Has the economic downturn affected your family’s healthcare coverage?

7 Comments

June 25, 2011 at 10:54 am by Sanne

Thanks for writing such an easy-to-understand article on this topic.

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April 30, 2010 at 10:57 pm by jessica

I was shocked to learn that pregnancy is a “pre-existing condition” and that no one in the world would insure me to deliver a child, but my insurance would certainly pay for that abortion.

I don’t understand all the Tea Party hoopla about the government health plans insuring abortions…private insurance companies do this quite well. we need governments to pay for having children!!!
At that time, I was shocked, scared, angry, and stressed and didn’t know what to do. Thank God for Healthy Families; the whole country needs at least a plan like HF for all children, even if it doesn’t cover adults.

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March 4, 2010 at 8:59 pm by Salsa

I have 3 boys on healthy families. we are self employed and only qualified for HF this last year as retail is so down. We were getting father and father in debt trying to keep up with the cost of our youngest sons private medical costs. Levi is 2 years old he has severe asthma and GERD and is classified failure to thrive he has to go the the children’s hospital every 3 months to meet with teams and asthma/allergist and Ped GI to try to get him better under control. This appt cost a ton and the daily meds are a ton on top of the hypo allergenic g tube formula. Daily he takes Plumicort. prevacid,zantec, albuertol, singlair and nasacort, plus his formula. With his prior medical conditions now now one will insure him. I have called anthem who insured him before HF and is his HF provider asking them if he gets cut of HF can I get him back on our private policy they have told me it’s not likely. What do I do with a high needs uninsurable child? His meds cost the same as my $1400 mortgage and I don’t have enough to afford both. I will have to pick to pay for my house or my sons meds! we are seeing a huge improvement on his new meds and he needs them! Please help us! His enrollment anniversary is Nov. so I know if something isn’t done he will be cut as we are in the higher income level C.

What do I do? I have wrote and called every Assembly man, Governor and Senator but no personal response has been given to what will happen to the high needs uninsurable children who will lose their coverage and now can’t get any other insurance if we could afford it?

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March 4, 2010 at 8:59 pm by Salsa

For the past 3 years, our family has been solely responsible for medically necessary physical therapies for our son, diagnosed with Cerebral Palsy. These therapies were prescribed by our son’s pediatrician, as well as physician/physiatrists at Children’s Hospital Oakland and recommended by physicians who reviewed our son’s gait analysis at Lucile Salter Packard.

My husband’s employer has changed insurance plans three times in the past 5 years, previous plans covered the necessary therapies, but the recent insurance plan, BS of California has denied the therapies. We had been negotiating in good faith with our insurance but were met with poor handling of our claims, inconsistent processing of paperwork, back pedaling on policies and procedures regarding medical necessity. We then pursued an Independent Medical Review with the Depart¬ment of Managed Health Care. Despite providing letters of medical necessity and 85+ pages of documentation, the state reviewer has mandated that Blue Shield is no longer obligated to pay for Ian’s prescribed physical therapy. This is very disconcerting; How is it that an independent reviewer can veto the medical opinions of physicians from two world renowned medical establish¬ments such as Lucile Salter Packard and Children’s Hospital Oakland? How can a state reviewer accept and agree with our insurance’s poor handling of our claims, inconsistent processing of paperwork, back pedaling on policies and procedures regarding medical necessity?

The significant gains our son has made with these prescribed, necessary thera¬pies has helped him to avoid costly, invasive procedures that were previously recommended by the aforementioned physicians, such as dorsal rhizotomy, rotational osteotomy. Our family will now be paying out of pocket upwards of $20,000+ annually for medical care; this despite secur¬ing medical insurance through group coverage with my husband’s employer. If our legislators are proposing a Health Care Initiative with health care for all, let’s insure that all parties involved, namely insurance companies, are providing services for some our most vulnerable citizens, young children with special needs. Please start by analyzing the state’s independent medical review process; as our experience has found such reviews to be biased, and very tolerant of misconduct on BS of California’s behalf.

We have no choice but to pay for the therapies; our son has come so far and progressed beyond our expectations. He is a happy, well adjusted 11 year old. While many folks were not sure if he would ever be able to walk, he progressed from using a walker 2 years ago and is now walking independently. He can get up off the ground by himself, and is starting to jump. To see him navi¬gate around his classroom on his own, carry his own backpack, contribute to class discus¬sions, spell, read and write well above grade standards, one can see that he is on his way to becoming a vital, fully engaged member of society, with much to contribute to his community.

- Maureen

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March 4, 2010 at 8:58 pm by Salsa

I am a Mexican legal non-permanent immigrant, I used to have a TD visa* and now I have an H4 visa** (TN visa and H1B visa holder dependant). I came to the States almost five years ago with my husband, our daughter was born here over a year ago.

TD and H4 visas are not entitled to work nor to have a SSN, so we are not allowed to any economical activity.

I have talked with several immigration lawyers; many of them justify the denial of H4 and TD visa holders to work, saying we represent a threat to domestic labor force. I think immigration authorities have not quite analyzed the numbers H4 and TD visa holders represent:

Each year 65,000* H1B visas are approved
* US Citizenship and Immigration Services, 2007
Not every H1B visa holder is married nor have children. In average, 30,000 of them are.

Let’s add 5,000 more people, assuming H1B visa holders have children that are old enough to work and have an H4 visa.

If 60% of these people are willing to work, we are talking about:

30,000 + 5,000 = 35,000 X 60%= 21,000

21,000 immigrants, H1B visa holder dependants, willing to work each year, in front of 141,730,000 economically active North Americans*
*US Census Bureau, 2005

21,000 people represent 0.0148% of American population. I can’t think how can these numbers be a threat to American labor force. In the contrary, our economical activity would bring benefits to domestic economy.

The majority of those of us, who arrived legally to this country, as wives and children of legally hired talented and especially skilled people, are people with college degrees, bilingual, ready to work. We came to this country filled with dreams and the desire to raise a solid family in a prosperous country.

However, life is not what it was 50 years ago, when immigration law was created. Today it is necessary for both parents to work in order to buy a house and pay for food and gasoline, basic needs in every family.

As if that was not enough, the United States of America is proud to be a country that protects and promotes women’s rights, however, immigration laws limit us and arbitrarily kill our right to professionally grow, turning us into our husband’s shadows, with the excuse of a national protectionism that is leading nowhere.

Our husbands work hard, pay our taxes on time, just like every American citizen does, plus every fee immigration asks us for. But we receive no benefit form the taxes we pay: we did not get a stimulus check from the government, we are not entitled to get a first home-buyer’s aid, and every insurance fee is more expensive for us. In the event of our husbands losing their jobs, we won’t see any benefit from those taxes, we have no unemployment benefits, we would be asked to leave the country as soon as possible.

To add more trouble to this mix, there is the fact that SSN is not only used for work, but for almost every important transaction. I have been mistreated by many companies because I have no SSN to give them, I even had Fedex denying to deliver me a package I bought on eBay because the “needed” my SSN!

We, H4 and TD visa holders, want to be part of the developing of this country and our families. We want our career to grow together with our husband’s, to build a patrimony together with them. We do not want to be just an accessory because of a law. If one day we want to stay home, we want to be us who make that decision, not a law.

I thank you for your attention, and hope my words find a place in your heart and mind, and get us what we, as progressive human beings and moms, deserve.

- Mayra

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March 4, 2010 at 8:58 pm by Salsa

Health Care Reform will ideally be fully funded by the Health Services Department and scrupulously avoid involvement of the Insurance Companies, which have only grossly inflated the costs of Healthcare for their own profit including obscene incomes and bonuses and numerous other rewards for the higher echelons of a massive and highly costly bureaucracy. Insurance Companies only act as Middlemen and contribute absolutely nothing to health care. They all exclude many from receiving health care for assorted reasons such as previous illnesses or accidents, loss of employment with loss of insurance, cancellation due inability to pay due to loss of jobs, foreclosures and many other reasons. Many plans exclude certain services and certain conditions, and many only offer partial service with deductibles, co payments and higher premiums for previous conditions.

The health service will only succeed so long as it can be afforded. The economic collapse, which we are facing, clearly dictates that the above discussed luxuries not be allowed to scuttle what will very plausibly be a very successful health plan.

Essential for radically cutting costs will be reform of the Malpractice Litigation Laws which have introduced a climate of fear and mistrust between doctors and their patients and which have exponentially increased the costs of every facet of medical care including Doctors, Nurses, Lab and X-ray technicians, Hospital Boards, Administrators, Suppliers of medications and equipment and many more. The detrimental effect of these factors is colossal in terms of the morale of Doctors, Nurses and Patients. It is even greater in terms of addition to the cost of EVERYTHING involved in medical care.

The number one step to reduce these costs and the detrimental effects on morale, is to limit contingency fees to the average hourly attorney fee multiplied by the verified numbers of hours worked on any case. This would eliminate the obscene rewards reaped by Plaintiff’s attorneys and reduce the greed factor which so strongly promotes the free malpractice lottery. It is recognized by those in the know, that more than 80% of malpractice suits are either frivolous or not supported by evidence of true wrong doing.

The other destructive effect of malpractice litigation is the damage or even destruction of a dedicated doctor’s career, which is damaged by the knowledge that the Doctor is being sued. (He/She is automatically deemed to be guilty until proven innocent, or even guilty in spite of being proven innocent). He/She may also be disciplined by the hospital where he/she works, by the Licensing Board, by his/her Specialty College or Society, and will certainly have the cost of his/her malpractice coverage increased drastically, or refused altogether.

Any or all of these consequences will severely damage his/her practice and livelihood or eliminate it altogether.

Malpractice suits are always dicey and depend heavily on medical witnesses, who are often less knowledgeable than the defendant. The appropriateness of care is usually highly debatable, and the verdicts unpredictable. If more than one entity is a party to the suit, the question as to who was responsible for an adverse outcome, becomes even more debatable, and usually both or all defendants will suffer in an adverse verdict.

The true consequence of all of these factors is devastating to the doctors or other professionals involved, and will frequently end their career, wasting as much as 10 years of training and study and all the costs so involved. Disciplinary actions by Medical Boards impose varying levels of discipline varying from admonition to probation to revocation of their license. However, regardless of the degree of the penalty, and no matter how dedicated, skilled, well trained and blameless the doctor or professional may be, it will be a virtual death sentence to their career. and any subsequent malpractice insurance will skyrocket, if it can be obtained at all.

All of this may seem blatantly unfair and it is.

The other down side of this is that a highly capable and dedicated professional has been lost to the patient population, and the entire profession is intimidated . This results in professionals shirking taking on high risk patients, especially for life saving operations, and attempts to avoid such operations, or trying to pass the buck and transferring the patient to another institution.

The latter may result in the patient losing their life in transit or even after arrival at the other institution.

Thus there is a clear need for radical reform of the malpractice litigation system, of the licensing and disciplinary system which are producing havoc with the quality of medical care and overburdening the costs, perhaps amounting to an increase of as much as 30% to 50%. .

Control of the cost of drugs: The long standing system of patenting drugs has inflated the costs of drugs exponentially. The justification by pharmaceutical companies for the huge costs is that the new drugs incur heavy costs for research. This argument becomes a political one, since the vast majority of new drugs do not represent dramatic advances in treatment or earth shaking innovations. Rather are they small changes which justify a new patent – sometimes a change in route of administration or a different time frame of dosing.

Most of the dramatic advances in new drugs emanate from Universities and are produced by researchers in those Universities, and tried and tested in those Universities. The costs are born by the researchers from grants given by private donors , by the government or by the University itself. Thus, the cost of these significant advances is not born by the Pharmaceutical companies, although Pharmaceutical companies do sometimes fund these researches, especially when one of their own products is being investigated. Such funding may be in relation to new genetic research agents.

To reduce the costs of drugs, the removal of some, if not all patents, would produce a dramatic reduction in costs. The funding of research would continue without the drug companies being involved and the savings engendered by removing patents could be added in part to increase research grants.

How think you?

Sincerely,

Ian Campbell Cree, MB(Hons.), MS, FRCS(Eng. & C.), FACS, LRCP.

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March 4, 2010 at 8:57 pm by Salsa

Money should not be the case for any child not to receive helath care.

This state should have every child covered for all health issues. It is very sad that we actually have to fight for all children to be cared for.

- Arsineh

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