Health care and health insurance reform have been in the national spotlight. Unfortunately, it seems, no one really knows the solution to our health care crisis.

Why is health insurance so expensive?

Photo by: Monique Discawicz

Why does a family of three have to pay $1,000 a month for coverage, just because they are self-employed?

In Massachusetts, it is mandatory to have health insurance yet if you are self-employed, you must pay out of pocket. A high deductable, high co-pay plan will cost a family of three in the neighborhood of $1,000 a month.

Who can really afford to be insured in Massachusetts?

What about if you get laid off from work?

If your unemployment is more than the federal poverty level guidelines, you must either purchase your own private insurance or enter the COBRA system. Rest assured that you will be paying much more for health insurance than you ever thought possible.

Would President Obama's plan work if it was ever passed through legislation?

I don't know.

Is there an answer to our health care need?

I don't know that either.

Does anyone out there have a solution?

A family of five is facing financial ruin because their father is sick. In 2004, he was diagnosed with a malignant brain tumor. After surgical removal of the tumor, radiation and chemotherapy, the father returned to work.

The father knew that this tumor might return someday, but he hoped for the best and hoped he'd be one of the 5% of people who never have their tumor return. After six years, he began to have hope that his brain tumor would remain in remission. He went back to work in 2004, taking periodic breaks when his health would decline, but always maintaining his employee status at work.

On January 12, 2010, he began experiencing odd sensations and he knew that something was wrong. He called his doctors and who recommended an emergency MRI. His health insurance was cancelled and the hospital would not perform an MRI without proof of coverage.

How did this happen?

The father learned on this day, after calling his employer repeatedly, that he had been terminated five days prior. In order to have health insurance he had to pay COBRA payments. He was quoted $1400 for his family of five. Most families on disability can't pay for COBRA at this rate.

Despite numerous phone calls, his wife is not clear who is covering their health insurance right now, but she is sure of one thing: her husband is getting a recurrent brain tumor removed, regardless of the cost.

The last thing any family needs to worry about is how their medical needs will be covered if a crisis hits. They had coverage as far as they knew and were not told about the layoff until after the father called about his lack of insurance for his MRI.

Maybe this family could have prepared better for the return of the father's brain tumor. They might have decreased their living expenses to a degree, but as anyone that has ever lived on disability payments will tell you, you can't exactly save money living on disability.

We need change in our healthcare system. There is no better proof than this family.

Why can't an average, working person get Masshealth when they discover a brain tumor has returned?

I looked into the guidelines and did a pre-qualification test based on my own personal financial information.

In order for a family of five to qualify for Masshealth, they must not have income of more than $2,800 a month, or 133% the federal poverty level. Masshealth recognizes the disability, but you must meet income guidelines to qualify.

Medicare, the federally funded health insurance for people over 65 or those with certain disabilities is also very confusing. If you are disabled, you must meet certain criteria before you qualify for coverage.

First, if you have end stage renal disease, you qualify right away. If you have a different disability, you must be out of work and collecting SSDI for at least 24 months before you qualify.

This scenario leaves those with some ability and desire to work stuck in the middle. What if you work part time, collect from your private disability insurance and only periodically collect SSDI?

I would think there are special circumstances where the government would approve Medicare health coverage, despite not having collected SSDI for two years, but I wouldn't count on it.

COBRA does offer reduced payments if you are under financial hardship or disabled, but for a certain period of time. Although reduced payments are more than welcome, a person with a diagnosed malignant brain tumor should not have to pay for health care costs.

There is still a gap between COBRA coverage and Medicare, even when you get approved. COBRA lasts for 18 months (as far as I am aware) and Medicare coverage doesn't start until you have collected SSDI for 24 months.

When you are approved for Medicare, this is still not the end all be all we would think it is. Ask an older relative who is on Medicare and they will tell you that Medicare doesn't pay for medications unless, again, you meet federal poverty level guidelines and apply for certain programs.

With health care reform in the national spotlight, consider the following scenario:

A family of 5, with a father who is collecting disability because of a brain tumor and an inability to work, is not eligible for any health insurance assistance because of the pittance received from disability.

This family of 5 must come up with a COBRA payment every month so that the father can receive treatment. COBRA payments for a family of five are generally over a thousand dollars a month. Without insurance, treatment options rapidly decline to comfort care only.

Health insurance is a necessity for all of us and it seems impossible that a person receiving disability is not automatically granted free health care. Health insurance is a right, a basic human right, and health insurance premiums should not stop anyone from the best medical care possible.

Although Social Security Disability is set up as a way to help disabled Americans continue their standard of living, most people that apply for social security benefits will be denied the first time.

Social Security Denies at Least 70% of Applicants the First Time

Applicants looking for SSDI benefits are often denied as a way to weed out people who aren't serious about getting disability benefits. People often get fed up with the appeals process and will give up before they see a dime.

Seizure Disorders are Not Considered a Disability

Oh, really?

After applying for benefits because I was having trouble driving, reading, walking, thinking and otherwise functioning due to a seizure disorder, I was denied benefits myself. Despite the words "if you have a disability such as a seizure disorder, etc." on the SSDI website, I was told that a seizure disorder is not considered a disability.

I might understand if it was written that "we are not sure your seizure disorder is causing you to be disabled" but a blanket statement that a seizure disorder is not a disability was not only wrong, it was callous and stupid.

I am thankful that I was able to return to work once doctors figured out how to help my condition.

Fight for Your Right to Collect Disability

Social Security Disability is for Americans. We are supposed to feel secure that if we are disabled, we will be taken care of. Instead, we wait for benefits, we worry and we have to fight for what we deserve.

Isn't there a better way?

Author Yamileth Medina

The fight over healthcare reform has reached the Senate, and may take longer than previously expected. Reform intended to promote the wider availability of affordable health insurance seems to have lost the momentum recently gained via its nail-biting passage in the House of Representatives. Republican senators have expressed unanimous disapproval of the bill and vow to filibuster in order to block it. Healthcare reform will require 60 votes to pass, which means that the entire Democratic caucus--the party's entire Senate delagation with a handful of independents--needs to support it. Senate Majority Leader Harry Reid is attempting to hold together two divergent wings of the Democratic caucus, with several factors coming into play.

As it currently stands, the health care reform bill isn't ideal for either liberal or conservative Democrats. While Democratic leaders have encouraged passage under the logic of imperfect reform being preferable to leaving the current system as it stands with soaring health insurance rates, many senators are understandably leery of voting for legislation that will take a monumental effort to amend later. Reid is doing his best to convince Democrats, as well as Democratic sympathizers, that this is a rare opportunity that shouldn't be passed up. Whether he will manage to bring them around to his viewpoint remains to be seen. President Obama has also pushed for a completed bill on his desk before January, although that possibility is becoming more and more remote. Obama has several major priorities on his plate (both domestic and foreign) besides healthcare reform, and is currently suffering from lower popularity ratings. Therefore, his influence is probably more decreased than many once thought.

One of the most controversial aspects of healthcare reform is the public option, which would create a federal government-run alternative to private health insurance plans. Proponents claim that it would drive down the cost of health care through using its buying power and regulatory muscle to buy health care services at lower rates, while at the same time forcing for-profit health insurers to lower their health insurance premiums to stay competitive. They predict more affordable health insurance as the result. On the other hand, opponents decry the increased level of governmental involvement and potentially deficit-busting cost of a public option. The former group consists of liberal progressives, such as independent Vermont Senator Bernie Sanders and Democratic National Committee chairman Howard Dean. Sanders, in particular, is threatening to vote against a bill that lacks a public option. Those in the latter group, including Ben Nelson of Nebraska and Connecticut's independent Joe Lieberman, have expressed their willingness to jump ship and vote against a healthcare reform bill that includes a public option.

The Democratic caucus appears to have reached an impasse in some respects. A compromise currently proposed in the Senate allows individual states to opt out of the public option. Liberals seem to begrudgingly accept the clause, but it isn't good enough for staunch fiscal conservatives like Lieberman and Nelson. Due to the Democrats' razor-thin majority in the Senate, Reid can't afford to lose a single vote. The chances of garnering Republican support for this healthcare reform bill are slim to none. The only hope of doing so is through writing a trigger function into the bill. Such a measure would only enact a public option if certain goals of expanding affordable health insurance to more Americans are not met. There may be a handful of Republican moderates like Maine Senator Olympia Snowe willing to vote for such a measure, allowing for a cushion in the event that Lieberman bolts; but that gamble has the possibility of angering progressives.

In the recent past, liberal Democrats tended to hold their nose and vote for legislation they had serious issues with because it was preferable to the alternative of getting even less of what they wanted; now, they are becoming more outspoken, threatening to withhold their votes if provisions regarding the public option or abortion are unacceptable to them--using the same tactics conservatives on both sides of the aisle have used to pressure party leaders in the past. It will be a significant struggle to keep all of the Senators in line. The bill is still being written, but Reid appears to be supporting a moderate approach that, by its definition as a comprehensive healthcare reform bill, leans more towards centrist and liberal Democrats but still has too many flaws for them to endorse wholeheartedly.

The chances of healthcare reform soon passing the Senate are mixed. Michigan Senator Carl Levin believes that the bill stands a "decent chance" of gaining the 60 votes needed to break a filibuster. Indiana's Evan Bayh seems to be similarly ambivialent, though he admits that a solution that satisfies everyone is virtually impossible. Meanwhile, Republicans are calling the bill fatally flawed and recommending that it be scrapped and healthcare reform put on the back burner. That idea is unacceptable to Democrats, who believe that increasing access to affordable health insurance is essential to their larger economic recovery effort. Moreover, they probably want to have some legislation to show their constituents before the 2010 midterm elections. If the Senate manages to pass the bill, its version will need to be combined with the House's version. In the event that the combined bill is approved by both chambers of Congress, it then goes to President Obama's desk. While it is doubtful that he would veto a bill regarding one of his highest domestic priorities, one that strays too far from its indended purpose has the small chance of not receiving a signature.

Yamileth Medina is an up and coming expert on Health Insurance and Healthcare Reform. She aims to help people realize that they can find affordable health insurance right now while waiting for a public option, if it ever gets passed. Yamileth lives in Miami, FL.

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