Lisa and Me: Birthdays and Republican-Style Medicare

Part of the Series

Solutions

Lisa and I have a lot in common within our lives. We live on the same street and have become good friends. She began working for a paycheck and paying payroll taxes the same time I did – 1976.

Since then, we have both worked steadily and have paid payroll taxes for the past 30 or so years. We both have survived life-threatening illnesses, have coped with aftereffects, often working while ill out of necessity and because we both love to feel that we are contributing to society.

These illnesses have branded us with the dreaded “pre-existing condition” label that has made health care coverage a nightmare of patchwork tricks to make sure that we always had some kind of health care through our work and always were one job loss from health care disaster.

Both of us are holding our collective breath until 2014 when, if Obamacare survives, we will no longer be held hostage for health care over illnesses that we either inherited or got while growing in our mother’s womb.

However, I will, by luck of birth, have a much better chance of access to health care and keeping my health into my old age if the Republicans institute their Medicare reform because Lisa is four years younger than me. I was born in 1956 and she was born in 1960.

Even though we have both paid about the same into the Medicare system for years, I am, according to the Romney campaign site, one of the baby boomers who will be able to sign onto the current Medicare system, where my pre-existing condition will clearly not be an issue.

I will have the Medicare single-payer system (note to the Tea Party people who had signs claiming that they want the Federal government out of their Medicare: Your beloved Medicare is a socialistic single-payer government health care plan!).

I will finally have the ease of knowing that, after age 65, with my purchase of Medigap insurance to pay the 20 percent that is not paid by Medicare, my health care will finally be as seamless as my parents.

Lisa, however, will have the option of getting “premiums” as the Republicans call it, or vouchers to go out into the insurance market to find health care.

According to the Romney campaign web site, she will also have the option of staying with the traditional Medicare. The web site has calming, but very vague, statements that make it hard to understand what they really are planning. For example:

“This plan has no effect on current seniors or those nearing retirement. It will go into effect for younger Americans when they reach retirement in the future.”

They don’t name dates of the cutoff for the traditional Medicare, but I am a “current seniors or those nearing retirement,” and Lisa is one of the “younger Americans” who gets to continue the insurance company journey with the help of an unclear amount of a federal government voucher.

Lisa and I both expected to be able to get off of the pre-existing insurance nightmare if Obamacare survives in 2014, but we always knew that we would definitely be able to get full coverage as we limped over the line to the traditional Medicare. That was the promise to us while we paid in our Medicare taxes.

I’ve had Crohn’s disease, a degenerative disease of the colon, for over thirty years. It was discovered during emergency surgery in 1980 when my colon ripped open, but I clearly had it for several years before that. I have had four abdominal surgeries, too many colonoscopies to count, and visit the hospital as many as several times a year for bowel obstruction.

I have been able to keep the Crohn’s disease at bay lately with very expensive biologic drug treatments that have cost my insurance company thousands of dollars a year. My co-pays for many of these drugs have also not been cheap.

I don’t dare lose my health coverage because I can, at any time, need emergency surgery if my bowels decide to crimp off and cause blockage. Needless to say, if I would lose continuous coverage and then try to get back on an employer plan, the insurance company by law would pull out all the stops to keep me off their plan.

I have done everything I can to stop this disease, to take care of myself and comb the news in hopes of someday finding a cure. This disease can be inherited and that is what probably happened to me, because my mother recently was diagnosed with it. I try to control my health but I can’t control my genes.

Lisa’s health calamity is much more recent but potentially more deadly. Being born at home, she had not ever been in a hospital until 2004 when she was diagnosed with two benign brain tumors after having unexplained seizures. The more serious one, called a DNET tumor, was in a very delicate part of the brain.

The surgeon warned her as she approached her surgery date to say goodbye to her family since she might not recognize them when she woke up. He also thought that she would lose most of her past memories.

The tumor was removed and Lisa, while losing some childhood memories, did recognize people and by will and pluck, was able to get back on solid footing and learned to cope with some brain function loss. She then had to wait six months to get the second surgery for a less risky tumor.

Her surgeon was elated to see her recovery and said that she was the “poster child” for these brain surgeries because of her amazing recoveries.

Lisa was determined to get on with life and continued to work when she could. But even after this great misfortune, she was struck a bigger blow to her future health – she lost her insurance when her ignominious husband decided to abandon her and cut her off his insurance policy.

Because she has not worked full time since her surgeries, Lisa has been without health insurance since 2007 and is unable to buy it on the open market because of her pre-existing condition. Her brain tumor may return and started as a congenital defect that happened while in her mother’s womb. Through no fault of her own, she is now uninsurable but wants to try to get into a state insurance pool until 2014 if Obamacare survives.

But you might say that the Romney Medicare reform plan says that she has two options: one to buy insurance with her voucher and the other to stay on the traditional Medicare plan like me. This is where I have found that pre-existing conditions and definitions of continuous coverage, and Romney’s vagueness toward where and how it would apply, might not only ruin Lisa’s chances of real care after 65, but also might sink the traditional Medicare for me.

It will take some getting into the policy weeds on this, but bear with me.

Governor Romney says that he plans to kill Obamacare on day one of his new administration. If he is successful in doing that, our dreaded pre-existing condition problems will continue to run our lives.

Romney says that he will help with the pre-existing problem on his web site with this language: “Prevent discrimination against individuals with pre-existing conditions who maintain continuous coverage.”

But when CNN tried to nail it down, his policy got disturbingly opaque:

[H]e says he would “prevent discrimination against individuals with pre-existing conditions who maintain continuous coverage,” according to his website

In a May 2011 speech in Ann Arbor, Michigan, Romney spoke broadly about the concept.

“If you’ve been insured for 10 years, and you have a heart attack, and you’ve changed jobs, because of that continuous period of insurance, of course you will continue to be covered,” he said. “If you’ve never had insurance, and you’re age 55, and suddenly you have a heart attack, and now you want to buy insurance – you don’t say to them: ‘Oh, fine, you get it.’ … That doesn’t work very well.”

For people with pre-existing conditions who do not yet have insurance, states would be able to pursue a number of different approaches, such as high-risk pools and insurance exchanges, according to Saul.

Continuous coverage is the key phrase here. Lisa had insurance when she had her brain surgery but lost it afterwards through no fault of her own. So when she wants to buy insurance can she get it?

It is surely not clear. As for the state high-risk pools, the Obama administration and the states have tried to fashion these high-risk pools to help uninsurable people to make it to 2014 when it becomes illegal to discriminate again pre-existing conditions; but they have been very ineffective, with low numbers of people signing up because of complicated rules. I wrote about this in a 2010 column.

So how does this affect our journey into the Medicare system? I would be able to go into the traditional Medicare with no questions about my past health problems.

Lisa would be given a voucher to go to the open insurance company field where the Romney plan insists that she would get as good or better care than traditional Medicare.

But what if these companies, as they are doing now, are allowed to discriminate against her for her potentially expensive pre-existing condition or lack of continuous coverage? The Romney plan on his issues web site does not address the pre-existing problem, or say that she won’t be discriminated against because she has not had continuous coverage.

Earlier versions of the Ryan Medicare reform bill say that they will give more money in vouchers for those with pre-existing conditions, belying the claim that pre-existing conditions won’t be considered.

The Romney plan language is ambiguous and the Romney issues web site does not have a search engine. Other Internet sites quote the Ryan Medicare plan and claim that there won’t be discrimination against pre-existing conditions, and other sites claim that language in the various versions of the Ryan law to prevent that is unclear and vague. https://citizenactionwi.org/myblog

Insurance companies have been reluctant to get rid of the pre-existing clause for all types insurance for years and fought against Obama’s plan to eliminate it by 2014. It is not a factor in the current traditional Medicare. If Obamacare is killed off as Romney promises, the pre-existing condition problem will be fought legislatively all over again with armies of insurance lobbyists trying to stop the ban all over again in all areas of health care where insurance companies dwell. Romney now plans to put the private insurance companies into Medicare. Will the pre-existing fight also move there too?

So, according to the Romney plan, Lisa can go into the traditional Medicare. There are two problems with this. There is this obtuse language on Romney’s site about how the cost and circumstances of traditional Medicare can be changed:

“Traditional” fee-for-service Medicare will be offered by the government as an insurance plan, meaning that seniors can purchase that form of coverage if they prefer it; however, if it costs the government more to provide that service than it costs private plans to offer their versions, then the premiums charged by the government will have to be higher and seniors will have to pay the difference to enroll in the traditional Medicare option.

So if Lisa is forced into the traditional Medicare to help deal with her existing illness, she might have to pay more for it than she could afford, as the Romney administration would possibly jack up the price of this now unwanted, single-payer plan. What if she could not pay the higher price with her voucher or any other way?

Would she once again face being uninsured with addition of the specter of old age and more untreated illnesses?

What if many of the new Medicare boomers with pre-existing conditions cannot get a reasonably priced private industry insurance plan with their Romney voucher and be forced into the possibly more expensive traditional Medicare plan? That would mean that the healthy aging boomer would be with the insurance companies who would reap the profits of not having to take as many sick people, and the traditional Medicare plan would be smaller and smaller but with more and more high-risk people.

Not only would this threaten the traditional Medicare plan’s viability, but it would also threaten it for me because I would only be four years ahead of Lisa on the plan as it is heavily burdened with her group’s most ill people.

This could be the death knell for the traditional plan for all of us who are on it.

Call me paranoid, but wittingly or unwittingly, this could be used to kill off one of the most effective and beloved health care plans in the world. Could it be that Medicare would then meet the fate that Grover Norquist, of the group Americans for Tax Reform famously suggested: “My goal is to cut government in half in 25 years, to get it down to the size where we can drown it in the bathtub.”

If the pre-existing condition discrimination, or more high costs are allowed to continue to exist for private insurance – whether it be for the employer-based insurance and/or the insurance companies looking to expand into Romney’s Medicare voucher plan, the insurance companies would cherry pick the healthiest people and build bigger profits, while dooming the government to try to make a smaller and smaller Medicare plan work under great odds.

Then it won’t matter if Lisa was born after and I was born, before the magic 1957 year – the plan could fail for all of us.

Yes, Medicare needs to be reformed and revamped to insure its viability, but this is not the way to do it. Unless the pre-existing condition nightmare is clearly and permanently eliminated from all health care situations, all of our health care will suffer. As my friend and columnist Jonathan Alter, who is also living under the specter of a pre-existing condition put it when the original Obamacare bill was being considered:

“The core principle behind health care reform is – or should be – a combination of Social Security insurance and civil rights. Passage would end the shameful era in our nation’s history when we discriminated against people for no other reason than that they were sick. A decade from now, we will look back in wonder that we once lived in a country where half of all personal bankruptcies were caused by illness, where Americans lacked the basic security of knowing that if they lost their jobs they wouldn’t have to sell the house to pay for the medical treatments to keep them alive. We’ll look back in wonder – that is, if we pass the bill.”

Medicare is something that we have been paying for our whole lives, even through the pain and struggle of our pre-existing conditions that are as much out of our control as being African-American, White, Asian or Hispanic. So many of us have had to struggle through lifelong insurance discrimination and high costs while living with terror and guilt that if we lose our jobs we could bankrupt our family. We are limping towards age 65 and Medicare – don’t make us live that terror into old age.

Note: Lisa’s name has been changed to protect her privacy and I contacted the Romney campaign by phone message and email to clarify their position on pre-existing conditions but did not get a response.