Worth all the nasty names...

[madamesilverspurs]

Over the last several months we've withstood townhalls overtaken by screaming wingers, we've smiled and waved at those who drove by our signs and hurled invectives, we've stood against fleets of red buses, we've marched and rallied to bring health care reform to even those who call us nasty names and accuse of us every political perversion. And we're not done, yet.

This morning, completely out of the blue, two of my coffee drinking buddies related stories of being denied either care or medication because of the pre-existing nature of their conditions, both happened this week. They were, quite understandably, upset and frightened, especially the woman who was denied care for some pre-cancerous cells in her throat. As it happens, one of my activist friends had joined us and we were able to relate that there is now help for both of them. They seemed surprised, then doubtful; but as we explained more to them the visible lines of tension began to fade from their expressions. By the time our coffee hour was over, both were smiling.

I came home and dug out the information I'd promised. After emailing the info to one I called the other; on Monday she will call the numbers I gave her, and I told her that we could go to the library next week and fill out her forms online to expedite the process.

Today I got to see some great big smiles, smiles that are the result of renewed hope. We helped to give them those smiles, you and I, because we stood up to those who tried to stop the idea of reform. We still have a long way to go, but by God those smiles are testament to a worthwhile beginning. And those smiles are worth any name the teabaggers howl.


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[napi21]

1. AFTER they get enrolled in the high risk plan, ask them to make SURE

they tel EVERYBODY THEY KNOW OR MEET! THAT'S the way the majority of people iwll get to know the HC law isreally a GOOD THING and dispell all the crap that's been spewed about it since discussions first started!

[felinetta]

3. Yes, we all must spread the word.

[enlightenment]

5. I'll be sure to let them know that they

need to read the fine print - assuming they can find it.

After digging down through five pages, I found the information for my state - which is one of the state's going with the federally managed plan.

Here's the info:

Pre-Existing Condition Insurance Plan

PCIP will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, beginning on your coverage effective date, even if it’s to treat a pre-existing condition - there are no waiting periods.
The monthly premiums for your state are:
Age 00-34 35-44 45-54 55+
$335 $402 $513 $714
In addition to your monthly premium, you will pay other costs. Covered in-network services are subject to a $2,500 annual deductible (except for preventive services) before the plan starts to pay benefits. Once you’ve met the deductible, you will pay a $25 copayment for doctor visits, $4 to $30 for most drugs at a retail pharmacy for the first two prescriptions and 50% of the cost of the prescriptions after that. If you use mail order, you will pay $10 for generic drugs or $75 for brand drugs on the plan formulary for a 90 day supply. You will pay 20% of the cost of any other covered benefits received from a network provider. Your out-of-pocket costs cannot be more than $5,950 per year. However, your out-of-pocket costs may be higher if you go outside the plan’s network. See below for a benefits summary.
If you apply for PCIP coverage, you will be billed for the premium once your application is approved. You will need to send in your payment in order for your coverage to be effective. Please do not send in the premium before you are billed.

That's nice. Too bad I can't afford the premium - not to mention the $2500 deductible, the $25 co-pays, or - possibly - that 50% for the third or more prescription I might need. I'm not sure what the 'covered benefits' are, since there was no 'below' in the 'see below for a benefits summary' - so I don't know if they're worth the 20% I'd pay for them on top of the premium, the co-pay, and the deductible.

A person with a pre-existing condition could very easily top out at the full out-of-pocket costs in a year, meaning that at best (assuming one doesn't need to go 'out of network') this program ranges between $9970 and $14518 per year (premium plus out of pocket), depending on their age.

Yep. I'll be letting people know all about it. Thanks for the reminder.

[ima_sinnic]

8. gee. so if they're rich, they'll be able to get coverage--how reassuring

(assuming "coverage" means actual health care ...)

of course, if they were rich, we wouldn't be having this conversation, because they could get whatever they wanted.

[napi21]

10. Have you checked with your State? You din't say what state you are in,

but a cousin of mine lives in PA. She managed to get enrolled in a State Plan where the buy in was $235/mo. and you get put on a list to become afull participant. When he name came up, her monthly premium dropped to $30.00 a month! It does not include drug coverage but it covers everything else & there are no pre-exist exclusions either. She only found out about this program by making a lot of calls to different agencies, mostly different kids f social services I think, when one told her about this program. Apparently the list is rather long to get the full participation, but she got fully enrolled in about 7 months.

It's worth a try.

[enlightenment]

11. I appreciate your concern, but yes, I have checked.

My state doesn't have a 'state plan' as such - and as I said, they have chosen to go with the federally managed option for the high-risk pool. The figures I quoted are consistent across the states that have gone with the federally managed option.

[napi21]

15. Check with some of the other social service state agencies.

One of the ways my cousin found this program was because she simply didn't have the $$ to pay for a regular on the marekt plan, and at first she was also told they didn't have anything. Her husband is on disability and has major health expenses of his own,and he's erolled in Medicare through SSI. I know she spoke to many different agencies before one person (seemed almost by accident) mentioned this particular plan. I know there is an annual income restriction, but AFAIK that's the only requirement.

[enlightenment]

21. thank you. nt

[tpsbmam]

20. Amen. See my post from today.....

and I didn't even mention in there that there are two prescriptions I need that I can't take because they're WAY out of my price range. The two together would cost me over $500/month. And thanks to Obama going back on his word about drug importation, I might have actually been able to afford them -- I checked and those medications would have cost me less than $100/month imported from Canada. I get one free through the company that makes it -- that one would have been $1,000/month. As it is, I can barely afford the meds I do take......which, again, would be far cheaper if I could buy imported Canadian meds. Thanks a whole hell of a lot, Obama.

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=8809439&mesg_id=8809439

[ima_sinnic]

25. if it's such a great thing, why is it such a "secret"?

downthread, a poster describes jumping through hoops and finally uncovering some obscure plan that he or she can afford. I wonder why it's kept such a secret?

I'm sure the people in Canada and England have to dig and hunt to find affordable health care, with only the persistent ones lucking out. :sarcasm:

how wonderful, that health care is available now to those who are not only rich but also intelligent and resourceful enough to go digging through mountains of red tape and obscure agencies to find the hidden plan that even they can afford!

no amount of happy talk is going to change the shock people feel when they open their first mandated, unaffordable insurance bill, sorry.

[MineralMan]

2. One on one, we can make a huge difference.

That's the beauty of walking your neighborhood precinct and talking to people. You learn what their concerns are and can share proposed solutions with them. Most people, these days, don't read newspapers or even watch television news. Contacting them, helping them understand what's available and what's in the works can do wonders.

We can counter the teabaggers without adopting their strategies. One on one.

[SheilaT]

4. I'm just curious.

Were these two buddies previously opposed to universal health care?

If so, I'm just mean enough to want to tell them to live by what they wanted for everyone else.

[kiva]

6. No, your buddies weren't denied care

or meds because of the "pre-existing nature of their conditions", they were denied because they didn't have the money for these services. If they had enough money, they could get any amount of care and medications regardless of their condition.

Given the amount of money it will take to be covered by the sad excuse we got for heath insurance reform, this will continue to be a problem. I really hope (no snark) that your friends will be able to afford the coverage, deductibles, and co-pays for this insurance, because otherwise they will be no better off than they are now.

[cornermouse]

7. Giving people false hope is not doing them a favor.

You apparently don't work in healthcare. You're flat out wrong and I'm getting tired of looking up the actual information and pointing it out. This is going to backfire on the democratic party because it is completely inadequate.

[proud2BlibKansan]

13. +1

[Spheric]

27. +1

[Name removed]

9. Deleted message

Message removed by moderator. Click here to review the message board rules.

[bvar22]

12. To fully appreciate how really BAD the Health Insurance Reform is,

simply compare it to what is available in every other civilized country in the WORLD.
The "historic" HIR is truly "a uniquely American Solution".
Rahm was recently overheard crowing to Big Corporate Patrons about preserving the Private (For Profit) Health Care Delivery System.
THAT is NOT a good thing when compared to Health Care in civilized countries.

Bill Maher summed it up nicely.
"After this "reform", Americans will be able to BUY Health Insurance from Health Insurance Companies...wow."


People with Pre-Existing Conditions WILL be able to BUY Health Insurance from For Profit Corporations IF:
*They can afford the premiums
and
they can access Health Care if:
*They can afford the deductible.
*They can afford the co-pay.

"Medical Bankruptcy" is STILL a very REAL probability for anyone with a serious Health Problem.
"Medical Bankruptcy"...a term unknown if the Civilized World.


bvar22
---cursed with perspective


"If we don't fight hard enough for the things we stand for,
at some point we have to recognize that we don't really stand for them."
--- Paul Wellstone

[yowzayowzayowza]

14. Vexed not cursed.

Off topic: Based on the example of your cruel and heartless treatment, I've taken to tossing the hormworms into the street in the evening. The scissor tails seem enamored of 'em. :)

[bvar22]

17. LOL

Thanks.

bvar22
---cursed with hornworms,
and vexed by perspective.

[kickysnana]

16. Reality Crosspost

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x8809439

tpsbmam
Sat Jul-24-10 03:46 PM
Original message
My Obama/Democrats meltdown

Edited on Sat Jul-24-10 03:55 PM by tpsbmam
I had a meltdown this week. Edited to add the meltdown part: I was literally sobbing, screaming, yelling, swearing up a storm.....a true meltdown. After yet another hospitalization I can't afford, I came home and checked into the high risk pool hoping against hope that it might give me an out, some way of getting the healthcare coverage I desperately need.

Let me backtrack. I'm disabled -- MS has left me in a wheelchair and with too many disabilities to continue to work. It's too bad -- I loved my work, I was good at it, and I spent many years in school learning my trade. But, life throws us unanticipated punches and we just have to buck up and deal with them as best we can. So I did. Then my kidneys decided to start failing (due to an MS thing) -- not on dialysis but I could be any day.

While I worked, I did the responsible thing and built up a pretty healthy IRA -- it would have done me well at retirement. Sadly, retirement came way earlier than I anticipated. Best laid plans, kaput. So I'm now living very carefully off of the small income my IRA affords me -- not much, but hopefully if I continue to live carefully, it'll last me the rest of my life. With all of my health problems (there are a couple of others) and looking at my financial situation, I'm frankly hoping that won't be more than about 10 years.

So, because of my IRA, I'm ineligible for Medicaid. And I was refused disability and Medicare due to a preposterous loophole -- an attorney was no help. So I rely on local community health, a nightmare but at least I can afford meds (most of the time) there.

So back to the high-risk pool. Yippee! I qualify and I can join it!! For a mere $397 a month with a $5000 deductible (the cheapest I could get) which supposedly includes the subsidy. Okay then, let me see......if I don't pay my electric bill, let my Internet go, cut back to eating once a day, give away the only 2 things that are making me happy at this moment (my 2 precious 13 pound dogs), and figure out how to write the next bestselling great American novel to be published in a month......well, gee, I can then afford to join the much vaunted high risk pool!!!

I contacted my piece of shit Congressman Shuler for help. Never heard a damn thing back. Big surprise there. :sarcasm:

Say hello to a newly minted Independent. I've had it. I've had it with the bragging about the "history making" healthcare bill, among other "history making" sell out bills. I've had it with the dozens of DINOs that populate Washington now. I've been a Democrat for over 3 decades. No longer.

Please let them be tough about the fines for going uninsured, the fines I along with thousands of Americans will refuse to pay. Please, please let them -- I'd love to be one among many joining a press conference to talk about this bullshit healthcare fiasco and who is responsible for it.

And yes, I include Obama in among those responsible for it. Selling out to big Pharma, the insurance industry, & private hospitals helped get us here.

I've recently seen some pro-Obama posts here. Good. I'm glad he still has some supporters. I'm just not one of them. Yes, I did have some hope when we had a Democratic president & Dem majority. Hah. The joke is on me.

I hate to see what happens when citizens find out what a crock of shit this healthcare bill has left us. I've seen some of it mentioned here from people who've already checked and discovered that their insurance is unaffordable. I knew it when this bill passed and it's now been confirmed for me.

Crap on me for venting and dumping on Obama, agree, whatever......just needed to vent!
I fly this flag in solidarity.

[area51]

26. +1

Each day, 273 people die due to lack of health care in the U.S.

We need single-payer health care, not a welfare bailout for the serial-killer insurance agencies.

[madamesilverspurs]

18. To repeat...

"We still have a long way to go, but by God those smiles are testament to a worthwhile beginning." It is a beginning. Maybe someday we'll have something that some DUers won't feel the need to piss on. Meanwhile, I've already spoken with one father who is thrilled to have access to some coverage for himself and his wife for the first time in several years, and he says it's better than the coverage he couldn't afford through his employer. I'll keep bugging my representative and senators to push for improvements, and I will not withhold resource information that might help someone just because I don't think it's good enough yet.


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[cornermouse]

19. I'm sorry. You are wrong. I know that to be fact. n/t

[enlightenment]

23. I'm sure that for people who can afford the coverage, what

is being offered is better than the nothing they have had.

You claim people are 'pissing on' what is available, but you also seem to be ignoring what is clear - that the worthiness of the high-risk pool the worthiness of the reform, et al, is completely tied to one's ability to afford it.

It's nice that you tell people about it. Good for you. If the people you inform can afford the premiums and qualify then they will probably appreciate your steering them in the direction of the information. Because it works for them, they'll probably let you know that it does - people are like that. Then you'll have more reasons to pat yourself on the back for the good work you've done.

Chances are that there will be some - perhaps many - people who won't be able to afford the premiums or simply won't qualify. They may or may not tell you it didn't work out for them - people are like that, too.

If they don't mention it to you, you can continue to believe that you have helped them by providing the information. Ignorance is bliss, after all.

If they do mention it, what will you say to them?

[madamesilverspurs]

24. Not that it will make one damn bit of difference,

but you're waaaay out of line.

For the record -- I posted this because I wanted to share a good moment with others who have worked so hard and so long on this issue. For myself, there was nothing self-aggrandizing in any of it; rather, my efforts have been and will continue to be made out of simple gratitude. I lived for decades without access to appropriate care and became permanently disabled because of that lack. My efforts have been predicated on my determination that the country doesn't need more people like me, and that health care reform could help others from suffering my fate. So, yes, I want to do what I can to help make things better and will continue to do so. And if all you can see in that is me patting myself on the back then tough shit; maybe if you thought better of your own efforts you wouldn't have to publicly and frequently dis others in order to try to make yourself look good.


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[nightrain]

28. how different is this new Federal pool? Those that can afford its obscenely

expensive premiums, copays, deductibles will get care, and those who don't have the thousands sitting around won't get the coverage. That's NO CHANGE. In my state, for a $500 deductible premium, it costs $480/month, that's with a $2500 out of pocket payment, and the plan only covers 80% after reaching the out of pocket limit. Of course that's with in-plan providers only, and the administrator is, guess who??? Blue Cross. What a waste of money, even if you could afford it!

For those who can't afford these new plans, NADA, no change. Thanks for nothing!!!

Who won? Blue Cross.

My state boasted on its pool website that a total of 4 people had signed up! That ain't change!

[enlightenment]

29. Actually, I am absolutely delighted-

that you have absolutely no issues with your self-worth. A healthy ego is a wonderful thing. That said, you might want to consider what qualifies as 'dissing' someone else - your suggestion that anyone who believes the plan is flawed is 'pissing' on it is far more vulgar than my pointing out that your post (like your OP) was self-congratulatory.

Your response to me is typical of what passes for debate on DU these days. You disregard the totality of the comment and focus on the 'dis'. You staunchly defend your motives (why? do they need defending?) and bring in your personal situation to bolster that defense. Finally, you make a determination of my character based on my statement and - to use your own words - piss on it (that being the sole purpose of your response).

You did not, however, answer my question.

[kiva]

30. Oh, the irony...

http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=388x23945

Guess it's much easier to whine about mistreatment there than to answer questions here.

[Missy Vixen]

31. Thanks so much for posting. Here's our REAL-LIFE situation

My husband lost our family's health insurance when he lost his job in November of '09. We are both over 40. We both have pre-existing conditions. We have been turned down for insurance. We also lost the COBRA coverage when he took a contracting job. Silly us -- we wanted to keep sleeping inside. He makes half of what he previously made in the same field.

My husband's prescriptions are over $500 a month. Good thing my prescription only costs $25. Yay, me. My condition is enough, though, to make sure I'm declined from every possible private insurance plan.

Here's the link to Washington State's high-risk insurance pool information. Here's our quandary. I'm sure you'll have an answer for us, too. Do we pay insurance premiums that will amount to another mortgage payment per month on top of the $500 per month for my husband's drugs, or do we go without, and pray we don't get sick?

http://www.healthcare.gov/law/about/states/wa.html

Here's the fun part.

Premium: $177 to $1,577 per month
Deductible: Plan 1: $2,500
Plan 2: $500
Out of Pocket Limit: Plan 1, medical: $4,950 in-network, $7,400 out-of-network
Plan 1, pharmacy: $1,000
Plan 2, medical: $1,000 in-network, $2,000 out-of-network
Plan 2, pharmacy: $500

The only people that will qualify for that $177 premium per month are those on public assistance. We'll probably fall into the middle range because of our income. If we're lucky. It's another mortgage payment per month. Where's the money coming from?

Here's my bottom line: We can't wait three more fucking years for "health insurance reform". We can't afford what's being offered. I suppose we fall into the "die quickly" category, hm?

[asdjrocky]

22. This post is 100% ture.

For people that happen to have a shitload of money.