A good health plan may not protect from high costs

Following is the story of  David Prats, a member of CWA Local 3805 in Knoxville, TN.  He’s been telling it at CWA workshops, and recently spoke at a health reform forum in Nashville. For more on the forum, see "CWA activist featured at Tennessee health reform forum".

My wife and I joke that all we get to do together is pay the bills.  Our family outings are the kind that don’t require any money – trips to the park.  And our night on the town is a burger and fries at MacDonald’s.

All of this is because I have a rare kidney disease. I have a very good, CWA-negotiated health insurance plan, sponsored by my employer, AT&T.   But just because you work for a financially sound employer and have a good health plan doesn’t mean you are totally protected against high health costs.

I’ve been reluctant to tell my story because I know that there are so many people who are sicker than I am and have it rougher than I do, because they have insurance that isn’t as good – or no insurance at all.  But when I tell my story to other CWA members, pretty soon they’re telling stories about their neighbors or their family, and by the end of the meeting, CWA members want to take action.

In 2005 my doctor told me I had kidney failure. Eventually the doctors determined that I have a rare kidney disease – LPHS.  I get what they call kidney spasms, and there is bleeding and a lot of pain.   Currently, there is no effective treatment.

I got dialysis for about six months, then I was able to participate in a clinical trial for medication to treat the disease.  All the expenses were paid by Merck, the pharmaceutical company.  But when the medication went on the market, I had to wait a few months before my insurance company would cover it.

In the past three years, I have had to undergo dialysis four times.  I have regular visits to my primary care physician – at least once every two weeks – as well as visits to specialists.  I have to get CT scans, an MRI once a year, and blood work weekly.

I now take 14 prescription medications.  To the extent that I can, I take generics.   Because I’m lucky enough to have good insurance, I pay an affordable copay for each prescription.  Otherwise, one of my generic prescriptions would cost $800 a month.  If I used the brand name medication, it would cost $2,400 a month.

The next step, if the medications do not work, is a transplant.  I have already done some of the prep for the transplant.  My brother is a perfect match.  But he has had some health issues too, and is also currently serving in the military.   This is not a step I want to take, if I don’t have to, because there is serious risk for my brother. It could take him 3 to 4 months to recover.   And my brother has a family and small children.  This is not something I want to put him through.

If I did not have good group insurance coverage, I do not know what might happen to me and my family.  Last year alone I spent about $10,000 out of pocket for my own care – including copays for drugs and doctor visits and paying for some care that my plan would not cover.  My youngest child has asthma, and we spent about $3,000 out of pocket for his care last year.  Between my wife and my two other kids, there was another $2,000 in out of pocket expenses.

Because of my experience, and because of my passion for the union, I volunteered in February to be a coordinator for CWA’s campaign for health care reform and the Employee Free Choice Act.  I went to training, and I trained six other people, who have been doing workshops with the locals in Tennessee.  Altogether, we’ve done 30 or more sessions, reaching around 600 people so far.  Once our members learn the facts, they want to get involved.  I’ve had several people call me and say, “How do I contact my Congressman?”  So I keep with me a book with all the Congressional phone numbers.

But until we have health reform, I live in daily fear that my job might be surplused or my job terminated.  I would not be able to afford the premiums for the coverage I now have – about $12,000 a year for my family – if an insurance company would even sell me a policy.  I had about $19,000 in savings before I was diagnosed.  Today, I have only $3,000.  And I have had to cut back so that I put aside only about one-third of the savings I used to.

CWA believes that we must now, more than ever, step up efforts to make affordable health care coverage a right for all citizens.  If we as union workers are to have secure and affordable health coverage, we must work to assure that all of us are guaranteed affordable quality health care.    This issue can not be solved by a “you’re on your own” approach.  We are in this together, and we must work together for a solution and we must create a solution that guarantees health care for everyone.

– 10/27/08

CWA activist featured at TN health reform forum

David Prats spoke  recently at a health care forum in Nashville sponsored by the Better Health Care Together coalition.  Members of the coalition include CWA and SEIU from the labor movement, CWA employers AT&T, Qwest and Embarq, and other employers including Intel, Wal-Mart and Kelly Services.  This unusual assortment came together last year in an effort to raise support for universal health care.

David shared the stage with Congressman Jim Cooper (TN-D), a leader in the House of Representatives on the issue of health reform.  An executive from Wal-Mart expressed the views of business in general and of Wal-Mart in particular.

At the forum, BHCT released a report showing the impact of rising health costs on American business - increasing the cost of goods and services, soaking up money that could be used for investment in growth, decreasing competitiveness against firms in countries that supply health care to their citizens.  The report also showed that Tennessee already has health costs higher than the average for other states, and increasing even faster than the national rate.  And it has fewer people covered by employer-provided health insurance than the average of other states.

Congressman Cooper, said the new president will inherit a lot of problems that took years to create, but he should act quickly to solve them, not waiting until end of his term.  Of course, Cooper added, he needs a Senate and Congress willing to act likewise.   Cooper supports the concept of universal coverage and believes there will be strong support for that in Congress.

CWA believes employers and unions need to work together to fix the broken health care system, and the Better Health Care Coalition is one of the groups the union is working with to press for national health care reform.

– 10/27/08

Tighter economy, less care

Americans are responding to the tight economy, the Wall Street Journal reports in the newspaper and on its health blog, by cutting back on a few things – including necessary medical treatment.  Among cutbacks reported: pap smears to test for cervical cancer, down 6%; prescriptions filled down 1.2%, the first drop in at least a decade; knee replacement surgery down 18.6%; visits to obstetrician-gynecologists, down 6%.

And it’s not just the uninsured who are getting less care.  The insured are facing much higher out-of-pocket costs than they did in previous economic downturns. The average deductible for the most common type of insurance (preferred-provider organization, or PPO), is $1,040 for families, according to the Kaiser Family Foundation. 

So, the typical family has to pay more than $1,000 on its own before insurance kicks in.  And even when insurance pays part of the cost, patients are facing higher co-payments.

Things are likely to get worse before they get better.  The Employee Benefit Research Institute projects that the number of uninsured has already risen since the last Census Bureau report, because more people have lost their jobs.  And an economic decline also means a drop in revenue for governments, making it harder to fund safety net programs for those who lose their employer coverage.

– 09/23/08