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Saturday, November 17, 2007

Not Nameless Faceless Kids - Hers

I read this blog about a mother's struggle to insure her special needs children - the real kind - in our current insurance system. Her child is being dropped because the insurance company isn't making any money off insuring her.

Basically once they are in the high risk pool, normal insurance will never cover them again, even if they "outgrow" their issues. They are a health risk, and insurance companies can't really make money off of those kids.

Did you know that our state provides an SCHIP program through the very company that KayTar currently has insurance through? With identical benefits? Did you know that we are eligible for this program if you use our net income, but if you go by our gross income we are just over the line? Just over the line! We don't even receive any of that money! Do you know where it goes? Taxes. We are paying the government to provide services like this for people in need and the TINY bit of money that we give is what keeps us from not being eligible for the programs ourselves. How can that be right?

The bill President Bush recently vetoed would have provided insurance for my kids. Not some faceless huddled masses. These kids. MY kids.

Read the full HealthCare is a Bitch.

But for the grace of God, there go I.

We've always been about $60 gross over the income limit for the Pre-K, free lunch and SCHIPS. The only major difference is our children are healthy and we have corporate health insurance.

My prayers are with you Kyla.

11 comments:

jen said...

Unfortunately I know exactly where this woman is coming from in her struggle. God bless her.

jen said...

I just posted about our struggles on my blog. jlogged.com

Today I go to check my son into a nursing home in a last ditch effort to make the state cry uncle.

It's put my morale at an all time low, but we have no choice at this point.

I didn't make the rules just playing by them.

Anonymous said...

I feel mean saying this, but Tracee, am I the only one who thinks you shouldn't be having kids if you need "Pre-K, free lunch and SCHIPS" to take care of them?

Why have a second child if you can't afford to pay for lunch and health care for the first? I'm not a terrible person, just tired of people who think they have a right to have as many kids as they want and then ask me to pay for it. Government money doesn't come out of thin air, you are taking money away from other families like mine.

When I looked at Kyla's site I saw she managed to have multiple computers (I counted 3), digital cameras, nice cars, furniture, clothes and TVs. She also wrote about taking a trip (plane ride, hotel etc.) to Chicago and another couple of family vacations. Going out to dinner. Cable TV. But she can't afford the health insurance that she fully admits is available through her husband's work? I can think of a few ways.

There are truly needy people who need welfare programs and Chip. Sorry, taking vacations instead of paying for your kid's health insurance doesn't make you one of them.

Tracee said...

Dear anonymous, While I will refrain from calling you "mean," I would say your statements are simplistic and unempathetic.

1. She has 2 children not 10. It's not like Kyla went crazy with reproduction she could not afford.

2. It's vastly different to be able to "afford" healthy children than sick children. We don't get to control whether our children are born with medical needs or whether they are born healthy. If they are born with medical needs whether we can afford them is already a moot point. Kyla probably could have afforded two healthy children.

5. Your assumption is that If they gave up vacations, computers, cameras, and all other "optional" expenses then they could afford either health insurance or medical care.

My guess is that you underestimate the cost of healthcare. I do not believe they could afford healthcare for a medical needs child - period. I would guess, not knowing who you are, that it's been either a long time or it's never happened that you've gotten a full price medical bill.

The actual costs are SHOCKING. I believe they are so shockingly middle class American family - regardless of how frugal they might live could afford treatment for a medical needs child.

It's not one-time or temporary treatment - which most middle class families could recover from eventually.

It's over the duration of a lifetime of a child and even if you made over 100,000 I don't think American families are capable of absorbing the cost.

Anonymous said...

My heart goes out to families who care for special needs kids. Kyla sounds like a great mother in many ways. But I am going to call these issues as I see them.

If you are going to write about health care, you should understand a few things about how insurance works.

Actually, insurance premiums through an employer (which Kyla has access to) costs the same whether you have a sick child or not. It's open enrollment. Yes, there are more copays and out of pocket expenses. But Kyla isn't talking about being burdened by that, which I could understand and sympathize with. She is talking about not paying for the basic insurance premiums.

Preexisting conditions only affect people who are trying to get an individual policy or haven't had coverage for the last 18 months. Even if you haven't had the prior coverage, after a waiting period, your sick kid is covered same as any other healthy kid.

The average health insurance premium cost for a family of four is huge, about $11,500 a year. Most employers pay a portion of that, but not all. Yes, I do believe that her extras could pay that. I think many people spend that much on car payments alone every year.

It would be lame to give up those luxuries, I know, because I have not been on a real vacation other than camping or visiting relatives in the car in over six years. I use public transportation. I shop at thrift stores. I'm not some rich person sitting on a hill telling her to suck it up as she struggles to put food on the table. But I don't really see her sacrificing much.

I know it hurts to feel like you don't want to give up having two cars and HBO. Moms of special needs kids probably need vacations more than most. But there is a level of personal responsibility and priorities that needs to kick in here. If only because her kid needs health insurance and the system is not changing anytime soon.

Of course I know how much health insurance is. I pay it myself for my own family and it hurts like hell. One of the sacrifices we make is that my husband works for an employer rather than for himself because my family needs health insurance and we can't get individual coverage.

There are lots of issues around health care that I do want to see changed. For instance, I want insurance access for everyone, including those who are self employed, handicapped or can't work because of medical problems. I want to see the small business loophole closed. I want people who work part-time to have access. I want programs to help the working poor (those making minimum wage) get coverage. I don't want to penalize poor people who are in between being able to afford insurance themselves and being kicked off state programs. I'd even like to see programs that help families with sick children or adults who are overburdened by copays and out of pocket expenses.

But "free programs" cost somebody something. You want to take money out of my pocket while you go on vacations my family could never afford? What a sense of entitlement. It doesn't matter if its two children or 10. If you can't afford them, you should not have them. If you have HBO, you don't need free school lunch. If you can afford fancy gadgets, you don't need WIC. If you have two cars, you need to give at least one up before you ask me to put you on a free healthcare program.

Sorry, that is just the way I see it.

Tracee said...

anonymous,

It sounds like you sacrifice a lot for your family. Your lifestyle sounds very much like mine.

Not all health insurance policies are the same. I don't know the details of hers. But, what I got from her blog is that it's more of a catastrophic insurance option - meaning it won't cover any of the things her kid needs.

Example: My husbands company offers dental insurance. I did the math on the premiums and their 2 year waiting period before I'd be allowed to use it and determined that it would be more expensive to pay the insurance and copays than it would to just self-pay for the crown I need.

I don't see any reason for any Americans to have to sacrifice like we are for basic healthcare There is enough money in this country for you and I to be covered and Kyla and everyone else. Take out the profit insurance companies are pocketing and there is more than enough actual resources to go around. Haven't you heard - we're the wealthiest country on earth.

Of course it's not FREE. Nothing is free. We pay for them through public programs. We pay for us through insurance. That's not going to change.

It's costing US more money for Kyla's family to be uninsured than it would if we had universal care. If something happens to them and they can't pay for the care WE pay for that. It never "just gets written off" the balance is applied to you and me.

Your family deserves relief too.

jen said...

Anonymous, I do agree with you on several of your points, and would like to add that my family has given up many, many "luxuries." We live a simple lifestyle on a modest wage, drive 10+ year old vehicles, and haven't ever once been on vacation in eight years.

When we decided to have a second child we had amazing group coverage health insurance, and then my husband lost his job while I was pregnant. It was then that we found out we were not only expecting twins but that one had health problems.

Our best hope is to get on a group insurance policy at this point. My husband is looking, but it could take months before group healthcare is actually available to our family. At this time he works for a small company that does not offer benefits. We pay for a private health policy for the adults,and will add our two healthy children when our CHIP policy ends, but our special needs child will be uninsured unless we can get in an open enrollment plan, or seek out loopholes in state insurance. At this time the loophole involves a 30 day stay for my child in a state nursing home.

I don't expect the government to raise my kids for me, pay for their school lunch, or give me money for making bad choices (which they would do willingly if I had a few more kids or divorced my spouse,) but I DO expect them to step in and help hard working families like ours who get punished for having a medically dependent child.

We did not CHOOSE to be in this place, but we are doing everything possible to better our situation.

"It's costing US more money for Kyla's family to be uninsured than it would if we had universal care. If something happens to them and they can't pay for the care WE pay for that. It never "just gets written off" the balance is applied to you and me.

Your family deserves relief too."

This is so true Tracee. I completely agree that Anonymous should not have to go without ever going on vacation in order to afford healthcare for her family.

Violet said...

I had to pay COBRA for about a year, and damn it stung. $9,000 for both of us. I would have way rather had a nice car.

At least with a car, you make X payment and you get X (your car) in return. But with health insurance, you are paying for the car that you might need to drive but probably won't.

jen said...

Ouch V.! We did COBRA once too, and good night it was pricey. We couldn't afford the full coverage for a family of five, so we just paid for dental and vision in order to get about 1800.00 worth of dental work done + new glasses since we didn't get it taken care of before my husband's sudden lay off.

Kyla said...

Hey Tracee, thanks for defending me. :)

As much as I shouldn't feel the need to justify, I do. My husband gets our computers free from work when they are done with them. Our TVs were bought long ago, before all of this happened. My trip to BlogHer was covered by flight miles we already had and my husband was able to sell some equipment to fund the remainder of my trip. It is easier to come up with a few hundred dollars for one specific trip than an extra thousand every month. I have a digital camera, that is over a year old and was a GIFT. Our cars are BOTH paid off. One vacation was totally paid for by my parents. The other cost us $80. We occasionally, OCCASIONALLY go out to dinner with friends. Like for my husband's birthday, and our friend's even picked up the tab. Yes, we pay for Internet. Our one extra. If we gave it up? We still would not have a solid insurance choice.

If you will notice, my issue is not with having insurance right now. We are paying for is and KayTar is properly covered. The problem is this plan is being canceled and we don't have another solid choice.

We don't want a free ride, we want proper COVERAGE. SCHIP is the only plan available with coverage that matches our current plan. COBRA is not available because it is not a group plan, or we would take that option. My husband's insurance is too expensive, and even if we could afford it somehow, it covers too little. It is not a worthwhile investment. That is why we have been paying for individual coverage all this time. It is not our fault this plan is being canceled. We aren't being dropped, the plan will not exist come the end of February. We would continue to be FINE if the policy wasn't being canceled. We don't want a free ride, we want adequate coverage.

And yes, I can pay out of pocket for SELF-PAY insurance (this is likely the option we will take), but it DOES NOT cover my child's needs. SCHIP would cover my child's needs, all of them. Her hearing loss, ongoing tests for that (it is likely progressive), her hearing aids, which are a couple thousand, and her therapies (which run more than $200 per week) WILL NOT BE COVERED. Not because of pre-existing conditions, but because they just FLAT OUT doesn't cover them.

There is another option, we could do this individual policy and apply for a Special Needs assistance fund for the extras our insurance doesn't cover, but guess what? That program uses the SCHIP guidelines for qualifications.

As far as "'free programs' cost somebody something," I understand that, I do. MY TAXES go to that and I don't mind it. But the amount I pay into taxes is what keeps our family ineligible for those services. I don't want a free ride, I'm not on food stamps or WIC or anything, I'm not angling for someone else to take care of me or my children. I just want my child completely covered. All of her needs, and it is much harder than you might think.

Did I know when I conceived my second child we would have a kid who needed all of this? No, I surely didn't. You can't budget for the unknown, when we had KayTar, we were financially secure and would have continued to be so. We both had full time jobs, which I have had to give up to care for her. You can't always judge a story from the outside.

There isn't always an easy answer, Anonymous, but I think everyone wishes there could be. And unfortunately, I think many people find the easy answer to be putting the blame on parents like me. It is easier not to care about others if you can place the blame squarely on their shoulders. Maybe some of it is my fault, but whatever the case, however I try to fix it, I cannot spontaneously create a plan that covers all of her needs and make it available to her, and THAT is the crux of my dilemma.

Tracee said...

But for the Grace of God, there go I Kyla. I wish you and yours well.

I think Americans can most certainly afford to help families like yours. There is no lack of resources in this country.

I believe medical care should be a fundamental right. I also believe the richest country in the world can afford to be compassionate to each other's health needs.

Saturday, November 17, 2007

Not Nameless Faceless Kids - Hers

I read this blog about a mother's struggle to insure her special needs children - the real kind - in our current insurance system. Her child is being dropped because the insurance company isn't making any money off insuring her.

Basically once they are in the high risk pool, normal insurance will never cover them again, even if they "outgrow" their issues. They are a health risk, and insurance companies can't really make money off of those kids.

Did you know that our state provides an SCHIP program through the very company that KayTar currently has insurance through? With identical benefits? Did you know that we are eligible for this program if you use our net income, but if you go by our gross income we are just over the line? Just over the line! We don't even receive any of that money! Do you know where it goes? Taxes. We are paying the government to provide services like this for people in need and the TINY bit of money that we give is what keeps us from not being eligible for the programs ourselves. How can that be right?

The bill President Bush recently vetoed would have provided insurance for my kids. Not some faceless huddled masses. These kids. MY kids.

Read the full HealthCare is a Bitch.

But for the grace of God, there go I.

We've always been about $60 gross over the income limit for the Pre-K, free lunch and SCHIPS. The only major difference is our children are healthy and we have corporate health insurance.

My prayers are with you Kyla.

11 comments:

jen said...

Unfortunately I know exactly where this woman is coming from in her struggle. God bless her.

jen said...

I just posted about our struggles on my blog. jlogged.com

Today I go to check my son into a nursing home in a last ditch effort to make the state cry uncle.

It's put my morale at an all time low, but we have no choice at this point.

I didn't make the rules just playing by them.

Anonymous said...

I feel mean saying this, but Tracee, am I the only one who thinks you shouldn't be having kids if you need "Pre-K, free lunch and SCHIPS" to take care of them?

Why have a second child if you can't afford to pay for lunch and health care for the first? I'm not a terrible person, just tired of people who think they have a right to have as many kids as they want and then ask me to pay for it. Government money doesn't come out of thin air, you are taking money away from other families like mine.

When I looked at Kyla's site I saw she managed to have multiple computers (I counted 3), digital cameras, nice cars, furniture, clothes and TVs. She also wrote about taking a trip (plane ride, hotel etc.) to Chicago and another couple of family vacations. Going out to dinner. Cable TV. But she can't afford the health insurance that she fully admits is available through her husband's work? I can think of a few ways.

There are truly needy people who need welfare programs and Chip. Sorry, taking vacations instead of paying for your kid's health insurance doesn't make you one of them.

Tracee said...

Dear anonymous, While I will refrain from calling you "mean," I would say your statements are simplistic and unempathetic.

1. She has 2 children not 10. It's not like Kyla went crazy with reproduction she could not afford.

2. It's vastly different to be able to "afford" healthy children than sick children. We don't get to control whether our children are born with medical needs or whether they are born healthy. If they are born with medical needs whether we can afford them is already a moot point. Kyla probably could have afforded two healthy children.

5. Your assumption is that If they gave up vacations, computers, cameras, and all other "optional" expenses then they could afford either health insurance or medical care.

My guess is that you underestimate the cost of healthcare. I do not believe they could afford healthcare for a medical needs child - period. I would guess, not knowing who you are, that it's been either a long time or it's never happened that you've gotten a full price medical bill.

The actual costs are SHOCKING. I believe they are so shockingly middle class American family - regardless of how frugal they might live could afford treatment for a medical needs child.

It's not one-time or temporary treatment - which most middle class families could recover from eventually.

It's over the duration of a lifetime of a child and even if you made over 100,000 I don't think American families are capable of absorbing the cost.

Anonymous said...

My heart goes out to families who care for special needs kids. Kyla sounds like a great mother in many ways. But I am going to call these issues as I see them.

If you are going to write about health care, you should understand a few things about how insurance works.

Actually, insurance premiums through an employer (which Kyla has access to) costs the same whether you have a sick child or not. It's open enrollment. Yes, there are more copays and out of pocket expenses. But Kyla isn't talking about being burdened by that, which I could understand and sympathize with. She is talking about not paying for the basic insurance premiums.

Preexisting conditions only affect people who are trying to get an individual policy or haven't had coverage for the last 18 months. Even if you haven't had the prior coverage, after a waiting period, your sick kid is covered same as any other healthy kid.

The average health insurance premium cost for a family of four is huge, about $11,500 a year. Most employers pay a portion of that, but not all. Yes, I do believe that her extras could pay that. I think many people spend that much on car payments alone every year.

It would be lame to give up those luxuries, I know, because I have not been on a real vacation other than camping or visiting relatives in the car in over six years. I use public transportation. I shop at thrift stores. I'm not some rich person sitting on a hill telling her to suck it up as she struggles to put food on the table. But I don't really see her sacrificing much.

I know it hurts to feel like you don't want to give up having two cars and HBO. Moms of special needs kids probably need vacations more than most. But there is a level of personal responsibility and priorities that needs to kick in here. If only because her kid needs health insurance and the system is not changing anytime soon.

Of course I know how much health insurance is. I pay it myself for my own family and it hurts like hell. One of the sacrifices we make is that my husband works for an employer rather than for himself because my family needs health insurance and we can't get individual coverage.

There are lots of issues around health care that I do want to see changed. For instance, I want insurance access for everyone, including those who are self employed, handicapped or can't work because of medical problems. I want to see the small business loophole closed. I want people who work part-time to have access. I want programs to help the working poor (those making minimum wage) get coverage. I don't want to penalize poor people who are in between being able to afford insurance themselves and being kicked off state programs. I'd even like to see programs that help families with sick children or adults who are overburdened by copays and out of pocket expenses.

But "free programs" cost somebody something. You want to take money out of my pocket while you go on vacations my family could never afford? What a sense of entitlement. It doesn't matter if its two children or 10. If you can't afford them, you should not have them. If you have HBO, you don't need free school lunch. If you can afford fancy gadgets, you don't need WIC. If you have two cars, you need to give at least one up before you ask me to put you on a free healthcare program.

Sorry, that is just the way I see it.

Tracee said...

anonymous,

It sounds like you sacrifice a lot for your family. Your lifestyle sounds very much like mine.

Not all health insurance policies are the same. I don't know the details of hers. But, what I got from her blog is that it's more of a catastrophic insurance option - meaning it won't cover any of the things her kid needs.

Example: My husbands company offers dental insurance. I did the math on the premiums and their 2 year waiting period before I'd be allowed to use it and determined that it would be more expensive to pay the insurance and copays than it would to just self-pay for the crown I need.

I don't see any reason for any Americans to have to sacrifice like we are for basic healthcare There is enough money in this country for you and I to be covered and Kyla and everyone else. Take out the profit insurance companies are pocketing and there is more than enough actual resources to go around. Haven't you heard - we're the wealthiest country on earth.

Of course it's not FREE. Nothing is free. We pay for them through public programs. We pay for us through insurance. That's not going to change.

It's costing US more money for Kyla's family to be uninsured than it would if we had universal care. If something happens to them and they can't pay for the care WE pay for that. It never "just gets written off" the balance is applied to you and me.

Your family deserves relief too.

jen said...

Anonymous, I do agree with you on several of your points, and would like to add that my family has given up many, many "luxuries." We live a simple lifestyle on a modest wage, drive 10+ year old vehicles, and haven't ever once been on vacation in eight years.

When we decided to have a second child we had amazing group coverage health insurance, and then my husband lost his job while I was pregnant. It was then that we found out we were not only expecting twins but that one had health problems.

Our best hope is to get on a group insurance policy at this point. My husband is looking, but it could take months before group healthcare is actually available to our family. At this time he works for a small company that does not offer benefits. We pay for a private health policy for the adults,and will add our two healthy children when our CHIP policy ends, but our special needs child will be uninsured unless we can get in an open enrollment plan, or seek out loopholes in state insurance. At this time the loophole involves a 30 day stay for my child in a state nursing home.

I don't expect the government to raise my kids for me, pay for their school lunch, or give me money for making bad choices (which they would do willingly if I had a few more kids or divorced my spouse,) but I DO expect them to step in and help hard working families like ours who get punished for having a medically dependent child.

We did not CHOOSE to be in this place, but we are doing everything possible to better our situation.

"It's costing US more money for Kyla's family to be uninsured than it would if we had universal care. If something happens to them and they can't pay for the care WE pay for that. It never "just gets written off" the balance is applied to you and me.

Your family deserves relief too."

This is so true Tracee. I completely agree that Anonymous should not have to go without ever going on vacation in order to afford healthcare for her family.

Violet said...

I had to pay COBRA for about a year, and damn it stung. $9,000 for both of us. I would have way rather had a nice car.

At least with a car, you make X payment and you get X (your car) in return. But with health insurance, you are paying for the car that you might need to drive but probably won't.

jen said...

Ouch V.! We did COBRA once too, and good night it was pricey. We couldn't afford the full coverage for a family of five, so we just paid for dental and vision in order to get about 1800.00 worth of dental work done + new glasses since we didn't get it taken care of before my husband's sudden lay off.

Kyla said...

Hey Tracee, thanks for defending me. :)

As much as I shouldn't feel the need to justify, I do. My husband gets our computers free from work when they are done with them. Our TVs were bought long ago, before all of this happened. My trip to BlogHer was covered by flight miles we already had and my husband was able to sell some equipment to fund the remainder of my trip. It is easier to come up with a few hundred dollars for one specific trip than an extra thousand every month. I have a digital camera, that is over a year old and was a GIFT. Our cars are BOTH paid off. One vacation was totally paid for by my parents. The other cost us $80. We occasionally, OCCASIONALLY go out to dinner with friends. Like for my husband's birthday, and our friend's even picked up the tab. Yes, we pay for Internet. Our one extra. If we gave it up? We still would not have a solid insurance choice.

If you will notice, my issue is not with having insurance right now. We are paying for is and KayTar is properly covered. The problem is this plan is being canceled and we don't have another solid choice.

We don't want a free ride, we want proper COVERAGE. SCHIP is the only plan available with coverage that matches our current plan. COBRA is not available because it is not a group plan, or we would take that option. My husband's insurance is too expensive, and even if we could afford it somehow, it covers too little. It is not a worthwhile investment. That is why we have been paying for individual coverage all this time. It is not our fault this plan is being canceled. We aren't being dropped, the plan will not exist come the end of February. We would continue to be FINE if the policy wasn't being canceled. We don't want a free ride, we want adequate coverage.

And yes, I can pay out of pocket for SELF-PAY insurance (this is likely the option we will take), but it DOES NOT cover my child's needs. SCHIP would cover my child's needs, all of them. Her hearing loss, ongoing tests for that (it is likely progressive), her hearing aids, which are a couple thousand, and her therapies (which run more than $200 per week) WILL NOT BE COVERED. Not because of pre-existing conditions, but because they just FLAT OUT doesn't cover them.

There is another option, we could do this individual policy and apply for a Special Needs assistance fund for the extras our insurance doesn't cover, but guess what? That program uses the SCHIP guidelines for qualifications.

As far as "'free programs' cost somebody something," I understand that, I do. MY TAXES go to that and I don't mind it. But the amount I pay into taxes is what keeps our family ineligible for those services. I don't want a free ride, I'm not on food stamps or WIC or anything, I'm not angling for someone else to take care of me or my children. I just want my child completely covered. All of her needs, and it is much harder than you might think.

Did I know when I conceived my second child we would have a kid who needed all of this? No, I surely didn't. You can't budget for the unknown, when we had KayTar, we were financially secure and would have continued to be so. We both had full time jobs, which I have had to give up to care for her. You can't always judge a story from the outside.

There isn't always an easy answer, Anonymous, but I think everyone wishes there could be. And unfortunately, I think many people find the easy answer to be putting the blame on parents like me. It is easier not to care about others if you can place the blame squarely on their shoulders. Maybe some of it is my fault, but whatever the case, however I try to fix it, I cannot spontaneously create a plan that covers all of her needs and make it available to her, and THAT is the crux of my dilemma.

Tracee said...

But for the Grace of God, there go I Kyla. I wish you and yours well.

I think Americans can most certainly afford to help families like yours. There is no lack of resources in this country.

I believe medical care should be a fundamental right. I also believe the richest country in the world can afford to be compassionate to each other's health needs.