Press Coverage
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My daughter, Josephine is 6 years old and until just this year was on the affordable Healthy Families program. I am so grateful to the program for providing her with excellent health coverage because she was hospitalized due to asthma and I don't know how we would have been able to afford her hospital care and medications otherwise.
Now we can afford health insurance through my employer, but there were 6 long years where we really needed and appreciated the affordable health coverage we received from the Healthy Families program.
Let's make this a reality for adults too!!
My son has bi-polar disorder. My mother committed suicide when she was only 32 years old so I take the illness very seriously. It took man years to get my son on the right medication and he has had success leading a normal life. He is in college and at 23 he was taken off our insurance plan at work. He has been on his own for three years so I told him it would be best if he looked into getting a p-olicy of his own. Imagine his surprise when all major medical carriers refused to insure him because of his pre-existing condition. Now he tries to make enough money to pay for his meds and blood tests hoping he doesn't really get sick. Bipolar disorder is a mental illness that can be treated but only preventatively,, once a patient is in a manic or depressive state there is nothing the doctors can do. He is engaged to a school teacher and getting married in July, he will then be insured. I hope he doesn't get sick until then.
When those who suffer from mental illness do not have access to their medication it is much more costly to society as a whole. My son was punished for catching his mental illness and taking care of it early in his life. Peventative health care is always more cost effective. We should not punish those who take care of business.
My children are covered under Healthy Families and it has been a health saver, if not a life saver. I'm self-employed and have to provide my own insurance. Three years ago my older daughter's school wanted her put on ADD meds to see if they would help with her learning disabilities. They didn't help but she was then marked in the health care system as "high-risk" and became almost impossible for me to insure privately. I was fortunate that my income was low enough that we qualify for healthy families, they accepted her even with her "high-risk" status. Her sister has extremely severe allergies and under the private insurance (and healthy families) I was having trouble getting her the medications she needed. At one point I was ordering them from Canada and paying for them myself. About 2 years ago she had a particularly bad reaction to something and it made one of her eyes bulge out and blood spots to appear. At that point she was OK'd by Healthy Families for name brand, state-of-the-art, medications and has been doing well on them ever since. She is probably now considered "high-risk" too because of this incident. I have my gripes with Healthy Families, specifically their medications policy, but overall they have been a lifesaver for this family in Poway, CA.
I moved back to Tustin, CA in December 2006 after leaving a man who had been abusive and the marraige was falling apart because we could not get along. I was ooking for work and needed to make enough money to support me and my two girls. While I was waiting I was on medical but I did not want to stay on for long because I felt others needed it more than me.
In February 2007 I got a job through a temp agency and I looked for medical. I made $62 above the max for Cal Families and when I looked into other plans, I could not afford to pay the costs to get insurance on my own.
During 2007, my oldest daughters teeth got really bad and started to hurt her a lot and I could not do much to help her with the pain. During 2007, a bill was presented to President Bush in which he denied that would have helped me and my girls obtain the much needed medical and dental. During 2007, I prayed nightly so that we would not get really sick.
Finally, in December of 2007 I was hired on at the company I had been temping with and started us on the healthy path. But the damage of 2007 has hit us hard. Myself and my oldeat have dental work needs that cost around $6000 after the insurance's portion through an HMO.
My oldest daughter is finally on her much needed medication but at the cost that she may be held back a grade because she is not where she needs to be.
The year 2007 was a struggle for me, but 2008 will be so much harder for me and MY GIRLS. We could have used the help last year that would have prevented what we are faced with now!!
I am scared of how I will not have the funds to take care of their needs because everything costs so much for me. Please stop and take a look around and really listen to those of us who are just barely getting by. We are the ones that want our children to have their needs met and struggle because we are damned if we do and damned if we don't. Please stop and listen to our children who don't see the struggle we go through because we are strong women, but who suffer because they lack the proper education, the proper medical, the proper dental, and more but are still great kids because they never truly understand that they are lacking because as a strong mother we cry when they are asleep!
Just last week, my son started vomiting violently. He couldn't keep down anything, not even water. We have been on Medi-cal for only 5 months.
He was feeling a bit better so I decided to hold off going to the emergency room. Then, the next night, he started vomiting again. He had lost 4 pounds in 2 days--he only weighed 27 before this happened.
A 1am rush to Children's Hospital and four hours and 2 IVs later, we were ready to go home. He was still limp in my arms, no smiling or laughing, just quiet with a slightly dazed look in his eyes.
What was it? The flu? Food poisoning? No, it was his molars. Something so simple could make him so sick and weak--he nearly passed out in my arms.
Thank God we had Medi-cal. I don't know what that experience would have cost without it.
You never know how or why you might end up in the hospital.
I am a married 45 year old mother of a six and a half year old who recently left a full time position which I held for years, after they refused to allow me a flexible and/or part-time schedule so that I could take better care of my son etc. I went into business for myself as a consultant right after leaving my job, but I didn't get Cobra because we can not afford the monthly premium. When I went to get health care coverage for myself and my child,
I was turned down due the fact that I have a preexisting condition. Nothing life threatening, just that I am helped by taking anti-depressants. They covered my child, after I called to find out what the issues where, and to register my concern, but not me. (Wait a minute. Aren't caregivers suppose to put the oxygen mask on first!??) I know, I know, the Insurance Industry is NOT out the make the world a safer place! And I should have researched all this before quiting. I learned that I could get insurance through my husbands employer, for $400 a month with a pre-existing condition, but so far, with our income, this is still out of reach with out me going back to work full time. So we wait until I have built up my business enough to be able to afford coverage and we cross our fingers.
My daughter was born end of 2006, she is now 16 months old. I have good healthcare coverage through my company (Apple), but I have always wondered what would have happened if for some reason I lost my job. My husband worked in several companies as a contractor first then as a full-time employee in a small company. My daughter was born with torticollis and strabismus, and because we initially put her in daycare, she would get colds all the time. So she has gone many times to the physical therapist, the eye doctor and the pediatrician. All of this is very expensive even without buying much medication. I hope everyone can have access to the healthcare they need, not just those that have (good) jobs.
I'm a single mom and a student, and without medi-cal, my daughter would not have health coverage. She's been very sick these past few weeks, so I'm glad I have the coverage to be able to take her in to the doctor at times like this.
I joined up with MomsRising, but I am not actually a mom. (I'm an aunt, though.) I have no kids of my own. I have no spouse or partner. I live alone. But until recently I could not get health insurance because of a combination of unemployment (no access/can't afford it) and past medical conditions (insurance companies won't sell it to me anyway). And I soon will be without it again when my current work contract expires; and COBRA is prohibitively expensive, so I don't know how long I can keep it. And when I can't get health care because I am uninsured, and some simple illness or injury takes me from this earth because of lack of proper treatment, my little nieces will miss me just the same.
I like most of what MomsRising does, but I must say that I am really offended by any call for health care reform that isn't a call for UNIVERSAL health care. Because anything less says to the world that some people are expendable. I am all for children, and I understand the strategy of asking for what you think you can get, like health care for those that society is most sympathetic to. But at some point you have to stand up for what is right.
Nobody is expendable. I am not expendable. Universal health care now.
Our kids are our future. The cost of preventative health care is a small price to pay for healthy, productive adults.
When I lost my job after my first son was born we went on Medicare. When I found new work, we were later able to go on to Healthy Families. I've been ever grateful for the coverage. My eldest son suffers from a more mild sensitivity spectrum disorder. He is both excessively sensitive to and obsessive about his environment. In the past this led to developmental delays, resulting in speech and occupational therapy. Now it means that he sometimes suffers social problems, and we have had to seek counseling to help him. Without the insurance, I would not have known how to help my son. We are now planning on having him evaluated by a neurologist to help him past some obsessive issues that behavioral therapy has not helped. Again, without the insurance, my son may become a life long sufferer of obsessive compulsive disorder, if not worse.
When my second son was born, his body had a purple stain covering over 75% of it. Because we had Medicare, I was able to take him to a doctor to find out why he was different. The doctors believed he had port wine stain with a high probability of Sturge Weber Syndrome. My son's vascular marks have faded, and we are now hopeful that he will not suffer such horrors. However, we need to monitor his condition and have him checked when any symptoms present. Not too long ago, he woke up crying that his arm hurt, and he stopped moving it for 3 days. Because we were on Healthy Families, we were able to take him in to the doctor, both to treat the problem, and to determine if it was related to a possible case of the Sturge Weber related condition, Klippel-Trenaunay. If my son did not have insurance, I am afraid we would miss some emerging sign that could have been treated.
As for myself, since we were able to step up to Healthy Families, I have no health care coverage. I have ignored many a warning flag because a doctor visit was not budgetable. While I would certainly love to be insured as well, I am happy that my sons are covered.
If health insurance becomes available to me at work, it still will not be affordable. For an employee plus family, the premiums amount to over $1400 per month.
I hope you will act to protect and expand health coverage. Thank you.
We have a health insurance policy for our children, but it does not cover most of the preventative treatments that have been working best for our family. Also, because my husband's company is based outside the US, we have to maintain a private policy, the cost of which is very high. We mainly keep this policy for emergencies, but should one ever happen, we'd be hard pressed to afford the maximum out-of-pocket amount allowed.
In summary, the best policy we could find for our family does not cover the majority of care we need, and comes with premiums, deductibles and maximum out-of-pocket amounts that are sky high. Families need real options for health care coverage that we can use and afford.
We need healthcare for our children but also for those adults who care for them. If an adult is ill and a child has healthcare, there is still something missing.
My concern is for the bureaucracy we now suffer under (private insurance) and the waste of resources that could go for better healthcare. That is why we need SB840.
When my husband went back to school to get his Ph.D. six years ago, we struggled to find healthcare for myself and my two daughters (the university provided care for my husband only). I'm self-employed and take care of the kids, so I didn't have health benefits. We applied for benefits for my children through Healthy Families and were very happy with the coverage. Healthy Families provided low-cost health, dental, and eye-care. Unfortunately, I didn't have any low-cost options for myself and had to pay a high monthly premium for my health care and paid for dental and eye care out-of-pocket. Healthy Families was a lifesaver as I didn't have to worry about the kids' care during a time when our incomes were low. Once my husband finished his degree, he found a job that provides good benefits for all of us and we stopped the Healthy Families benefits. I'm so thankful Healthy Families was there while we worked toward a better financial situation for our family.
My two children have received excellent public health benefits in San Francisco since before they were born. I qualified for no-cost Medi-cal during both pregnancies though my partner and I were both self-employed. Since the kids (ages 5 and 2.5) were born, he has provided the lion's share of our income and I have stayed home with the kids, worked at their co-op pre-school, toured kindergartens, nursed each child for a year and a half, shopped for and fed them healthy meals, read them lots of books, talked with them endlessly, taken them to museums, zoos, parks, aquariums, libraries and more, all in the hope that I'm helping them become healthy happy people for the rest of their lives. If I'd had to find a corporate job I hated and put my children in day care just so they could have health insurance, we would all be more stressed out , unhealthy, and unhappy today. If we'd made the same choices for me to stay at home with them and pay for private insurance, we would not be able to afford living in San Francisco, high-quality food, occasional family trips, or annual visits to grandparents. As it is, I've slept well knowing they have excellent medical coverage either through Healthy Families or San Francisco's Healthy Kids and I am proud and happy to have spent their early years doing what I believe is best for my kids and our family.
As a public school teacher, you would think my district would provide excellent healthcare for me and my family. Unfortunately, you would be wrong. My district only covers 75% of my healthcare costs and NONE of my son's. Instead of paying the $500 a month for healthcare through my job, I have to buy my son's healthcare independently through Kaiser, for $200 a month. Why is my district not covering my entire family? They must expect that I'd have a husband whose job would cover healthcare for the remaining family members. As a single parent (who alone shoulders all the costs of raising my son), this is unacceptable. My son's combined healthcare and childcare cost are more than I pay for rent! California's public school teachers deserve better. California's children deserve better.
I was very lucky to have been able to qualify for Healthy Families coverage for my son for one year. I barely qualified then because I did not receive an income from my employer while I was on maternity leave. Now I cannot qualify for Healthy Families to continue my son's health care coverage. I am a single working mother with a child to raise and the cost of health care is beyond outragous. The US needs to honor it's citizens like other countries do and make health care available at a very accesible cost to ALL CHILDREN and all its citizens. Why does the US, being such a wealthy country, does not provide UNIVERSAL health care? Please think of our children and their wellbeing.
A year ago, when I sat down to write about my five-year-old daughter’s hospitalization, I had no idea it would lead me to testifying at a hearing in Sacramento before a California State Senate subcommittee on Health and Social Services.
I also didn’t know how it would feel to publicly stand up for a cause I believed in – but I was about to find out.
With my two children at my side, as a grateful mother of Medi-Cal recipients and as someone who believes in health care coverage for all children, I shared our story with the senators:
This is my son Dane, and this is my daughter Aubrey. They’ve both been on Medi-Cal while my husband, their dad, attends dental school full time at University of the Pacific in San Francisco and we work hard to make ends meet.
Until last Spring we gratefully used Medi-Cal for the basics: physicals, vaccinations, minor illnesses. But last March, Aubrey came down with a mysterious illness: a 104 degree fever, vomiting, and pain in her side. Two trips to the Emergency Room led her to treatment for a kidney infection. However, when her symptoms were uncontrollable, not responding to antibiotics and fever reducers, doctors admitted her to the pediatric ward, fearing she might also have appendicitis. Many needles, ultrasounds, urine samples, and a CaT scan later, doctors were finally able to make a full and thorough diagnosis – and provide a treatment plan that worked.
Thinking of Aubrey, though, with that shunt and I.V. looming large in her little arm, thinking of her pale and exhausted after days of fever and pain and uncertainty, what makes me most disheartened is thinking of not having Medi-Cal.
It’s thinking of having to choose between paying rent and putting food on the table, and whether we could afford medical care. Thanks to Medi-Cal, I didn’t hesitate to seek medical attention as soon as I knew something was wrong – so Aubrey was able to get the most effective care before her condition worsened or became more expensive to treat. I am so, so grateful for that.
Shouldn’t it be that way for every child?
When I finished, I thanked the senators and left the platform, with my kids skipping ahead of me as if they accompanied me to senate hearings every day.
And that’s when I identified what were perhaps the real lessons of testifying: we had all felt the power of trying to make a difference – of how, now, not only was it normal to us for a regular person to talk to the rule-makers, but it was normal to see a mom speaking up on behalf of her children, and, ultimately, on behalf of all kids.
Some healthy lessons to learn.
Medical saved my daughter's life! My daughter Ellie was born with reflux. Seemingly innocent, a condition that many children have and outgrow. But Ellie was different. She would choke, and turn blue and had pnumonia by the time she was 10 days old and would become dehydrated from not being able to keep anything down. We had good insurance and saw specialists at a well reputed children's hospital who prescribed various different medications- none of which helped. Whe couldn't even keep the medications down, and it would take several doses just to get the required amount in her stomach.Often times we would have to pay "out of pocket" for refills sometimes 3 times a month, costing about $300 a month. Finally after 8 months, and 4 hospitalizations for pnumonia and dehydration, Ellie had surgery to correct the problem. It only got worse from there. The surgery left our 8 month old with a stomach capacity of under 2 ounces. We had to place a feeding tube in her stomach and slowly pump special high calorie formula at an ounce an hour into her. Our insurance wouldn't pay for feeding pump, they said "it isn't our responsibility to pay for food," and the hospital was set to discharge her. I was infuriated! I told the hospital that if they discharged her without a feeding pump I would walk down to the emergency room and come right back through. I had no way to feed my child! I could not feed her slowly enough to keep her from throwing up the formula the way the stomach pump did. As I was refusing to leave, social worker was sent in. The social worker from the hospital said we could qualify for secondary medical, and from there arranged for a medical supply rental of a feeding pump, the formula and supplies. We had to feed her with the feeding tube for 3 years. She is now 4 years old and truely amazing. Other than the tiny scars on her stomach, where her tube was removed 6 months ago you would never know she was ever sick! Without the medi-Cal, I would never have been able to afford a feeding pump and the cost of the formulas, and I attribute this program and our hard work to saving her life.
I work for a family owned business with my husband, father and brother. Both my family and my brother's family have 3 young children. Despite many long hours spent researching the best small business provider of health care benefits, the costs are so high, that we have all put our children on local government funded healthcare programs. None of the adults are insured. The government program actually turned us down at one point, saying we earned to little and therefore needed to be enlisted in Medi-Cal. We are still searching for an ideal program that provides real care. In the meantime, we are vigilant in avoiding illness and injury if at all possible - I say this with no irony, despite being the mother to 3 young boys. My children have had sporadic access to a family physician who knew them and could make them feel comforted and taken care of. It's a shame we don't have access to a system that let's us pay for doctor's visits like check-ups, etc. in an easy and accessible way. I can go in to any auto dealer and drive out in a new car, but I can't get through the doors of a competent family doctor without an overpriced insurance plan we can't seem to access.
When my son was 12 years old, he got appendicitis. If I had had a health plan, he would have gone to the doctor immediately for a "tummy ache" and vomiting. We cared for him all weekend, but by Monday morning, when he still couldn't keep anything down, I took him to the doctor as soon as his office opened. Fortunately, our wonderful Dr. Sachs was willing to see my children and bill me later. Still, by the time we took him in, his appendix had ruptured. His office called the local hospital a few blocks away, and was told that unless we had $5,000.00 cash to give them on admission, they would not treat him. We drove that terribly sick boy in terrible pain 25 miles through LA traffic to the county hospital where some of my neighbers were residents. They saved his life, and let me pay over the next several years. We applied for emergency Medical to pay the bill, but were uncaccountably turned down (our income was, at that time $18,000 a year for six people). I paid the bill every month for the next seven years. On his nineteenth birthday, I made the final payment. I sent a note with my final check, "Do I get the pink slip now?" I thank God every day that he didn't die on the way to the hospital.
Right now, he is changing jobs, because the factory where he works is cutting hours so much he can't make a living. His new job does not provide insurance for three months, so he is working a day job and a night job. He left at 0815 one recent morning and came home at 2130. He ate a little soup and bread, and went back to work at the factory from 12 midnight to 0400. He came home, slept a little, and went back to work at 0830. I was there because his wife was in the hospital with pneumonia and unable to care for their small sons, 5 and 2. When I had to come home to go back to work, he had to spend what little time he has trying to find someone to take care of his little boys the next day. He can't let his coverage lapse, he remembers too well what can happen if you don't have insurance. I wonder how long he can hold out before he has pneumonia, too.
I don't have the capability to download pictures, but there are some cute ones on Shannon's my space page:
http://www.myspace.com/cabeswoman
I inherited my teenage brother and sister as a result of financial hardship. Due to neglect, they didn't have a lot of common sense basics that most children learn gently, gradually as they grow up. Knowing that they would be eligible for Medi-Cal was a reassurance to me that if they encountered any health difficulties as a result of poor hygiene and sanitary habits, carelessness, or just the unavoidable accident life may bring, that we wouldn't be stuck with their medical bills too.
As it happened my brother fractured his arm shortly after due to riding a razor without our knowledge or permission. He rode it Andown a steep hill and hit a bump and due to not being taught basic safety in using this, he fell on his arm. These type of injuries are common with kids, but it would have been one more hardship that we would have had to face if he had not had insurance.
Medi-Cal covered everything. This year, I fractured my foot after over 30 years of dancing and although I have insurance, it is not as wonderful as Medi-Cal. I now know in dollars and cents just how much it would have cost us to pay for my brother's injury, not to mention the cost of taking time off work to take him to doctor's appointments. Luckily I was able to get the Medi-cal coverage approved for him just a couple months beforehand.
Policies that support families are more than just common-sense. They are a life saver.
It is essential that families are given the tools to care for their children when circumstances make it impossible due to illness or poverty. It is also important to reward the productive members of society that work hard and whose taxes fund these kind of programs. They too need a hand (not a hand-out) every so often, a fair wage, reasonable family leave for those emergencies that come up and to bond and give kids the love and care they need to grow up into responsible adults.
If we hadn't taken in my brother or sister it's hard to say what would have happened to them, as they had no where else really to go. I would venture to say there would have been a cost to society sooner or later, whether it was a hospital not being paid, juvenile dilinquency, or the cost and affect of their actions on others.
When families can take good care of their kids, everybody wins.
I get angry when I hear the argument that we can't have any kind of universal healthcare because then we won't be able to choose our own doctor. I've been employed and living in the same house the whole time I've been a mom and my kids and I have had to change doctors 4 times in the past 5 years, for reasons having nothing to do with patient choice. One time it was due to my changing jobs, which meant a change in health plan, and the other 3 times it was due to either my employer changing plans or my doctor changing what plans they accepted. This has a big impact on continuity of care.
Hi My name is Denise. I have 3 children. I am fortunate enough to be able to qualify for Healthy Families. This has made a huge difference to our lives. It literally means that we can afford to keep our house as we can pay the monthly mortagage and so prevent forecloxure. Paying the huge amounts that medical institutions require for 5 person families would definitely drive us into foreclosure. But most imortantly I feel secure that my kids will be looked after. To be able to visit the doctor when nessecary and not have to worry about how much it will cost ensures that my kids get the health care they need.To have to make the decision whether to bring a sick child to the doctor or to pay this months bills is a VERY REAL choice people are having to face daily !! Children's health SHOULD be a PRIORITY & NOT an issue that is in jeopardy !! What is happening to us as people if we are denying children proper health sevices ??
Thanks Denise
In 2006 my husband left the family for a girlfriend, and his well paying/extremely dangerous job serving our country in Iraq. I suddenly was a single mother with no job, no income, and no health insurance. Due to my now-ex-husband's career change, his income has become sporadic, so not only does he not provide insurance, but also there is often no money for child support. I found a part-time job teaching at the community college, but as adjunct faculty, there are no benefits. Some semesters I can pick up classes at several colleges, but with the State's budget cuts, my employment is not guaranteed, and I am not eligible for any health benefits at this time.
The children are covered by Healthy Families, but I cannot afford coverage for myself. This coverage has been very valuable for us, especially the opportunity to take the kids to counseling to help them cope with the divorce. We also have needed the dental coverage for check-ups and cleaning, and a broken front tooth.
We were charged in excess of $2000 for 3 hours in the Emergency Room at Glendale Memorial Hospital. It was on a Sunday and our pediatrician wasn't in the office to give us a prescription for a steroid we needed to help our son. He had a bad case of the croup which had been diagnosed the day before in the same pediatrician's office! We didn't need to go to the hospital. We'd been through a case of the croup before. We recognized all the signs and knew what we needed. But due to liability issues, our pediatrician wouldn't give us the prescription over the phone. So essentially, we were charged $2200 for an office visit at the hospital--not to mention the agonizing wait with a sick child and the rude customer service we received!
That is a lot of money for a normal family to pay out of pocket for a pretty normal healthcare situation! Kids get sick on a regular basis and what family can afford to pay $2200 just because it's Sunday?
My family of three currently depends on my job for health insurance. I've enjoyed this job for the last 7 years, and it's been good to me. However, the commute to the job is taking up too much of the time I would prefer to be spending with my toddler, and there are no possibilities for advancement, so I'm planning to leave the job this summer to go back to school for a nursing degree and spend more time with my son. This puts my family in a very risky position, since my partner's current employer does not provide health coverage. She is actively looking for another job that would provide both enough money to keep our household afloat and the health insurance we desperately need. She has several preexisting conditions, so insuring her individually would be ruinously expensive if possible at all. If she doesn't find a job with good health insurance benefits, either I'll have to scrap my plans for a brighter future in a new career (in health care, no less!), or we'll have to take our chances paying too much for limited coverage for her, relying on state-funded (Healthy Families) coverage for our child, and risking no insurance for me.
The sooner we can get universal coverage, preferably single-payer, the better for my family!
I work at a non profit organization serving children in LA County FosterCare. All of our kids receive their healthcare coverage through MediCal. Without this, 30,000 kids in LA County, who have no real parents to speak of, would have absolutely no access to healthcare. This is a vital service to these kids.
My Story
I was recently surprised to learn that my Individual Health Insurance Plan does not have any participating OB/GYNS in the County, where I live and work. I started asking more questions about my health insurance and am shocked with the answers that I am finding.
My husband and I are each self-employed and carry an Individual Health Insurance Plan. We have HSA (health savings account) compatible plans with a $5,000 deductible each. We contribute the maximum allowable contribution to our HSA every year and use those funds to pay for our annual and preventative health care. We consider ourselves to be a financially responsible upper-middle class couple. We own our own home, have an emergency fund set aside, and contribute to our own retirement plans. We plan to start a family eventually but do not have any children yet.
While I ultimately support a plan to provide universal health care to everyone, there are three issues I learned about in my journey that directly affect mothers and ultimately our children.
1) Group plans are mandated to include maternity coverage; however individual plans are not mandated to include maternity coverage. As a result, most individual insurance plans exclude maternity coverage. The few individual plans that do include maternity coverage are significantly more expensive. In the individual insurance market, the ‘risk’ of maternity is not shared. A mandate that requires individual insurance market to include maternity coverage is needed to ensure that women have equal access to health insurance plans. California Assembly Bill 1962 (De La Torre) will put this mandate in place; however Governor Schwarzenegger is expected to veto the Bill.
2) High-deductible health insurance plans are based on calendar year deductibles. Maternity costs are rarely limited to one calendar year. In most cases, pregnant women must meet the deductible in the two calendar years spanning pregnancy. Additionally, the newborn is typically covered on a mother’s insurance plan, however some plans stipulate that the newborn will become subject to its own deductible if it leave the mother’s room at any point during the hospital stay. In my case, I had been planning on my $5,000 deductible, but an extra $10,000 would have a devastating effect on my financial situation. Women are disproportionately affected by these significant costs. Even more concerning is the practice of inducing labor for women due in late December so that they artificially limit their maternity to one calendar year. A mandate that limits the deductible for maternity expenses to the equivalent of one calendar year is necessary to ensure that women are able to choose and benefit from high-deductible plans.
3) Government programs that are available for pregnant women are commendable and necessary for many un and under insured women. However the way they are currently written encourages undesired behavior and does not address the needs of self-employed/insured women. It is ironic that I could receive coverage on the AIM program – at a cost significantly less than my current deductible for maternity - if I were to a) get divorced, or B) quit working for 1-3 months. Furthermore, the income eligibility requirements for this program do not address the unique situations of the self-employed, such as disallowing deducting business expenses from one’s gross income. Changing the AIM income eligibility guidelines to offer coverage to women who would otherwise pay over 10%, 20%, or even 30% of their annual income for maternity care would ensure that maternity coverage is available to all women at a reasonable cost.
For what its worth, I’ll share a little more about what I learned when I started asking questions. Since our local hospital was covered by our insurance plan I thought that we could pay out of pocket for the pre-natal visits to an Out-Of-Network (OON) doctor. It turns out that the OB-GYN is much more expensive than I could have imagined, and the pre-natal tests were even more costly – although no one could provide me with any specifics about the cost of pregnancy in my area. It all depended on the rate allowed to be charged and other theoretical situations. My health insurance company told me that I would have to submit my claims before they could let me know the costs. (No one seemed to care that I did not yet have any claims, and was only trying to responsibly plan ahead.) A few phone calls later I was informed by my insurance company that there was a further problem with my plan to use an OON doctor. If I used an OON doctor, then the hospital would be considered OON as well. I was told that my insurance might cover the hospital as an in-network provider if I arrived in labor through the emergency room, and the hospital didn’t have time to transfer me to another hospital.
After concluding that I couldn’t take a chance on the unknown costs for using an OON provider, I contacted my insurance broker to inquire about other insurance plans that include local participating doctors and hospitals, considering that there are many in my County. I learned that most individual plans exclude maternity coverage; however there were two other individual plans available to choose from. There were however some compelling reason to stay with my current insurance. Both plans required an application process with a detailed health history. I’ve been denied for coverage in the past because of an abnormal PAP, and was concerned that the application process would not be an easy one. Additionally, the plans that included maternity coverage were significantly more expensive than the plans that excluded maternity coverage. It’s not hard to figure out why since the only people who would be buying a plan that includes maternity coverage would likely be utilizing that coverage.
Next stop on my search was a call to my current insurance company to find out if they could make an exception to my plan to include a local doctor for maternity care. They explained that I lived only 28 miles from the nearest participating provider in a neighboring County and exceptions were only made for people living outside of the 30 mile radius. It didn’t matter that there is only one rural county hospital and maternity clinic within the 30 mile radius of my home or that this clinic was not a health care provider I would choose if given a choice. Lucky for me, there were many more participating providers farther away in the neighboring County. I resigned myself to taking a day off work to navigate the traffic and congested two-lane freeway for regular prenatal visits and an hour-long (during non-traffic hours) drive while in labor for delivery.
I was telling a friend about this crazy pregnancy / insurance situation I was in, and they mentioned that if possible I should plan to conceive in Jan – March so that my maternity costs would be limited to one calendar year deductible. The thought had never occurred to me, but suddenly became a very relevant and compelling reason to consider when planning to start a family. I wondered if there were more babies being born in October –December. Or even worse, were pregnant woman being induced in late December and having pre-term low birthweight babies so that their delivery didn’t subject them to an additional calendar year deductible?
Someone I spoke to along the way mentioned that I might look into state-sponsored supplemental insurance plans. The AIM (Access for Infants and Mothers) program in particular looked like it might be a great option. It provides supplemental maternity coverage for women who are un or under insured. The total cost for AIM program is 1.5% of your gross annual income, which would be significantly less than the $10,000-$15,000 in insurance deductibles that we’d be subject to otherwise. We won’t know for sure until we apply, but it is likely that my husband and I will fall just above the income eligibility requirements. I’m thinking that we should get divorced and contact the media to cover the twisted logic of the AIM eligibility requirements. Or better yet we should take a short break from working so that we will meet the income requirements. Our loss of income would be much less than $10,000 and we’d get a nice long vacation from working. And we’d pay less income tax too!
Being self-employed has been great for me, and I love knowing that I’ll be able to keep this job and work from home with a flexible schedule when I do start a family. But this whole maternity health insurance dilemma has caused me to rethink my plan. I could leave this business that I’ve worked so hard for three years to build in order to get a job that has an employer sponsored group health plan that includes maternity benefits. I don’t plan on working outside the home after I have kids, so I’d have to then quit the new job after taking advantage of the maternity leave. This choice really benefits no one - I'd lose everything that I've worked to build in my own business, and an unsuspecting employer would incur significant costs in training me & increased insurance premiums just so that I could leave them.
I am compelled to share my story with you today in the hopes that it will lead to increased awareness and action related to maternity issues that affect women. More importantly I hope that we can work together to enact change that will protect and support childbearing women.
Please do not do this, I have a five year old son. And if you cut out him and lot's of other children that are in the same financial state as I'm in, poor and barely making ends meet, my son will suffer as we will not be able to afford to pay money out of our pockest when he get's sick or needs to go to the hospital or Dr.s. Lets not CUT OUT the childrens healthcare. We NEED IT. please find another way to cut back. thanks
from a single mom
I have a friend and she is a single mother with 4 children, ages 9 down to 11 month twins. She is an amazing mother and is still nursing her babies. She tries to pick up work where she can as a massage therapist, however, it is more important for her to nurse her babies, giving them the right start, then trying to get a full time job and not ever be able to be with them or raise them. Having healthcare for all would actually reduce our healthcare in amercia, if coupled with education for preventative healthcare and nursing and parenting, etc. We MUST take care of our young mothers, and advocate them staying at home with their babies.
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In August of 2008, we brought our 4-month old son, Simon tothe E.R. because he was breathing a little funny. He was diagnosed with a rare condition called Idiopathic Dilated Cardiomyopathy that had put him into acute congestive heart failure. We were told he had equal chances of complete recovery, stabilizing enough to get out of the hospital but be sick for the rest of his life or get worse and need a heart transplant and/or die. He spent 4 months in the ICU at Children's Hospital Oakland fighting for his life.
I was fortunate enough to have a good paying job and good benefits, but while my son was in the hospital, my employer (a women's health center, no less!) started giving me a very hard time and I was forced to leave. I found a new job, but making about 40% less than I was. We also now live on one income because my partner stays home with our son since he is too medically fragile to be in daycare. The cost of my health benefits went from about $300 a month (before copays) to over $1200 a month. Our son is now considered "stable"but still is on 7+ medications, doesn't eat by mouth which requires a feeding pump that connects driectly to his stomach and is very developmentally delayed due to his prolonged hospitalization.
We had been receiving services through a regional center for free for help with his eating, walking and talking but a few months ago our dear Governor decided to cut funding to these centers. They're now "payers of last resort" which means we now need to get those services through our insurance, which means more copays that we already can't afford.
We spend close to 40% of my salary just on medical expenses. We're both in our mid-30's, have Master's Degrees and have been fully independent for years, but if we didn't have our parents to help us, we would have been bankrupt within a few months. This system is BROKEN. I'm heartsick that the public option seems to be dead. I'm not sure how much longer my family can continue like this...
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