge’s complaint that Medicaid hasn’t been managed well enough in the state, and that annual cost increases are too unpredictable, I say this: We send people like him to Columbia to assure that such programs are run well. If they aren’t, that says more about our General Assembly – which has been in GOP hands for essentially the past quarter of a century – than it does about the flaws of the ACA. Some Republican governors have decided to use the Medicaid expansion to force Medicaid reform in their states, which makes annual cost increases more manageable and foreseeable. That’s been done by state leaders elsewhere who still speak out against the ACA. But they haven’t let their political rhetoric to get in the way of what’s best for their poorest residents – unlike Haley. Haley isn’t the only one whose stance against the ACA seems particularly odd. Sen. Ted Cruz of Texas a few months ago made a big show of his opposition to the ACA in a much-discussed faux filibuster in the U.S. Senate. He spoke about several things during those 20 hours, including even reading some Dr. Seuss. This is what he didn’t mention while railing against the ACA and dependence: Cruz and his wife, who works on Wall Street, receive a larger government health care subsidy than two poor families on Medicaid combined. Cruz and his wife are quite wealthy but benefits from the same employer-subsidy I benefit from through my job. That’s another of the conceits of this debate. Those who receive government help through their employers don’t receive the ridicule and shame poor families have to endure for receiving government assistance, most of whom also work. When Cruz – or just about everyone who has insurance through a large employer – receives help, we give it bland titles such as “subsidy” or “tax credit” or don’t call it anything at all, because that type of government assistance is spoken of in hushed tones during inequality debates. Cruz spoke for 20 straight hours and never once said, “I’m a wealthy U.S. Senator married to a woman who works on Wall Street. Why is the government subsidizing my lifestyle, helping me with my expensive home and expensive private health insurance policy? I will not sit, will not shut up, will not leave this chamber until that travesty ends!” But when poor people get help, we call it food stamps and welfare and wonder if the poor will grow lazy and dependent in the way we never assume about the rich – who receive more government goodies on average than the poor through things such as employer-sponsored health plans and a mortgage interest deduction policy designed for the middle class but mostly benefits the wealthy. We are subsidizing million-dollar and second homes with taxpayer money but are angrier with the poor S.C. single mom who receives a $200 “welfare” check and Medicaid coverage for her children. We do as little as possible to help the poor recover from or avoid potentially crippling chronic illnesses then blame them for not working hard enough despite their having to grapple with medical issues that would prevent most of the rest of us from being productive even at our desk jobs. There are solutions to all of this. The ACA, while not perfect, is pushing us in the right direction. We’d get there much faster in a saner political environment, one which rewards leaders for struggling to implement policies to help the least of these while punishing those who stand in the way.
Posted on: Tue, 01 Apr 2014 20:36:01 +0000
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