Health Care For America Now

We received this story from a women in Louisiana illustrating perfectly why the insurance industry needs to be regulated:

Pregnancy is treated like a high risk, disease that should be avoided or punished.

When I got married, I tried to add myself to my husband's health insurance. Of course I told the representative I talked to from the health care company I wanted to be covered for pregnancy. The woman said all I had to do was to write down "add maternity coverage" on my application form. I did that and faxed in the form.

Following up with the insurance company, I learned that my husband's policy did not even have the option to add maternity coverage. The woman on the phone had lied to me. I was told I had to call an agent and get quotes on another policy that would cover pregnancy. I went back and forth with that agent and learned that I would have to sign up for a separate plan to get the coverage. It would have a premium of over $300/month just for me.

Begrudgingly I agreed, only to be told that I could get that plan, but I couldn't change it to add maternity coverage for a year, since I was past the "30 day enrollment period" after a marriage. I told them to forget about it.

So I went without insurance for months until I got another job that offered coverage. Then I got pregnant a few months later. That is when I learned how bad my company's insurance really was.

It is a high deductible plan. For individual coverage, I had to meet almost a $2000 deductible before they paid for anything. That meant I paid for every prescription and doctor visit. I got pregnant in September, then I learned (as I was about to fulfill my deductible) that the counter would start over in January. No rollover for the fact that I had just paid $2000 for an ongoing condition. I had to meet it again. I could have changed insurance in January (that was the enrollment period), but no other insurance company would cover my pregnancy since it was a pre-existing condition.

So I kept the bad insurance figuring it was better to keep it in case something went wrong. I kept paying for everything, though I couldn't afford all the medical bills piling up. I couldn't even afford maternity clothes and had to wear the same outfits multiple times a week just to get the most wear out of them. I cycled through the same three or four pair of pants the entire time, and would have been in really bad shape toward the end if some nice co-worker hadn't given me another pair of larger pants to wear. I wore that pretty much ever day for month.

I had the baby, a few weeks early, and my infant had to be in a neonatal intensive care unit for about a week. That is when I learned that my maternity coverage only covered well baby care for newborns, NICU wasn't covered. I had to add him to my policy (and the deductible went up to around $4,000). I had planned to drop my horrible insurance when he was born, but now I couldn't. I had to add him to get any of his hospital stay covered. I couldn't get other insurance for him before he was born, as you can't get insurance for a baby before they are born. So, unless you already have insurance you can add them to, newborn hospital care won't be covered by any insurance.

So here I was, out of pocket around $6,000 for a pregnancy when I had health insurance the entire time. My payroll deduction at work went up and $80/month was added to cover adding my infant to my policy and I still couldn't afford anything on top of these monstrous medical bills. I looked at my explanation of benefits and learned that my insurance company gets a huge discount on medical costs. The actual cost of everything from the first prenatal visit to when he was released from the hospital was around $70,000. I did not get an epidural or need a c-section. I was never on any expensive treatment of any kind, and the only thing he needed was some oxygen for a few days. They didn't have to do any extravagant surgery or anything like that. The cost my insurance company paid was only around $30,000. They got a $40,000 discount. If I hadn't had that crappy insurance, I would be out of pocket $70,000, but if I have insurance, they will accept less than half that. How does that make sense? Either it costs them $70,000 or it doesn't. If it doesn't, what right do they have to jack up the price that much for someone just to make a profit?

People scream when gas stations price gouge a few dollars during a storm, but health care organizations can price gouge people all day, every day without anyone doing anything about it. Why should they charge someone that much to have a baby, with few complications? It only costs around $3,000 to do a home birth. These extravagant prices mainly hurt the middle class. Poor people get free health clinics, welfare to pay for food and medicine, and tons of non-profit organizations trying to help them out. Rich people can afford the bills and can afford good health insurance to offset the bills. The middle class is more likely to not have insurance or not have good insurance, and they don't get any assistance from the government or special interest groups.

Where is the assistance for middle class moms to take care of their kids? I can't even afford to by a toy or a book for my baby without agonizing over the price. I work all day, never get to see my child, and I still can't even afford to take care of him. Where is the justice in that? This system is broken. The country needs to get it's priorities straight and start worrying about being good people instead of being good politicians or businessmen.

She's right. Any system that treats pregnancy as a disease, a pre-existing condition to make money from, is indeed broken.

Today, we've released a report along with NWFCO [pdf] showing that health care insurance profits have risen 170% in the past five years. While insurance companies like United Health Group were raking in billions, new moms like the one above were having to scrape by and work overtime to pay for health care costs related to their pregnancy.

It's wrong. It's unequal treatment. It must change. Insurance companies need to be highly regulated to force them to fully cover pregnancy.