Archive for the ‘The Point’ Category

The Point: The Incredible, Uncoverable Leg

Wednesday, March 3rd, 2010

In this installment of The Point, Hub blogger Kate Petersen’s mother tells about her attempts to get both legs covered by a single health plan. Easy, you say…

I am a speech and language pathologist in a public school system in Arizona. My husband is a retired Public Health Service officer with excellent federal health insurance, and additionally he works full-time as an epidemiologist at a nonprofit organization.  In addition to his federal health benefits, he has  also subscribed to the insurance program offered by his employer so as to cover our daughters as dependents, and to provide primary insurance for me.

My story begins in May 2005 when I was going to an awards dinner. Late on the afternoon of the dinner, after my two-mile exercise walk, I decided that I certainly needed a new frock for the dinner and slipped on sandals to take a brief walk-through of our local outdoor mall.  I succeeded in finding a new dress, but was running very late in getting ready, so I was running across a street in the mall area to get to my car, when the side of my sandal hit a pot hole in the street between brick pavers and I fell.  I continued on my way and went to the dinner, but I had trouble walking and so afterward my husband took me to the emergency room.

I had a non-dislocated fracture of my right ankle.  With a standard course of treatment of casting and non-weight-bearing for six weeks, followed by a walking boot, I gradually returned to full function.  There are no residuals from the fracture.

In 2007, my husband’s business changed insurance companies, and the monthly premium substantially increased.  We considered buying our own policy in order to maintain my coverage and that of my remaining dependent daughter, who was still in college.  My husband got several quotes through an insurance broker who came to the house to ask the ‘few questions’ before collecting the fee and signing us up.

After a lengthy discussion, he told me I would be covered with the exception of my right leg…Not ankle—leg!   I told the agent that there was no follow-up care to my simple fracture, my right leg was uninvolved, and that I was back to hiking and exercising and had been for two years. But he was unswayed in his pronouncement that my right LEG would never be covered.

Needless to say, my husband and I signed up for his company’s group insurance with a higher premium after all, to avoid my leg exclusion.  If the broker agent had only asked the right questions, he would have found out that I had also had a minor surgical procedure on my right index finger earlier that year to remove a cyst – again, without any further treatment. Perhaps then he could have offered me insurance with an entire right SIDE exclusion!

With health care reform,  companies would be barred for denying people with pre-existing conditions coverage – pre-existing conditions that I found out can be specious and exaggerated at the expense of consumers.

Our current system of health insurance coverage is sad and unfair, and I am so grateful to the President, Congress, and all the advocates who are devoting their time and energy to seeking change and justice in the health insurance system so that people get health care benefits they so badly need.


Do you care about changing the health care system? Send your support of health care reform to Congress by signing the petition now (the link works today!)  then sending it on to your family, friends and coworkers.


The Point

Tuesday, February 9th, 2010

While we were encouraging folks to write letters to local newspapers, telling stories about what health care reform means for people they know, we realized each of us here knows someone who would be helped by health reform passing.  Who reminds us that words like premium subsidy, out-of-pocket maximums and minimum benefit standards actually stand for other words: friend, parent, child, colleague.

So this week we begin to share why we’ve been drinking so much office coffee this past year, and spending more time connecting with the Congressional switchboard than with our families.

The first story is from Ann Rudy, a field coordinator here.

My mom, who is 60, works as a hairdresser in Texas. Her employer does not offer insurance to employees so my mom and her husband, who is self-employed, purchased policies on the individual market.  She has worked since she was 16 and has always been healthy.  Like many without an affordable insurance option, she rolled the dice when she purchased a high-deductible plan.  Unfortunately, she lost.

Several months later, my mother fell. By the end of the day, she was in pain and was having trouble moving one of her legs.  She thought she could ‘walk it off,’ but eventually she went to the ER in pain. She had shattered her hip.  After major surgery and a hospital stay, my mom is now chipping away at her $10,000 credit card bill.

National health reform could prevent this from happening to others, or to my mom again. Small businesses like my mom’s salon would get tax credits for offering insurance to their employees. And if they didn’t offer an affordable insurance option, she would be able to shop for a plan in the insurance Exchange, where companies would be required to make clear what a plan covers and how much it costs. (In Texas and other states, no such requirement exists right now.) My mom might have qualified for new subsidies to help with her premium and out-of-pocket costs. And new rules in the federal bills would set limits on out-of-pocket expenses, so someone who falls sick—or a healthy person who takes a fall—would never be asked to pay $10,000 of her medical costs from her paycheck, or on her credit card.


If you have a story to share about how health care reform matters to you, please email us at hub@communitycatalyst.org.