Wisconsin is enjoined in a lawsuit to repeal the Affordable Care Act (ACA), taking us back to the market-driven approach of the past and returning health care into the hands of powerful insurance companies.
One of the many rights and protections in the Affordable Care Act is that insurance companies cannot place annual or lifetime dollar limits on coverage. Let me tell you about my sister. This is highly personal, painful and difficult to write about. It is a story that I feel called to share as it truly demonstrates the very real life and death consequences of this lawsuit.
My sister was a healthy 45-year-old mother of two, with a teenager and an 8-year-old. She worked full time with “excellent” employer health insurance benefits. She was separated from her husband but not yet divorced.
Fourteen years ago, my sister suddenly and unexpectedly developed a life-threatening cardiac condition and she needed a heart transplant. The only way that she could stay alive until a transplant was available was to surgically implant a left ventricular assist device (LVAD) immediately.
Before the ACA, health insurance typically had annual and lifetime limits, a dollar cap on what it would spend to cover benefits. Her insurance limit/cap would be reached with the LVAD and then there would not be any insurance dollars left over to cover the heart transplant. Since an LVAD was only done as a “bridge” to a transplant at that time, she was denied the LVAD surgery. Without the LVAD she was indeed going to die very soon.
Following almost two weeks of wrenching anguish for our family, a determination was finally made that since she was separated but not divorced, her estranged husband’s health insurance would then pick up her health care costs for the transplant and the LVAD surgery could proceed. She barely survived. A few months later, she received a transplant. Since that time, she raised her children and still works full time.
Before the protections in the ACA, how many people died unnecessarily because they reached the dollar limits of their insurance and were unable to get the medical care they needed? How many children lost a parent unnecessarily? How many people remained sick or more disabled than necessary because they couldn’t get the care they needed? How many people were bankrupted after reaching dollar limits or due to lack of coverage for treatments or medications?
No family should have to go through this because of powerful insurance company rules.
This lawsuit ends the ACA, gutting the rights and protections against annual and lifetime limits and arbitrary cancellations. It guts requiring prescription drug coverage, the 80/20 rule that holds insurance companies accountable to spend at least 80 percent of premium income on health care. And, it guts many other essential benefits.
They are counting on us to be fooled into thinking that we will have the same health care coverage, rights and protections after they repeal the ACA and pass new initiatives. To date, the new initiatives do not include all these rights and protections. Ask yourself if it is acceptable that people should be denied health care while insurance companies spend less on providing care, spend more on their CEOs and marketing, and increase their profits.
What happened in my family could happen to anyone. All it takes is one illness, disease or accident. Urge your legislators for solutions that include the ACA essential benefits and protections for all.
Betzig-Lundberg is a retired occupational therapist who lives in Eau Claire.