Putting a Face to a Debate - Part 2

So, to finish up the previous post....how does Jonah's story relate to the health-care reform debate?

1. "Pre-existing conditions:"  Since Jonah has a "pre-existing condition" we can't just go out and buy him an individual plan.  He would be denied, or he would be offered a plan at a ridiculously high rate that no one could afford.  Our only option is to get him on a group plan, which can be very tricky when his mom works part-time for a nonprofit and his dad is in law school full time (no group plans here!).  Thankfully, Steve's fantastic employeer (who he works part-time for while he is in school) recently agreed to get a group plan on our behalf and let us pay for it (and he is even paying for part of Steve's coverage).  So, Steve and the 3 boys are on that plan.  I'm on a "cheaper" individual plan.  But, gosh...it sure would be nice if Jonah had the same access to individual plans as everyone else so we didn't have to stress about that so much.  And, it would be better still if any of the plans out there were actually affordable.  Which brings us to #2....

2. Crazy out-of-pocket expenses.  Last year we spent $15,000 on health care expenses for our family of five.  Most of that was our monthly premiums to the insurance company, just to have coverage. But a good portion of it was from the co-pays that we paid each month ($300 per month) for Jonah's medication.  A smaller portion was from co-pays for office visits.   We might as well have a second mortgage with the amount of money we spend each month on health care costs!  We make too much money to qualify for any of the assistance programs, but we don't make enough to afford the premiums we currently have.  So...it would be nice to have an affordable option for those times in your life that you need it, so you aren't going in debt because of health care costs. 

3.  "Prior authorizations:"  A prior authorization is an extra step that insurance companies require before they decide if they will pay for certain medicines.  Jonah's medication requires a prior authorization because it is very expensive and insurance companies do not like to pay for it.  Unfortunately, these prior authorizations can take a very long time, creating gaps in treatment like the one we just had when we changed insurance companies.  It would be nice if this process could somehow be streamlined to prevent gaps in treatment.  And, it would be fabulous if doctors were making the decisions on what a patient needs, rather than someone at a desk in an insurance office who is looking at a checklist (and not physically seeing the patient).

From what I heard on the news today, it sounds as if change is on its way.  Hopefully some of these issues will be addressed and maybe even alleviated?  At this point, we're willing to try anything!