A Lifeline for the Uninsured

[vimeo http://www.vimeo.com/63288396 w=500&h=279]

New America Media, By Viji Sundaram // Video: Josué Rojas & Edith Romo

— After undergoing emergency brain surgery in November 2010 to drain fluid that doctors believed was being caused by a tumor, Erika Chain cut short her stay in Asia where she had been doing volunteer work and returned to California where she hoped to continue her medical care.

Sorry, she was told by every health insurance company she contacted, you are “medically uninsurable” because of your pre-existing condition.

“Being 27, diagnosed with a life-threatening brain tumor and denied coverage was the lowest I ever felt,” Chain, now 29, recalled.

But before long, Chain found out through a friend about a federally funded program that grew out of the 2010 Affordable Care Ac. The program allows people like her with pre-existing health conditions to secure affordable health coverage in the insurance marketplace.

Called the Pre-Existing Condition Insurance Plan, it guarantees access to insurance for United States citizens who have been uninsured for at least six months. To prevent people with private health insurance from switching to this less costly plan, the health reform law put in the six-month requirement provision. Applicants need only show a letter from a doctor stating they have had a medical condition in the past year.

For Chain, enrolling in PCIP couldn’t have come sooner. Within days after she did, she fell into a coma and was admitted to neuro-ICU at Stanford Hospital. There, doctors performed brain surgery to remove a rare aneurysm that had burst in her midbrain, which was previously thought to be an inactive and inoperable tumor.

She remained in what doctors called a “living coma” for the next two months. She was awake, but wasn’t aware of anything going on.

“I thought I was living a bad dream,” she said.

The Stats

Meant to be nothing more than a “bridge” program, PCIP will fold into federal health care reform when it’s fully implemented Jan. 1. That’s when insurers will no longer be able to deny individuals with pre-existing conditions coverage, or charge them higher rates because of those conditions.

Since the PCIP program began in September 2010, California has consistently led the nation in the number of enrollees. As of Dec. 31, the state had an estimated 15,100 people, with Los Angeles County boasting the highest enrollment. New Mexico, by comparison, is closer to 1,400.

At 56.9 percent, white enrollees far outnumber other ethnic groups, with Asian and Pacific Islanders coming in a distant second. Chain, who is of Chinese descent, is among the 9.3 percent of Asian and Pacific Islander enrollees.

Health care advocates have lauded the PCIP program for providing access to health care to thousands at an affordable cost. Chain said her monthly payments are about $200.

In New Mexico, about $37 million has been allotted to the program. A complete list of qualifying conditions in our state (and a link for registration) can be found here. Early next year, PCIP will stop accepting new patients in New Mexico.

Suspending Care

Health care advocates worry about the federal directive ordering states nationwide to suspend new enrollment in PCIP beginning March 2. The Centers for Medicare and Medicaid Services, which funds PCIP, defends the move as necessary in order to ensure that there are sufficient funds to cover those already enrolled for the rest of the year.

Chain estimates that her medical bills would have set her and her family back by about $1.3 million, forcing them into bankruptcy. That amount includes her long rehab, where she had to relearn how to walk, talk and eat on her own.

“I came out of the coma with no short-term memory and double vision,” she said.

Thanks to PCIP, she said, she has made a 100 percent recovery, which she calls nothing short of a “miracle.”

She lamented that some people who learned of her enrollment in the program from her blogs think she got a “free ride” at the taxpayers’ cost. That, she asserted, is a misconception.

“It’s just like paying for any other normal health insurance,” she said, adding: “Without it, my case would have fallen into a county hospital or charity care,” and that would have cost the taxpayers a lot of money.


This article was originally published by New America Media, which is running a series on health care reform.