October 3, 2012

Cheating death and debt

Rep. Yarmuth touts second anniversary of life-saving provisions in the Affordable Care Act

Sarah Adkins says that on Jan. 9, 2011, the Patient Protection and Affordable Care Act — known as “Obamacare” — saved her life.

Adkins rushed to the emergency room with a familiar pain in her lower back, as she had struggled with kidney stones for years. The doctor discovered her left kidney was blocked by a stone and going septic. Emergency surgery removed the blockage, and her doctor gave some startling news.

“He told me, ‘Had you waited an hour or two, had you hesitated, you would have lost this kidney or died,’” Adkins says. “I was 24 years old.”

Based on past difficulties with the health care system, Adkins might have hesitated, just as she had before. But because of a new provision under the health care law that had just gone into effect — allowing young adults to stay on their parents’ insurance through the age of 25 — she went to the ER without fear of debt.

Adkins told her story last week along with several other Louisville residents at an event held by U.S. Rep. John Yarmuth celebrating the two-year anniversary of key consumer protections under Obamacare.

Despite mixed reactions to the law since its passage, Yarmuth says that highlighting success stories such as Adkins’ — and combating misinformation about the Affordable Care Act — is vital for his constituents.

While on her parents’ insurance a few years earlier in college, Adkins had been treated in emergency rooms for her kidney stones without any difficulty. But after graduating in 2009, without a job providing insurance, her parents bought her a costly individual plan, which turned out not to cover much at all.

A 2010 trip to the ER for kidney stones brought a $6,000 price tag. Her insurance company declined to cover the costs — as well as follow-up visits with a urologist — because they considered it a “pre-existing condition.”

The same pain returned last December, but Adkins — already reeling from that bill and $45,000 in student loan debt — chose not to go to the ER. Instead, she lay on her bathroom floor in agony for hours, passing the stone there.

The following month, just nine days after joining her parents’ plan, Adkins did not hesitate to go to the ER, possibly saving her life. Since then, she’s been able to see a urologist in order to manage her problem. And though she turns 26 in November and will no longer be eligible for her parents’ plan, she just found a job with health insurance.

While many Democrats in Congress have shied away from defending the controversial health care law, Rep. Yarmuth is an outspoken proponent.

“My job, as I see it, is to make sure my constituents are fully informed about things that directly impact their lives and their families,” Yarmuth says. “So that’s why I do things like this, because I’m convinced that this has already been an enormous benefit to thousands of my constituents and would be a huge benefit to many thousands more over time.”

At last week’s event, Yarmuth highlighted the second anniversary of various patient protections under the law. Besides 5,800 young adults in Louisville now having insurance through a parent’s plan, children can no longer be denied coverage because of a pre-existing condition, with 32,000 now having access to free regular pediatrician visits and preventative care.

Additionally, 510,000 in Louisville no longer can have their coverage rescinded if they get sick, or have lifetime or annual limits on their coverage, and 130,000 adults now have access to free preventative care and health screenings through their insurance.

Several of the biggest provisions under the Affordable Care Act won’t go into effect until 2014, including a ban on discrimination by insurance companies based on gender or a pre-existing condition, requiring individuals who can afford insurance to buy coverage or face a fine, and expanding Medicaid to those whose income is up to 133 percent of the poverty line — which states can opt out of, and Gov. Beshear is currently considering.

While opponents of the law point to a $1 trillion price tag over its first 10 years, Yarmuth notes that the expansion of coverage is paid for, and the non-partisan Congressional Budget Office estimates it will actually save roughly $200 billion over that time.

Jessica Hasbrig spoke at last week’s event of the financial burden of being uninsured. Hasbrig, who has a congenital heart condition, lost coverage when she lost her job, racking up $420,000 in debt from visits to the emergency room over the last two years. She says she was often denied additional treatment from doctors who told her they didn’t want to “run up my tab.”

Just the day before on “60 Minutes,” Mitt Romney claimed all Americans have access to care because anyone can go to an emergency room.

“It’s a laughable concept, because that’s the most expensive setting you could possibly be treated in,” Yarmuth says. “It’s one of the problems with financing places like University Hospital that provide so much care that’s uncompensated. We all pay for that, one way or another. It’s a huge burden on the system, and that’s why having basic coverage, which allows somebody to go to a physician or a community health center, is so important.”

The most recent national polling on the Affordable Care Act shows the country split down the middle on the law, but only one-third support its full repeal. A poll by The Courier-Journal showed almost half of Kentuckians oppose the law, with large majorities favoring three of its key provisions but rejecting the individual mandate.

Sarah Adkins is forever grateful for the law that saved her life — which she proudly calls “Obamacare” — and hopes people don’t discount it because of the mandate, which was once the cornerstone of Romney’s reform as governor of Massachusetts.

“There’s a lot of mythology about that,” Adkins says. “A lot of intelligent people are afraid they’ll have to pay some sort of fine on their taxes for not having health care, but that’s only for people who can afford to buy it.” 

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