End stage

Mar 16, 2010 — Tulsa World

Kim Archer

Mar. 16, 2010 (McClatchy-Tribune Regional News delivered by Newstex) -- As the yearlong health care reform debate appears to be winding down, it is time to find out just how its provisions will pan out.

The issue has been at the top of President Barack Obama's domestic agenda since he took office. Over the last year, debate in Congress became acrimonious over what kind of reform is needed and what it will cost.

The House and the Senate passed their own versions of health care reform in November and December. But the election of Republican Scott Brown in Massachusetts to the Senate seat previously held for years by the late Ted Kennedy eliminated the Democrats' filibuster-proof 60 votes for passage.

Obama recently presented his own plan and is urging Congress to use a procedural move called budget reconciliation to get legislation approved and to his desk.

Administration officials want action by week's end.

Here is a look at how

the status quo is affecting a sample of Oklahomans and what they would like to see in health care reform.

Some of what Obama's proposal would do:

--Create a National Health Insurance Exchange to promote insurer competition and allow individuals to purchase more affordable plans

--Expand Medicaid and SCHIP

--Make federal income-related premium subsidies available to individuals

--Provide tax credits to small businesses that pay a meaningful share of their employees' health plans

--Prohibit insurers from denying coverage based on pre-existing conditions

--Children up to age 25 could remain on their parents' health insurance plan

--Prevent insurers from abusing monopoly power through unjustified price increases

--Reform medical malpractice while preserving patient rights by strengthening antitrust laws and promoting new models for addressing physician errors

Source: The Henry J. Kaiser Family Foundation, Menlo Park, Calif.

What do you want to see in a health-care bill?

Mary Baker -- Age 60

Unemployed -- Uninsured -- Sallisaw

A. I would like to see no pre-existing condition clauses, affordable co-pays and deductibles and a choice of packages to pick from. Even when I had insurance, I still could not afford the deductibles and co-pays.

After working in the medical billing field and then as a pharmacy technician for most of her adult life, Mary Baker lost her latest job after undergoing two knee surgeries.

"When I came back, they said they had no job for me," she said of her pharmacy employer. "I always showed up at work. I even came in when they called me. I worked there three years and tried to be a model employee."

At age 60, she isn't old enough for Medicare. Now she has difficulty walking or standing and needs total knee replacements. But she can't afford them.

Baker said she has sent out multiple employment applications to no avail. She believes that -- despite the law -- once employers know her age and the fact that she has a disability, they overlook her.

Even if she got a job now, she thinks the pre-existing clause would prevent insurance coverage of her knee surgeries. Baker said there should be affordable insurance coverage for everyone.

Even when she had insurance, it was difficult to get by, she said.

"After two surgeries less than three months apart, I could not afford to pay the 20 percent. And I could not afford to pay what the insurance company considered nonessential, which came out of my pocket," Baker said.

She said she was billed by seven different medical departments, from anesthesia to recovery room, hospital surgery room and more.

"I could not possibly pay all those different bills and have anything left to live on," Baker said.

Amber Herndon -- Age 23

Real estate agent assistant -- Tulsa

A. "I want to see them making health insurance somewhat affordable. Clearly, something has to be done about it."

Amber Herndon is just getting started on her career path.

Having graduated from the University of Central Oklahoma last May with an education degree, she didn't have quite enough time to get a teaching job.

So she works for a real estate agent, who can't afford to offer health insurance benefits.

In January, Herndon turned 23 and "aged out" of her parents' health insurance plan.

"It scares me to death not to have health insurance," she said.

Despite her youth, Herndon is well aware of what one major illness or accident could cost. While growing up, she had scoliosis.

That required surgery at age 12.

Now, she is a migraine headache patient, and she can't afford the medication she needs.

"I can't afford to pay for it without insurance," Herndon said.

The medication costs up to $300 a month, which would take a huge chunk of her paycheck.

Herndon plans to seek a teaching position next fall, which would provide her that medical safety net.

But amid the rough economic climate, she knows schools are cutting back and she may have to go longer without health insurance.

"I also know there are tons of individuals and families with children who don't have health insurance and I feel for them," Herndon said. "That is really scary."

Liz Masters -- Age 47

Employed for small family-owned supply company -- Uninsured -- Tulsa

A. Well, I'd really like a public option. I've been so burned personally by insurance companies that I'd be happy to never give them another dime, whether it's subsidized or not.

Liz Masters likely will be paying for years on a broken arm that needed surgery a few years back. She doesn't have health insurance and the bill came to more than $16,000.

"I've been fortunate enough to live to 47 and be relatively healthy," she said.

Unfortunately, like so many others, the small family-owned business she works for can't afford to offer its employees health insurance.

Masters said she actually bought private individual insurance once, with a monthly $125 premium. Because she admitted up front that she had hay fever, the company disallowed coverage of allergies and raised the premium anyway. Then, after seeing her gynecologist and making a claim, the company made other excuses to refuse payment, she said.

"They said they didn't have my medical records and that the gynecologist wouldn't give them to them. I called the gynecologist's office and they said nobody had requested them," she said.

Within 30 minutes, Masters had the records faxed to the company.

But that's not how things ended. Masters said the company then wanted eight years of medical history, as opposed to the five years she had provided them.

She dropped the plan and hasn't had insurance since.

"I think elimination of pre-existing condition discrimination is really important," Masters said. "Nobody makes it through life without a single pre-existing condition. And what good is insurance if it doesn't cover your whole body?"

Lauren Orcutt -- Age: 24

Hairdresser -- Tulsa

A. "Pre-existing conditions eliminated. With our insurance policy, either we would be denied or the premium was so high it's unaffordable and doesn't even cover half our bodies," Orcutt said.

Recently married, hairdresser Lauren Orcutt and her husband fear any major illness could lead to financial ruin for their family.

"The health care bill means a lot to us. It's peace of mind for us as a young couple," she said.

Both have pre-existing conditions -- she was in an automobile wreck with head injuries in 2005 and he injured his back while on the job a few years back. Fortunately, most of her medical bills then were covered by the other driver's car insurance policy.

But now, the Orcutts are paying down a $6,800 bill for an overnight hospital stay when doctors wanted to observe her husband overnight.

"They thought he had tuberculosis," she said. "He had nothing.

And all they gave him was Tylenol 3. I could have given that to him at home."

Orcutt said the couple work hard, pay taxes, vote and try to give back to the community they love. Yet they can't afford health care insurance, which means they often defer medical care.

The Orcutts had a policy for a short time. But at $368 a month, they canceled it. "That was not doable for us," she said.

Orcutt has worked out a barter system with her primary care physician. She cuts the hair of all the physician's family members in return for office visits. "I feel very fortunate in the sense that if one of us had pneumonia, we have a doctor to go to," she said.

Her father lived in Europe for years and once was hospitalized there with SARS (a serious form of pneumonia), which was followed by months of medications. It was excellent care and he paid for none of it, she said.

Kim Archer 581-8315

kim.archer@tulsaworld.com

Newstex ID: KRTB-0205-42961225