Uninsured heart patients find different payment paths

October 19, 2009|By HEATHER KEELS
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To manage the payments along with his rent and living expenses on a part-time salary, Horst has relied on a roughly $5,000 "nest egg" he inherited when his father died.

"If I did not have that at this point, it would be difficult," he said. "I even thought about selling my car."

Assistance gaps

Horst said he applied for medical assistance, but was told he didn't qualify because of his salary of almost $20,000 a year.

"That apparently puts me above the poverty line or something," Horst said.

He also looked into buying private health insurance, but found there was no way he could afford it on top of his existing health bills.


Heavner said he, too, had run into problems with medical assistance programs and income guidelines.

After his surgery, the free clinic helped Heavner enroll in a state medical assistance program called Primary Adult Care (PAC), which provides free visits to a primary care provider. However, the program does not pay for cardiologist visits or the blood tests Heavner is supposed to get regularly because of the blood thinner he takes.

While he was enrolled in PAC, he couldn't go to the free clinic for those tests, either, because the free clinic does not serve patients with any form of medical assistance.

"I would have been better off not having the state program and staying with the free clinic," he said.

Recently, Heavner lost his coverage under PAC as well as his children's coverage under the Maryland Children's Health Program. Income guidelines for those programs take into account family size, and one of Heavner's children recently turned 18 and no longer qualifies as a dependent, he said.

Heavner said he thought something should be done to make insurance affordable for those caught in the gap between qualifying for assistance and being able to afford private plans.

"I can never understand," he said. "It's the people that goes out and tries to work to make a living that can't seem to afford their medical insurance."

Heavner said a relative who died from cancer at 38 years old was struggling to raise two children alone, yet made too much money for medical assistance. His own mother sometimes doesn't eat because she doesn't have enough money for her prescription medications, he said.

"You're caught in these positions where you don't know which way to turn," he said.

Reform views

Heavner said he believes health care reform is needed, but he has been watching the legislation in Congress closely, and doesn't like what he's seeing.

One of his biggest concerns is the effect the reform might have on seniors should a cut to Medicare be instituted to help pay for the legislation.

The AARP has said that none of the health care reform bills that have been introduced by Congress would cut Medicare benefits or increase out-of-pocket costs for traditional Medicare services.

Heavner said he also is concerned about the possibility that illegal immigrants could receive coverage under the reformed system and doesn't like the idea of taxing people who don't apply for insurance.

"We live in a free country," he said. "I never heard such a thing."

Horst, on the other hand, said he would like to see the country move away from private health insurance in favor of a system where everyone contributes, based on their income, to a public health care fund that would pay for care for anyone who needed it.

"It'd be like our Social Security," Horst said.

He said the country has a negative knee-jerk response to "socialized" medicine, but the idea of insurance companies profiting from people's ability to become sick ought to be the more repulsive idea.

"It's a sad story that we do live in the wealthiest nation in the world and a person can't assume health care," he said.

Horst said part of the reason he decided not to buy insurance was that he didn't want to become "insurance poor," compromising his own happiness and well-being out of fear of a worst-case scenario.

"I don't want to have to labor many, many hours just to try to make sure I have health insurance because I believe that's absurd, but in any case, I'm reaping the consequences now of those values," Horst said.

Keeping that in mind helps Horst resign himself to the constant threat posed by his heart condition.

"I'm only 63, but I've lived a good life, so whatever happens, happens," he said. "That's the way I feel."

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