My youngest son. He’s not the type of person insurance companies like.
That’s because he consumes a disproportionate amount of health care. At a cost far more than his monthly premium.
And that’s because he lives with a chronic condition. In his case, it’s Fetal Alcohol Syndrome from being exposed to alcohol in the womb. The result is permanent brain damage. Although his challenges will be life-long, he’s working today. Contributing to society.
But let me be clear. Without his finely-tweaked cocktail of psychotropic medications, that wouldn’t be possible. He wouldn’t be emotional stable. Unfortunately, their monthly cost is huge – $1500.
That’s more than he brings home in pay. That’s more than he could ever afford on his own.
Affordable healthy insurance – with a pre-existing condition – is his lifeline.
As a special-needs adoption, the State of Indiana provided Medicaid coverage until 21.
Yet, unlike his two older brothers who also have Fetal Alcohol Syndrome, he didn’t qualify for ongoing Medicaid coverage as a disabled adult.
So what about employer-sponsored health insurance through his job? Like many in the service industry, his weekly work hours conveniently vary – making him and many others ineligible for coverage .
In other words, Obamacare is a blessing.
Since others will disagree with that statement, let’s look at history to further understanding.
During World War II, the federal government capped wages to combat inflation. That’s when employer-sponsored healthcare took off as a replacement for compensation. Shortly thereafter, President Truman endorsed universal coverage with strong public support. Not surprisingly, special interests disagreed and prevailed in the end.
While much of Europe embraced national health care at this same time – and still does today, employer-sponsored insurance became the norm in the United States. Even so, problems lingered. With only half of seniors insured in 1965, Medicare became law – along with Medicaid for the poor.
Meanwhile, health care expenditures steadily increased as a share of gross domestic product (GDP). From 5.0% in 1960 to 17.4% in 2013.
And the result was skyrocketing health care premiums – that forced fewer employers to offer insurance. From a peak of 75% in 1975 to 55% in 2009, millions of working people couldn’t afford insurance on their own.
Finally in 2010, the Affordable Care Act – known as Obamacare – became law with the inclusion of an individual mandate to purchase insurance. 20 million people gained coverage. Many with subsidies. Many with pre-existing conditions. Many with mental health issues.
Including my son at a price he could afford.
Interestingly, President Nixon in 1971 – and again in 1974 – introduced plans that would have gone beyond the scope of Obamacare. Republicans in Congress agreed. Democrats did not – pushing instead for universal health care.
Yet the pool of healthy young people didn’t grow as predicted, even with Obamacare’s mandate. This left too few people to cover the hefty increase in sick or chronically ill people like my son. In turn, insurance companies increased premiums for the middle class – much more than expected.
Frustration soon turned to anger.
Now Congress must act. Will access to affordable insurance be maintained for all? Will pre-existing conditions still be covered? Will insurance companies be encouraged – even pushed – to increase competition in every state? Will federal government subsidies for working families remain a priority?
Please no confusing Medicare vouchers for Grandpa and Grandma. No complicated Medicaid block grants that could allow some states to reduce essential coverage, while others do not.
Here are important questions that must figure into the solution.
How do we rein in health care costs – knowing that the sickest 10 percent of the population accounts for two-thirds of all spending?
How do we make prescriptions affordable while supporting research and development?
How do we shift the mentality of Americans from illness to prevention?
How do we re-define urgent care and improve cost-effectiveness of emergency rooms?
How do we create a culture of wellness that would reduce diabetes, hypertension, obesity, smoking, some forms of cancer – and even preventable conditions like Fetal Alcohol Syndrome?
How do we encourage every patient to have a medical home – with a primary care physician who coordinates care and improves outcomes, without duplicating services?
How do we replicate local programs where seniors, on their own, decide end-of-life measures before losing mental capacity and putting decision-making for expensive procedures in the hands of others?
And on a very personal level, how do we ensure health care coverage for my son – enabling him to retain stability and continue his place in the workforce?
There are thousands – perhaps millions – just like him. DCP
Peterson publishes EACH Child every Tuesday. To subscribe, open this link and “Like” the page. EACH Child is Special: Working Smarter Not Harder to Raise Every ONE
To follow Craig’s journey in raising his six children with special needs, click here: Adopting Faith: A Father’s Unconditional Love
To follow his son Andrew’s inspiring story, “Like” his special Facebook page Andrew Peterson Goes for the Gold