Month: July 2017

Pre-Existing Conditions & ACA

After the roller coaster regarding the Affordable Care Act (ACA) and the House and Senate’s Republican effort to dismantle it, I felt the need to speak to something very personal for me.  I’ve made mention on my social media accounts of my concern about losing my coverage because I am a woman.  Concern that anything having to do with my reproductive system would not be covered because of my “pre-existing condition—“a C-section.  But there’s something that makes it a little more real and personal for me.

In the 1990’s, I lived in my home state of California.  At the time, California hospitals could, and often would, refuse treatment for uninsured individuals.  Emergency Room visits included. There were a few instances of people dying in Emergency Room parking lots because the hospitals refused care based on insurance. This despite the passage of EMTALA in the previous decade.

In early 1999, many years before the passage of the Affordable Care Act, I was diagnosed with gallstones.  I was young to have such a health problem. I was only in my early 20’s. But it was a common health issue among the women on the matriarchal side of my family. Most of them survived this health issue, but a few did not. My grandmother died due to complications from gallstones that couldn’t be removed.  Ironically, the timing of the outcome of my incident coincided with my grandmother’s death. More on that later…

So, in 1999, pre-ACA, I was a young twenty-something single female. I hadn’t had health insurance for years. Since I was a pre-teen on my mother’s insurance plan. When I was younger, I told my mother I wanted to live with my biological father for a year, so she removed me from her health insurance so I could be added to his.  Things were rough during my summer stay, and I decided I did not want to live with my father for a year and I went back home to live with my mom.

She was never able to get me back on her insurance. Because I had been removed, she had to wait until open enrollment.  And even then, it was all in the hands of the insurance company whether they would cover me at that point. At that time, I had no major health issues. I’d never had so much as a broken bone. We don’t know why they rejected putting me back on my mother’s insurance.

Back to early 1999. I had gone out to eat with a long-time friend of mine, and almost immediately began feeling abdominal pain. By the time I got home, it had become so sharp and intense that I couldn’t stand.  I couldn’t stop crying. It was the most painful feeling I’ve had. Maybe even worse than my labor was when I had my daughter.

My mother got me to the nearest Emergency Room, where they ran an ultrasound and found a few gallstones, one of which was the size of a quarter. They sent me home with a bottle of Vicodin and instructions to call my primary care provider for a follow up and further action.

One problem: I didn’t have a primary care provider. I didn’t have insurance. None of the local doctors would see me because I didn’t have insurance. So, I was stuck.

I spent the next several months in and out of Emergency Rooms to be “treated” (e.g. given a bottle of Vicodin and sent home) for my condition. This was the most they could do.  You see, regardless of what some Republican Senators and Representatives think, the Emergency Room doctors cannot refer you to another area for follow-up or surgery, etc. if it’s not immediately life threatening. You have to go to your doctor.

Eventually, I was able to get past the pain by avoiding certain foods that triggered my gallbladder. So, a lot of bland foods and very little dairy. But, that doesn’t really take care of the actual problem. Obviously.

In October of 1999, another friend of mine and I were at the mall browsing, chatting, and eating giant pretzels. All of a sudden I had a sharp pain that was so familiar to me, but somehow a little different. We left the mall to head back to the military installation my fiancée was stationed at. By the time we reached the base that was only a short 10-15 minutes away, I couldn’t walk. I couldn’t talk. All I could do was cry. And I felt sick to my stomach. I was cold but sweating.

My fiancée didn’t know the area that well. He wasn’t a California native. So, he took me to the closest hospital he knew of—the hospital on base.

As a civilian, the military hospital was not technically allowed to treat me. Normally you’d have to be a federal employee, and even then it’s only in certain areas where you can get care on a base hospital. Typically when you’re employed by the military in foreign countries. Otherwise, you have to be Active Duty, Reserves, or a spouse or family member.

So, the hospital staff did what they could to give me pain medication and try to make me as comfortable as possible. They got my mother’s contact information from my fiancée (later my husband, and even later my ex-husband) and called her to let her know what was going on. They had called to the gate guard and given them her information so she could get a pass to get on base to see me.

The hospital staff then began calling local civilian hospitals to have one of them come and pick me up. Turns out my condition had gotten quite serious. Actually, it had become deadly.

Because I didn’t have insurance, no one would see me to treat the actual problem. They just managed the symptoms for me. Because the actual problem was never addressed, it just got worse. The gallstones had gotten larger and shifted. The larger of the stones had shifted and placed itself right in the duct of my gallbladder. Nothing could get out. So it just sat there and festered. For MONTHS.

It had become so bad, my gallbladder had become gangrenous. It was inflamed, impacted, and infected. I was bleeding internally. My gallbladder had detached from my liver bed.

I would literally die if I did not have surgery right away.

Knowing that I didn’t have insurance, and would die if I didn’t have surgery, the local civilian hospitals STILL wouldn’t take me.

A high level decision made by the Medical Group Commander of that base saved my life. He approved the military hospital to do my surgery. This is part of the reason I have such deep love, affection, and loyalty to the United States Air Force. The Air Force literally saved my life. And I will never be able to express my gratitude for that.

I had my surgery on the two-year anniversary of my grandmother’s death. As mentioned above, she died of complications from the same medical condition.  Two years after her death, I nearly joined her.

You can imagine how happy I was to finally have insurance after my ex-husband and I got married. Not only was I covered again, I was covered by Tricare. A federally run insurance program for our military members and their families. When we divorced, I had found a job that offered health benefits. It was the first job I ever had that offered health insurance. Ever. I was in my mid-twenties. With a pre-existing condition.

So, what did that mean? My employer policy covered everything. EXCEPT for any gastrointestinal issues. Because of my gallbladder surgery. Under Tricare, I was still covered for it. Because there were no surveys, etc. to fill out for coverage. It was pretty much automatic.  So when I got divorced, even though I had health insurance, I still wasn’t covered for anything related to my gastrointestinal tract. So there was really almost no point to having insurance at all. The gastrointestinal tract covers so much of your body; it ends up being nearly the majority of your body function.

When the ACA was passed, for the first time in my adult life, I would have complete health coverage. COMPLETE. My insurance could no longer deny me care for any reason. Zero. And what a relief it was. Although I haven’t had any other gastrointestinal issues, knowing that my insurance had to cover it if I did was a huge relief to me. I felt safe. I knew that I’d be taken care of if something happened again.

I don’t think people that much younger than me remember the days prior to the ACA. I think there may be some people my age who don’t remember. My mother and I had a very open and adult type of relationship. Otherwise, I don’t think she would have told me about the health insurance stuff. But as a single mom, it was important to her that I know these things. That I know what adults have to do as responsible people. And I’m glad she did, because I am more aware than other adults my age or even just a few years younger. They have the luxury of not remembering what it’s like, or not having to deal with not having insurance. They take the ACA for granted while spewing ignorant hate about this legislation that has benefited them in ways they don’t know or understand. All because of the man who gave it to them.

I am relieved that the current Congress’s attempts to dismantle, repeal, and replace the ACA have failed. It means I still have coverage and will keep my coverage. And now that I have even more “pre-existing conditions,” I need the ACA to stay in place more than ever. In addition to my gallbladder surgery, I’ve also had a C-section. And I’m (obviously) a woman. I have three checks against me right there.

And I’m only one of millions of Americans in the same boat. My health issues now are so minor, so miniscule, in comparison of millions of people who are disabled, cancer survivors, etc. People who need the coverage more than I do.

And I simply cannot fathom the people who are meant to represent us would rather take away the safety net that we pay for with our premiums just to make a mockery of our previous president.

That they have no qualms about actually harming millions of people. People who voted for them no less!

It is my hope that something will reach them. Something will touch them and make them think about what they are doing to the people they are meant to serve. The people they are meant to speak for.

It is my hope that if they do attempt to go after the ACA again it will be to improve the law, not to repeal it. Not to replace it.

The only acceptable substitute to replacing the ACA is single payer. And I have no problem pitching in an extra $.50 per paycheck to ensure that every American has health coverage. Because if we are not doing this for all of us, what is the point?

NY Political Mom