Words matter: shaping the way you look at experience

health_care_costs

Words are just words, and yet they are very, very powerful, because they shape the way you look at the world.

I contend that much of the challenge we face with health care in the United States results from a basic misapprehension that most of us never stop to think about: We keep talking about “health insurance.” Whatever it is, it isn’t insurance, at least not in any sense that most of us would recognize. Continue reading “Words matter: shaping the way you look at experience”

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Tennessee wants me or my daughter dead

hannah
Hannah snoozes, with no idea of the danger she faces.

The state will not be satisfied until either I or my daughter is dead.

That may not be the intent, but that is the effect.

(My apologies that this is not the usual communication-related post. I have decided to go ahead and share through this blog, though, because it helps explain why I didn’t get my usual post up mid-week.)

You see, my nine-year-old daughter is severely disabled. Hannah cannot close her airway (so anything that goes down her throat will go into her lungs), cannot sit up, cannot roll over on her own. She eats through a tube and breathes through a trach, and has to be suctioned every 10 minutes or so to avoid suffocating on her own saliva.

Although our primary insurance would much prefer to pay for home nursing care, since they know it’s cheaper than paying for hospitalizations, the way the policy is written with my employer (which happens to be the state of Tennessee, ironically enough), they cannot pay for it.

During her first four years of life, she was hospitalized 22 times, with the longest stay being 58 days. We did our best to take care of her, but the simple reality is that I cannot work all day and also take care of my daughter 24 hours a day. My wife is partially disabled, and can do little hands-on care for Hannah because of her severe arthritis in her back and hips as well as fibromyalgia. So she was frequently in the hospital with respiratory infections or other challenges.

But when we finally got her on TennCare (Tennessee’s version of Medicaid), which paid for her nursing, she was only hospitalized five times in five years, most of them one-day stays, with the longest being five days. Because the nurses are with her all the time, they have been able to catch issues while they were still small and get them addressed before having to take her to the ER or put her in the hospital.

The state’s other solution would be to take Hannah away from us and put her in a nursing home, and surely no one believes that she would get suctioned there every 10 minutes. She requires meds and breathing treatments around the clock, in patterns that don’t fit the typical schedules of nursing home. She will die in that situation, and it will cost the state much more than what it costs to pay for nursing.

She cannot live without someone with her all the time. She has to have the nursing to live, and obviously home nursing is the cheapest and most effective solution.

But the state has said I make too much money to qualify Hannah for TennCare, and they are going to kick Hannah off. They don’t care that we had to skip meals last month because we ran out of money. They don’t care that I finally sold my high school ring to get enough money to pay for gasoline so I could keep going to my job. If I get a second job, it will bring more money into the household, which will raise the floor for her to get insurance, and it will all go to pay the new uncovered medical bills–in other words, we will go hungry just as often, although I would be working twice as hard.

In light of that situation, it’s easy to understand that we have no savings. If we had savings, the state would have kicked her off sooner, because we had too many “assets.”

The state says that in order to get Hannah back on nursing care, we have to have about $4,000 in unpaid medical expenses. Nursing costs about $1,000 a day (vs. $10,000 a day for a hospital), so we will requalify after only four days, but how can we afford to do that? We don’t have the ability to pay the bill that would follow, so we would be forced into bankruptcy.

Reading between the lines, it seems there is a possibility I could save my life and my daughter’s by divorcing my wife. Then my income would not be a part of the household, and the child support would not be enough to bump her household income above the cutoff.

So I suppose I should add to the first paragraph “or until my family is shattered or we are forced into bankruptcy.”

Most other states have what is called a Katie Beckett Waiver–basically, that means to qualify for Medicaid insurance, you have to show that you would have the required expenses without the Medicaid coverage. Tennessee is one of the few states that does not have such a waiver. The waiver not only would save us the expense, but would also save the state the expense of going through the convoluted process of reapplying for TennCare. But that would be too sensible.

I fear that my daughter will spawn another article like this one and that I will wind up being the one to write, “Tennessee kidnapped and murdered my daughter.”

Insurance is supposed to protect you against catastrophe. Instead, health “insurance” limits care so that everyone can have their doctor visits covered, and so the ones who truly need insurance against catastrophe must go without.

I can’t blame the individuals who have tried to help me through various state agencies. They can’t help it. This is the way the regulations are written.

Is there someone, somewhere, who is able to do something about this situation who gives a damn? Or must we become another in the long list of victims of a bureaucratic, broken system?

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