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HEALTH CARE: What if you had a pre-existing condition?

Letter by Colin Guthrie, Puyallup on April 5, 2012 at 12:41 pm with 14 Comments »
April 6, 2012 9:55 am

People complain about how those who don’t have health insurance drive up the cost of coverage. However they seem to view all people as healthy and able to afford insurance. Many people (like myself) often find insurance too costly or unavailable due to pre-existing conditions. Medical insurance for me is $2,100 a month – if a company even decides to cover me. Most companies refuse to cover me due to cerebral palsy.

What if people find themselves having a pre-existing condition that insurance companies either refuse to cover or raise the premium to a unaffordable level? Is it appropriate to fight for equal access to health care so people with pre-existing conditions could be productive citizens or continue denying them coverage that can be a death sentence or condition which forces them to be dependent on other people?

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  1. alindasue says:

    Colin Guthrie,

    The moniker “cclngthr” suddenly makes sense. What’s the first “c” from?

    Anyhow, I know and have worked with a couple people who have been on SSI for disability. They are able to work, but once they reach a certain minimal dollar amount, a portion of their wages are subtracted from their SSI checks. Both co-workers deliberately kept their hours down to part time so that they could keep a few dollars of their SSI.

    Why? Because as long as a client is receiving at least $1 in SSI benefits each month, his medical is covered under Medicaid. With Medicaid, they can get the medications and treatments that make it possible to work. Without SSI and Medicaid, their “preexisting conditions” leave them unable to get insurance to cover their medications and treatments and they are back to being too disabled to work.

    In the end, that little bit of assistance enables them to be productive TAX PAYING citizens. If we were to have universal medical coverage – or even if the Affordable Care Act starts to allow them to purchase insurance at the same rate as any other worker – then that would be that many more people working full time, no longer on assistance, and now contributing to their own health care costs.

  2. aislander says:

    I truly believe we need to help people with pre-existing conditions, but please don’t call that help “insurance…”

  3. alindasue says:

    aislander,

    In that sense, not of it is “insurance” since we all end up using it – even if only for regular preventative care. So, we can call it “health care coverage” instead.

    The point is that when a disabled person doesn’t have to rely on government assistance just so he can obtain necessary medical coverage, he is more likely to be a full time tax paying member of society who is able to contribute toward his own medical coverage.

  4. alindasue says:

    That should be “…none of it…”, not “…not of it…”

  5. cclngthr says:

    alindasue,

    A person CAN receive SSDI (not SSI) and still earn up to $1010 a month in wages; but this leaves them completely out of the medicaid income standard because with SSDI usually is over the SSI payment limit.

    When I was working full time, I did not have insurance, and when I went to part time, I was elegible for medicare, but not medicaid. Medicaid, like SSI is a state issued/controlled/federally funded program. Meaning the state sets the income levels and issues the state determined medical program once the SSI payments are in effect. I am not elegible for medicaid due to my income being above the SSI maximum limit which is $694 a month.

    However, people want disabled people to be dependent upon the family for all of their “services” rather than allowing some kind of assistance to be in place; including coverage of pre existing conditions.

  6. alindasue says:

    cclngthr said, “However, people want disabled people to be dependent upon the family for all of their “services”…”

    However, that is only feasible if the person can be covered under the family’s medical plan – which brings us back to the whole “preexisting conditions” dilemma.

    Medicare or Medicaid (my son has Medicaid) – the point is that, under the current system, without it neither of the people I worked with would be able to work because they wouldn’t have access to the medications that enable them to be healthy enough to work.

  7. cclngthr says:

    alindasue,
    I doubt that adult children are elegible to be on the family’s medical plan. Most plans that I have seen only allow those under 25 (new rules) to remain on the family plans.

    People like concerntacoma7 and Blaine expect the family to provide all needed services for the disabled person, including paying for the medical care rather than having a service available for the disabled person. They believe the benefits are unneeded and require disabled people to depend on family to provide for them. Unfortunately, with private medical plans, pre existing conditions are not always covered, as a family in Renton found out when their insurance company denied coverages for their 13 year old son who has autism. Such coverage for the condition ends when the person is 7 years old.

    As I said above, medical plans do not allow a disabled adult to be on a family plan due to their age.

    I am surprised your son only gets SSI; he should be elegible for disabled adult child benefits. (I also think I know him; did he attend Foss in the early 2000’s? I was there at the time working in the developmental program covering for Doug, Pia and Frankie).

  8. alindasue says:

    cclngthr,

    Yes, my son did attend Foss until the early 2000s. Frankie was one of his teachers several times from grade school on. Her husband taught him for a while too, but I can’t remember what year.

    My son is a little guy about 5’2″. I think at the time, he was still not quite 5′ and was the shortest boy in the school. Very friendly. Striking blue eyes. Likes to wear his hair in a pony tail.

    I’m always amazed how many people do seem to remember him. He does tend to make an impression on people.

    Anyhow, he gets SSI, medicaid and DDD services. I am paid as his personal care provider through DDD. Is that the “adult child benefits” you are talking about?

    I may not be able to get him on the family’s insurance any more, as you point out, because he’s 28. I know even when he was 19, I had to jump through hoops providing proof of disability for them, which they kept losing. I finally gave up on the insurance company since it was becoming too much hassle and he had the medicaid coverage already.

  9. cclngthr says:

    alindasue,
    Yes, I remember Kurt well. I taught him when I covered for the teachers in the DD program at Foss after I went to part time. I also worked with Kurt when I saw him at Park Ave Center in the transition program when I was there for a couple days.

    Have you considered having him go to Tahoma Associates to work? I know Scott and Pat (I and a friend call him Fat Pat) very well; we service their vehicles at the shop we manage).

    Disabled Adult Child benefits are actually managed through Social Security Administration and instead of getting SSI, he would be getting SSDI and this usually is more than SSI. Only issue is medicaid isn’t available; he would be covered under medicare/medicare drug plan and QMB medicaid.

    Another program I know he is elegible for is Camp Stand By Me. DDD actually will pay the fees and he will get to stay there for 6 days and have a weekend respite several times a year.

    No, you won’t be able to get Kurt on your family plan. He is too old and the insurance would require a separate plan for him, at a high cost.

  10. aislander says:

    Perhaps, alindasue, if we didn’t depend on “health-care coverage” for “regular preventative care,” there would be more money left to spend on those with pre-existing conditions.

  11. cclngthr says:

    aislander,
    That won’t work either. Preventive care involves pre existing conditions more (they need it more often).

    I take a drug that does damage to my gums and teeth. This requires more frequent trips to the dentist. However no medical dental plan offers more frequent dental cleanings and visits.

  12. alindasue says:

    aislander,

    It actually saves insurance companies money to cover regular preventative care, because it cuts down on the expensive conditions that need to be treated.

    Think of it like the free oil changes and maintenance checks that are required to keep a car’s warranty valid. The dealers know that warranty work costs them money, so they minimize it by offering maintenance services.

    Medical care works pretty much the same way.

    As cclngthr said, in the case of someone with “preexisting conditions” and regularly taking medication, preventative care becomes even more important for saving money on possible expensive treatments later.

  13. alindasue says:

    cclngthr,

    Actually, his name is Kirk, not Kurt – it’s a common mistake. It’s either that or I have to explain to people that, yes, I like Star Trek, but Kirk is a family name in my son’s case. Half the time, though, I just call him “Dude”.

    The biggest issue with getting Kirk into something like Tahoma Associates is that he’s still not fully potty trained.

    I’ll have to ask his case worker about SSI/SSDI and Camp Stand By Me. I’d heard about the Easter Seals camp but always thought it was just for children. Thank you for bringing it to my attention.

  14. cclngthr says:

    alindasue,
    Camp Stand By Me is for both adults and children with any disability. They have 1:1, 1:2 supervision, depending on the session. I knew Ellen, the former director for a while, she and I talked regularly on Facebook when she was there. I have talked to the new director a few times, but have not met him. The camp used to cater to physically disabled people a lot when it started (I went there when it first opened, then quit after a few years), but now caters to those with DD and related disabilities.

    Yes, I remember Kirk well. I had forgotten he needs reminding to use the toilet. After so long of teaching, kids seem to blend together and it is hard to remember everything about each one. I know Pat and Scott have severely disabled adults in their program (Pat supervises the work crews) and the workshop they have in the basement may be something Kirk can do. Scott also runs several group homes that are part of that non-profit agency. That is something that some parents choose, particularly when the individual is older. You might want to give Scott a call to see if it is something feasable for Kirk to work there even if it is part time.

    I don’t know if SSDI will allow Kirk to be on the Disabled Adult Child (Kirks dad’s benefit system) since he is severe enough to be on DDD as well. I don’t qualify to be on DDD, so it is something to ask his caseworker about if he can get DAC benefits. He likely will get more if he can get it.

    I think Kirk will enjoy the camp. They have a heated pool, therepy pool, and almost everything to do at the camp. They also have a thereputic horseback riding program as well. If you are on Facebook, the camp has a page and they often post pictures of the sessions. Although I am not in any of the older pictures, I do know a lot of the campers from that era.

    Yes, with pre existing conditions, regular preventive care is absolutely necessary. A neighbor of mine has a 5 year old son with Aspergers and ADHD and he is at the doctor often to manage the meds he is on. Some medications work with some people, but not work with others. With my neighbors son, finding what works for him is a challenge. When he takes meds for ADHD, his Aspergers goes through the roof, but without the ADHD meds, and only the meds to manage the Aspergers and anxiety, he is fairly even.

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