The Story of a Copay

Once upon a time, my son was diagnosed with a neurogenic bladder. After neurosurgery at Duke and a special surgery at CHOP, his bladder still did not function properly or respond to generics. This was many years ago. He has been on the name brand for as long as I can remember. The picture below shows the cost increases from 2009 on. In 2009 and 2010, the copay for this medication was $131.75. In 2011, the year after Obamacare passed, the copay jumped to $281.47. In 2012, the copay increased to $343.35. We refill it for the first time in 2013 next week and the copay will be $495.03. I'll blog about it again once I get the invoice!

Obamacare Price Increases

I keep talking about the medication that protects my son's kidneys. Through 2010, it had a $150 co-pay and cost us $600 for the entire year. It went up to $283 in 2011, then $343 in 2012 and this year $495.03- $1980.12 per year. I don't know about you, but we don't have that kind of money lying around. We don't qualify for any of the assistance programs.

Walter E Williams on Abraham Lincoln

Walter E Williams has it right on Abraham Lincoln. Read his article here: http://econfaculty.gmu.edu/wew/articles/13/AbrahamLincoln.htm

Homeschool Moms Against Obamacare

I scheduled meetings with Senator Hagan and Senator Burr's offices.  Two other homeschooling moms are coming along. We will be talking to their Health Policy Assistants. Obviously, Kay Hagan has the opposite view from me, so it might not go so well.  I've already spoken to Burr's people. They think much lik eI do and already hear from people whose families are negatively impacted by Obamacare.

I'm hoping that this meeting in March leads to my being able to share my family's experience with other senators who voted for Obamacare. 

If your family has been negatively affected by Obamacare, please contact me. I'd love to hand carry your letter to the senators' offices.

The Harm of Obamacare

The sadness is overwhelming every time I receive an email from someone telling me of the financial woes Obamacare is creating for their family. So many sick kids like mine may not get their medications because their families are in the same position as ours-- not poor enough for assistance programs, but not rich enough to cover all the increased costs of Obamacare.  Obamacare targets the sick! Friends in the High-Risk pool have told me their premiums and co-pays have gone up, making it harder and harder for them to take care of their chronic illnesses like Diabetes.  I've compiled information from recent articles that detail the harm Obamacare is doing to families like mine. We are still waiting for the specialist referral review for my son, which makes me so angry that the Democrats thought people were lying when they wrote Primary Care Doctors who Refer Patients to Specialists will Face Financial Penalties.  In 16 years, we've never had a wait or review like this for a specialist appointment.

On January 31, 2013, Daniel Kessler lays out Obamacare's Broken Promises in a Wall Street Journal OpEd, which is a great start for any blog entry trying to explain the harm of Obamacare! Mr Kessler notes, "Now, even advocates for the law acknowledge that premiums are going up." He goes on to list the other broken promises and ways in which Obamacare is harming average, hard working Americans.

A February 15, 2013 Wall Street Journal article states that A Lefty Website conceded recently that Conservatives were right about Obamcare. Imagine that!

In Kaiser Healthy News, it is reported that the Feds Increase Costs to High-Risk Pool Members.  The article says, "Under the changes which took effect Jan. 1, enrollees in federally-administered plans saw their maximum out-of-pocket spending limit increase from $4,000 to $6,250, according to a Jan. 31 report by CMS. Enrollees also began being required to order medicines to treat chronic illnesses by mail order after the second prescription refill."

In a January 7, 2013 article titled Obamacare Guarantees Higher Health Insurance Premiums 3,000 + Forbes reports the following: "[His] first term is just about up. And health insurance isn’t any cheaper. In fact, it’s more expensive. Premiums have increased by an average of $3,065. And they’re about to go up even more, as Obamacare takes effect during the president’s second term."

But... The Unsung, but massive Obamacare Sales tax increase is on it's way! In 2014, the largest of the Obamacare taxes hits. The worst is yet to come, folks!  Forbes has a February 15, 2013 article about it here.  A few highlights from the article:

•  “The health insurance tax will add a financial burden on families and small businesses at a time when they can least afford it, and it should be repealed, ” says AHIP, a trade association representing health insurance industry providers, in today’s call for the repeal of the health insurance tax before it can take affect.
•   Starting next year the ACA imposes a new $100 billion tax on health insurance. The tax will start at $8 billion in 2014, increasing to $14.3 billion in 2018, and will continue to increase each year.
•  The health insurance tax is larger than the device tax and the prescription drug tax combined.
•   The health insurance tax will increase costs for individuals and families purchasing coverage on their own, small businesses, seniors and people with disabilities enrolled in a Medicare Advantage plan, and state Medicaid managed care plans.
• The health insurance tax is far greater than the minimum penalty for those who choose not to buy health insurance – further incentivizing young, healthy people to forgo purchasing insurance until they need medical care.
• “The ObamaCare health insurance tax hits some of the most vulnerable people in our society, including poor people in Medicaid managed care plans and seniors in Medicaid advantage plans. It is also a tax on middle-income families who were promised by this administration that taxes would never rise.”

On February 5, 2013, The Wall Street Journal reports that the Congressional Budget Office figures more employers will drop health coverage.  In the article, the WSJ reports the following: "The CBO has long said it expects the new federal health law will prompt some companies to drop millions of employees from health plans because workers have new options to buy insurance on their own. In August, CBO put the number at four million over 10 years. Now it’s seven million."

 Feb 12, 2013 article by The Heritage Foundation: Obamacare doesn't actually lower healthcare spending

 2013:  Greene County Insurance Committee reports: "The ACA, commonly known as Obamacare, will take effect at the July 1 opening of the 2013-2014 fiscal year, bringing with it new taxes and fees that may worsen the county's financial situation in the coming year, county insurance broker Jim Jordan informed the Greene County Insurance Committee."

 Feb 13, 2013, Yahoo reports that Obamacare turns Employer Care into Bad Deal for Many. In the article, yahoo points out the following: 

• A new ObamaCare rule sends a strong signal to modest-income families that they can no longer afford to work for firms that offer affordable health coverage.
• Millions of such families could find themselves in what Cornell University economist Richard Burkhauser calls ObamaCare's "no man's land," where they can neither afford employer-sponsored family coverage nor access new government subsidies.
• It's unavoidable because the law's definition of "affordable" — interpreted by the Treasury Department — only makes sense for single individuals.
•  Several analysts have suggested that employers would respond to generous ObamaCare subsidies for moderate earners by dropping coverage. Burkhauser, along with co-authors Kosali Simon and Sean Lyons, suggest another option: Workers and employers could "change their current contracts" to make dependents eligible for exchange subsidies. Shifting employer premium costs to wages could make an "affordable" plan unaffordable by ObamaCare's definition for several million workers and their families, the authors conclude.
  

In October of 2012, the New England Journal of Medicine blasted Obamacare. In the article, the authors noted several things, including the following:

•  Obamacare will do little to address two of the three major problems facing the U.S. healthcare system — holding down costs and boosting the quality of care for patients, according to a scathing article published in this week’s prestigious New England Journal of Medicine.

•  “Although the ACA expands coverage, it ignores the structural problems in the organization and reimbursement of care — a limitation that is disappointing but not surprising,” said the editorial’s author Gail Wilensky, an economist and a senior fellow at Project HOPE, an international health education foundation. “Adding more people to the insurance rolls is politically and technically easier than finding a way to ensure that care is effective, high-quality, and affordable for both the recipients and taxpayers.”

 The NEJM editorial also criticize other aspects of Obamacare and suggests more market-based approaches, such as those proposed by Democrat Sen. Ron Wyden of Oregon and vice-presidential candidate Paul Ryan, would more effectively reform the nation’s healthcare system.

•  FEE-FOR-SERVICE: Despite widespread recognition that fee-for-service reimbursement rewards doctors and providers for the quantity of healthcare services delivered and not high quality, Obamacare does little to change reimbursement strategies now used in Medicare. “Much of the coverage expansion is financed through Medicare budget savings, which are produced by reducing the fees paid by Medicare to institutional providers such as hospitals, home care agencies, and nursing homes,” Wilensky noted, “but using the same perverse reimbursement system currently in place.”
•  PHYSICIAN PAYMENTS: Obamacare contains no reform of the way physicians are paid for some 800 specific services, which is “the most dysfunctional part of the Medicare program,” she argued. “This system rewards the provision of highly reimbursed services without consideration of whether clinicians are providing low-cost, high-value care for patients.”
•  MEDICARE CUTS: Obamacare provides Medicare “productivity adjustments,” but unless these institutions find ways to reduce costs, lower Medicare reimbursements will force providers to bargain for higher payments from private insurers. “Eventually, seniors' access to services will be threatened,” she said. “The Medicare actuary expects that 15 percent of institutional providers will lose money on their Medicare business by 2019, and the proportion will increase to 25 percent by 2030.”
•  FEW QUALITY PROVISIONS: Although some reforms are included in the law, such as value-based purchasing and accountable care organizations (ACOs), that could drive up quality while holding down costs, she said the amount providers will be paid are small and not likely to lead to many changes.
•  NO MARKET-BASED REFORMS: Like Medicare, Obamacare relies on regulatory methods, instead of harnessing market forces, to promote spending reductions and improve quality of care. If that approach fails, the law authorizes an Independent Payment Advisory Board to reduce payments to clinicians and institutions. Although Congress can override the IPAB's recommendations, it can do so only by a three-fifth’s “super majority,” and only if it acts within a limited time and comes up with comparable savings.
•  “What is needed are reforms that create clear financial incentives that promote value over volume, with active engagement by both consumers and the healthcare sector,” Wilensky added. “Market-friendly reforms require empowering individuals, armed with good information and non-distorting subsidies, to choose the type of Medicare delivery system they want.”

Colleges and universities are feeling the crunch. In turn, families sending their kids off to college are also strapped with an extra financial burden. A North Carolina college just up the road from me has had to increase its tuition costs because of Obamacare, as reported in a Blaze article found here.  Here are a few quotes from the article:

• Guilford College in North Carolina will likely be forced to charge students 75 percent more for health insurance in order to comply with federal regulations under President Barack Obama’s sweeping healthcare law, college administrators told Campus Reform.
• The cost for university provided health insurance is expected to increase dramatically from $668 to $1,179 in the 2012-2013 school year, Greg Bursavich, vice president for finance at Guilford College, told students in an email in late July.
• “Our student health insurance policy premium has been substantially increased due to changes required by federal regulations issued on March 16, 2012 under the Affordable Care Act,” read the email from Bursavich.
•  “It is directly related – it is only related – to the new healthcare law,” said Bursavich. “There is no reason why it has gone up except the requirements of the new law have forced it to go up. That is the whole story.”

The Galen Institute writes in Why Health Care Costs are Rising:  " "Health insurance premiums will increase as much as 100% because of ObamaCare over the next year, with states that have been most responsible in regulating insurance being hit the hardest, according to health policy experts Merrill Matthews and Mark Litow......Although President Obama repeatedly claimed that health-insurance premiums for a family would be $2,500 lower by the end of his first term, they are actually about $3,000 higher—a spread of about $5,500 per family."

As you can see, Obama, Pelosi, Reid and all of the Democratic lackeys in Congress lied to the American people.  I have a long list of articles I could quote, but instead, if you'd like to do further reading, please click on the links below. If you are negatively affected by Obamcare, please like the page "Families Negatively Affected by Obamacare" on Facebook!

More links that reveal the harm of Obamacare:

Everyone Pays for the Obamacare Freebies

Higher Co-pays seen for Medicare Brand Name Drugs

Shifting Obamacare Costs to Others

What Doctors and Patients have to Lose Under Obamacare

Primary Care Doctors Who Refer Patients to Specialists will Face Financial Penalties under Obamacare

State Lacks Doctors to Meet Demand of New Health Care Law (and wants to broaden who can legally practice medicine! Scary!)

Dr. Zelling: You Won't be able to keep your doctor under Obamacare

Some Students May Not Enjoy Obamacare Protections ( A CNN Article, no less!)

Obamacare: It's Not Working

From Sept 2011: The survey of private and public employers conducted by the Henry J. Kaiser Family Foundation disclosed that the average cost of a family policy climbed 9 percent to $15,073 in 2011, the largest increase since 2005. Premiums for single coverage rose 8 percent. http://www.newsmax.com/InsideCover/mccaughey-healthcare-costs-insurance/2011/09/28/id/412623#ixzz2LAVUw84T

From 2011: The Galen Institute has an excellent summary of the damage that ObamaCare has already caused, such as driving insurers out of the child-only, small-group and individual markets. The article is only about four pages long, with plenty of supporting tables at the end.http://blogs.investors.com/capitalhill/index.php/home/35-politicsinvesting/2487-obamacare-reducing-costs-care-on-the-back-end

Feds Increase Costs To High-Risk Pool Members

Obamacare was supposed to help people. Or so the Democratic Party told us, anyway.  A friend who shared this article with me writes: "Thanks for the $70 premium raise ( that will increase even more this year). Thanks for the $30 price increase on my insulin. I cannot wait to see how much the insulin pump supplies will be."  

People in the High-Risk Pools are being harmed by Obamacare's increased costs, too.  The article from February 13, 2013 Feds Increase Costs to High-Risk Pool Members states the following:


"The Obama administration has increased costs for about 38,000 people enrolled in high-risk insurance pools run under the federal health law to prevent the program from running out of money."

"Under the changes which took effect Jan. 1, enrollees in federally-administered plans saw their maximum out-of-pocket spending limit increase from $4,000 to $6,250, according to a Jan. 31 report by CMS. Enrollees also began being required to order medicines to treat chronic illnesses by mail order after the second prescription refill."

Day 47 Medical Expense Update

Here we are on the 47th day of 2013 and our average medical costs are $81.12 per day.  Our out of pocket expenses so far are $3,812.53, not including 2 appointments we've had but have not yet been billed.

My S has an appointment next week, J has catheters being shipped next week and the $495.03 copay is fast approaching!

Obama still sucks.

Families Negatively Affected by Obamacare

How's Obamacare working out for folks?  Apparently, not so well. 

One mom told me today that she went to pick up two of her son's medications that used to be covered 100% and the cost was $252 for them both. She has to contact the doctor to see if there are other options for her son.  Another mom tells me that one of her daughter's prescriptions for migraine headaches went from a $65 co-pay last year to a $170 co-pay this year. 

I share this so that folks know we are not the only family negatively affected by Obamacare.  Most of our co-pays have gone up-- the biggest one being a drug that protects my son's kidneys. For five years prior to Obamacare, it had a $150 co-pay.  This year it has a co-pay of $495.03.

Obamacare passed in 2010 and in 2011, my son's med co-pay jumped to $283 and in 2012 it went up to $343. We were really hoping the co-pay would only go up to about $400 this year. I was completely shocked when I found out in 2 weeks we will have to pay $495.03 to refill it ($1980.12 per year for ONE medication)

If you are a family negatively affected by Obamacare, please like this page on Facebook: Families Negatively Affected by Obamacare

Real Life Consequences of Obamacare

I talk to many families who are already dealing with the real life consequences of Obamacare.  It is not only having a devastating effect on the finances of families with chronically ill members, the quality of care is also starting to decline.

Case in point: My two boys have been seeing Dr. K, a specialist since they were about 2 and 3 years old. He follows them for a particular aspect of Shwachman-Diamond Syndrome.  We were going to see him every six months and then yearly. Since their primary care physician could just as easily keep an eye on them and tell us when she felt he should evaluate them, a few years ago, we stopped follow ups on our own.

Fast forward to 2013 and my youngest has a problem that has been going on for approximately 10 months. We waited to see if it would clear up on its own, then we went to the pediatrician who felt it was neurological in origin. She had us do several dose increases of Neurontin. The pain stayed the same.  In December, she referred us to PT/OT. The PT evaluated the condition and felt it was neurological. Given that she agreed with the pediatrician, she felt it would be best to see someone who specializes in the body part affected.  Here's where I have to let you know:  our insurance DOES NOT require any referrals ever.

I called to get an appointment, but since it had been 2 years since we last saw Dr. K, they needed a new referral. No problem. The pediatrician sent in a new referral.  I wait. I wait some more. I still do not hear back.  I call and leave a message.  No return call.

Yesterday, I call again and get switched over to person after person after person. They can all see the referral in the system. I finally get a lady who explains that there are new procedures now. They can't make the appointment with the referral until the pediatrician also sends over clinic notes. THEN Dr. K will review notes and decide if he thinks he needs to see J. If he decides yes, then we can make the appointment. I wonder what happens if he says no? Does my son have to live with the pain forever? Do we keep getting referrals (not needed by our insurance) and see if a specialist will finally see him?

It is a major SNAFU. The last lady switched me over to the first lady. Before she did, she told me that the first lady didn't know it was her job to do these new things.  Great. Our local hospital recently laid off 950 employees, too.  Still no word today. I wonder how long it takes for this *NEW* process?

I don't talk about this on my blog for pity - I am speaking out because so many people have no idea the crap they have unloaded on my family and others like ours with their Obama vote. You see, we've been dealing with chronic illness for 16 years and we don't have to speak  hypothetically.  We can tell you how it was before Obamacare and exactly how Obamacare has changed the quality of healthcare for the worse.

Obama still sucks.

Trip to DC

I'm planning a trip to DC. It is my hope that I can put a face to the families with sick kids negatively affected by Obamacare.  I put in a request with my representative, Virginia Foxx and both of the senators from North Carolina. I'm betting Kay Hagan won;t have time to meet with me-- especially after I confronted her about Obamacare a few years ago here in my town!

My plan is to go up on a Wednesday and meet with them. I've let them know my ultimate goal and if I can;t meet with other senators and representatives, I'm willing to go back another day to talk to them.

I wrote this the other day:

 I'm going to Washington, DC. Kay Hagan doesn't want to see the likes of me again, but she is my senator and she WILL hear my voice. I WILL put a face to the families with chronically ill kids being harmed by her vote for Obamacare. I'm going to make appointments with any senator and representative who will allow me to speak to them. The train fair is $135 and I won't even need a hotel. I can do it in a whirlwind 24 hr trip. Hubby doesn't think it will do any good, but I can't let those people destroy my family, the lives of my children without a fight. I can't complain about what Obamacare is doing to my family and families like mine yet do nothing. I'm just an average American mom who believes all things are possible with Christ. I will suit up with His armor and I will be unstoppable. Prayer warriors- pray for me! Just as I finished writing this, the song "I won't back down" started. I take that as a sign. "I won't back down. You could stand me up at the gates of hell and I won't back down."

Medical Expense Update: Feb 6, 2013

As of yesterday, our insurance company had paid out $51,479.47 for medications. Yes, that's over 51K for medications this year. Our portion: $824.01

Our total out of pocket expenses as of today: $3,417.90. Of which, only $955.38 goes toward our insurance deductible and out of pocket max.  

Can you feel our joy? At the end of the year, when we can't deduct as many medical expenses as we have in the past, it will be even more joyful.  Remember that Obamacare droped flex spending (a tax increase) and increased itemized deductions to anything above 10% of your AGI.

Obama still sucks.

Shwachman-Diamond America Awards Research Grants

I wear many hats.  I'm excited to announce that Shwachman-Diamond America has awarded two research grants. One for a SDS MDS (leukemic transformation) study and another for a SDS bone density study.

Having two boys with Shwachman-Diamond Syndrome, it is very important for me to stay active in helping find a cure!

Medical Expense Update Day 35: A Humbling Day

I keep telling myself that God will provide. We got another shocker last night. Js next shipment of catheters cost $195 and flex is used up-- we have already had over 3K in medical expenses this year. We are at $3,137.80, not including 3 appointments from January we have not been billed for yet. Today has been humbling for me. Calling assistance programs and explaining that we can't do this on our own. All things I've done in past years since our co-pays have skyrocketed.

I've called all the assistance programs, asked our doctors to help and then called CSS.  I was chewed out this morning. I wasn't even asking for money, but rather if they knew places who might assist middle class families with insurance pay for their children's medication co-pays. $495 is a lot of money. That's $1980 a year and we already have huge medical bills. The woman would not even let me explain what we'd already tried. She just kept telling me to be quiet and to listen to her. I asked her not to be condescending and almost hung up on her. It is very difficult for us to even reach out and ask for help. 

I sent the following email to the director after our conversation and received an apology with a list of things to do, that  we've already done. I simply replied that I would not have called CSS unless I had already tried everything on the list first. *sighs*   If you work for a charity, maybe my letter will help you with your compassion level.

To whom it may concern:

I placed a phone call to your organization this morning. As a Catholic, I am embarrassed by the condescending manner in which I was treated.

My family is active in our local parish, we donate to charity and I certainly did not deserve to get a *what for* when I called looking for prescription help for a medication that protects my son’s kidneys.  Our co pay was $150 for 5 years. In 2011,it went up to $283, then last year $343 and this year (in a few weeks) we will have to pay a $495 co-pay.   Last year, our family had 16K in out of pocket medical expenses—we paid 13K in cash, flax and credit.  Our flex has been dropped because of Obamacare and we ran out of that before the end of January. Because of increased taxes and premiums, my husband is bringing home $400 less a month. We’ve already had over 3K in medical expenses in 2013.

The woman with whom I spoke seemed to fixate on the fact that I had not gone into Johnson and Johnson to apply for their medication scholarships--  I can’t fly to another state. We have insurance and my husband has a job. My two boys were denied SSI and CAPC – my youngest gets a blood product infused once a week, caths every 4 hours and doesn’t respond to the generic form of this particular medication that protects his kidneys from damage. The woman with whom I spoke insulted me and treated me if I was some dolt who hadn’t tried to find the “safeguards in the system” – those were her words—she said the system has safeguards.

I do not appreciate her ill treatment.  Had she actually listened to my story, she may have found out a bit more about what we’ve done over these years to get help from the *system* and its *safeguards* --instead, once she heard the medication issue and got stuck on my not going in person to apply, all she could do was tell me to listen to her. Perhaps had she listened to our entire story, her bitterness toward me would have faded and she might have been able to help.

My youngest has had a neurogenic bladder since he was  (likely) born... at the age of 5, he began leaking urine all day long -- after he'd been potty trained for a year. We tried every med available. NOTHING worked...He had a psychotic reaction to Detrol LA, which eliminates that class of drugs. Tests showed that he had a neurogenic bladder. He had neurosurgery at 9 1/2 -- probably too late as it doesn't reverse damage....only prevents further damage. The Duke doctor and CHOP doctor decided that it would be worth trying this surgery-- they go in and inject the bladder with Botox. The Duke doctor had only done it once and the CHOP doc 20 times, so, with Js history, they agreed we should go to CHOP.  Medical literature showed that all patients who had not responded to medications like Joseph responded to the Botox injections.  Joseph had ZERO response.ZERO. That's when we went to the complex urology clinic at CC. Testing there showed that even on generic meds and Botox injections, he still had pressures high enough to cause kidney damage.  He started cathing... titrated up to dose on generic Ditropan and was still leaking. Dr.  told us some kids do not respond to generic-- so we started name brand Ditropan and for the first time in his life, Joseph wasn't leaking urine during the day. He wasn't lying to his friends about why he changed clothes. He wasn't embarrassed because he smelled like urine. He didn't have to get up during Mass 3 or 4 times to run to the bathroom to clean himself-- We've tried generic again and we've tried dose reductions-- he starts having pain and leaking urine, both signs that the pressures are really high.  If this was the only medication he took, there wouldn't be a problem.... but we paid almost 6K for meds last year.... and can't afford any increases!

I am not impressed with your employees—if they treat every person like I was treated.......   I hope that you all stay healthy and that your children are healthy. I pray that you don’t ever have to know what life is like with 2 chronically ill kids or know what it is to be thankful that by Jan 7 your insurance has already paid out $44,000 plus for your children’s medications. I pray you never have to ask people if they know where you can find copay assistance for middle class families with insurance. I pray that you learn to be a bit more compassionate when answering the phones. Chances are anyone calling Catholic Social Services is in need and in some sort of distress.

Peace be with you,

Pattie

"If at any time the going gets harder in our interior struggle, that will be a good moment to show that our love is in earnest." ~St. Josemaria Escriva

Sandy Hook Dad Testifies

This man's daughter was in Sandy Hook. He gets it. Thank you, sir, for explaining the second amendment to those at the hearing. A MUST watch video.

An American Patriot by Choice on Gun Control

This man rocked it.  Why can't the left do their research like this new American citizen did? Ahhh...that is because AGENDA comes before FACTS.  He nailed it- societal decay. He also reads several excerpts from case law.  I am proud of this Patriot!

One Million Moms AGAINST Gun Control

Please like their page on Facebook:  One Million Moms AGAINST Gun Control.

Stand up for your second amendment rights!  Like their page! Tweet about their page if you have a Twitter account.