Security, peace of mind and health coverage

March 10, 2017

By Janis Lambert Connallon

“We are one economic downturn, one unfair worker’s compensation package away from medically related, financial disaster” said Lauren, pregnant mother of a 14-year-old girl and a 2-year-old son with Down syndrome.

Lauren is speaking on behalf of her family but there are families across California just like hers who are worried about what their lives will be like if Congress repeals the Affordable Care Act or cuts the Medicaid program. Proposed changes being considered by Congress now would put caps on benefits and spending in Medicaid, allow insurers to again deny coverage to people with pre-existing conditions, and increase costs for families. Those changes would put the health and insurance of 5.2 million California children in Medi-Cal and 79,000 children in Covered California at risk.

Lauren’s husband, Robbie, is an electrician and has been with the same union but in different jobs for thirteen years. Although the job has been stable, their health care benefits and services have been consistently downsized over the last decade with increasing co-pays. Their current health coverage through a union contract is subject to renewal, changes, or termination. In a recent contract negotiation, they lost access to behavioral health services (mental health, substance abuse, and family counseling) which used to be covered. So they know what it is like to be under insured and uninsured. At one point, they had a health plan that covered 80 percent of in-network providers, leaving them responsible for 20 percent of their health costs. Unfortunately, during that time, Lauren had to have a benign tumor removed from her spine. Even with 80 percent covered, Lauren and Robbie received bills they could not pay. “We aggressively avoided medical bills for several years and ruined our credit,” Lauren said. “We got bills that were laughably out of reach for us.” This was before the Affordable Care Act, before families were able to purchase plans to fit their needs through Covered California.

Over the last few years, they have slowly been able to rebuild their credit, but their situation is precarious. Their oldest daughter has a severe nut allergy and needs at least two epipens, ambulance rides, and ER visits per year; their son with Down syndrome needs the ACA’s requirement to include Durable Medical Equipment in insurance coverage; and Lauren, she needs the protections in the ACA to keep from being denied insurance due to her own preexisting conditions.

The Affordable Care Act gave them hope that should Robbie’s contract expire or union negotiations yield a poor health plan, they would be able to afford insurance, provide for their family, and not go back to years of unpaid, accruing medical debt. But the reality is, if any of these proposed changes occur, this family could easily fall through the cracks. The Trump Administration campaigned on addressing the needs of working families. Well, this plan will do just the opposite. It will leave this working-class family, along with so many others across the state, without needed security, peace of mind and health coverage.