Why Medical Insurance?

I recently got to do one of the most exciting parts of my job. I called a client, who I think is very deserving and told him he had won his disability case. The first two questions they always ask of me are, "When will I get money?" and "When will I get medical insurance?" The hardest part of my job is explaining to some people that although they have won their disability case, they must wait two years from the date they qualify for disability benefits before they will get medical insurance. In the case that I dealt with today, this man will not receive medical insurance until March, 2014. To me it is one of the most inequitable and unfair situations in the whole disability process. When you are sick, what do you usually need? Doctors, medicine, hospitals, surgery, tests all of which cost money. If you do not have medical insurance, they will not even schedule your test until you pay a certain amount, if not all of the money. When you are diagnosed with a disabling disease, you will find that it is almost impossible to obtain medical insurance. If you have insurance, it will go up so high that you likely will not be able to afford it

It is disheartening to look at statistics concerning healthcare of the world. Although the United States spends more money per capita on healthcare, our healthcare is rated 37^th in the world as to overall performance and those provided for. Yet, in France there is universal coverage and they spend half as much as we do and are ranked number one in the world. There are many reasons, that these numbers are what they are and I am not sure I am the proper person to even wager a guess. I do know that the lack of healthcare insurance is causing a rise in disability cases and causes cases to linger on for decades because people have no medical evidence to prove what is wrong with them.

So we are faced with a dilemma. Many of us become sick and have no way to treat it. Insurance isn’t always provided with jobs these days and I have discovered that when it is–it is expensive. One of the great benefits of working for a large company used to be good medical benefits, but that is not the case any longer. My husband and I have recently had to drop our medical coverage because the premiums were raised to an astronomical amount. He has applied for other coverage, but was denied due to preexisting conditions. One would think that when you applied for disability, that you would automatically qualify for medical insurance, but this is not true. This is a situation where it pays to be poor.

There are two types of medical insurance that can come with disability: Medicaid and Medicare. This is determined by whether or not you receive Title II (RSDI) or Title XVI (SSI.) I explained the difference in these two in my post "A Picture of Disability". Those who qualify for RSDI (who have paid social security taxes and are insured for disability purposes) will get Medicare. Sometimes, if you have no more than $2,000.00 in assets (not counting your home), and your RSDI check is under a certain amount, you may qualify for SSI as well. If you qualify for even $1.00 of SSI you will get Medicaid. The great thing about Medicaid and the unfair thing about Medicaid is that the moment you qualify for SSI, you get Medicaid. There is no two year waiting period. If you have worked and made a good income for all of your working career, you will likely not qualify for SSI and you will have to wait until you get Medicare. I am very socially liberal and all about helping the poor, but to me this is extremely unfair to have created two different types of insurance and to make one group wait.

Why is this? There is no good reason. The Social Security Administration will tell you that they have not been given the reason. I searched for the reason on the website to no avail. The Christopher Reed Paralysis foundation along with the Commonwealth Fund did some in-depth research entitled, "Waiting for Medicare: Experiences of Uninsured People with Disabilities in the Two-year Waiting Period for Medicare." In their research, they address the question of, "Why the Wait?" They also received no good answer. It is a historical question that must be looked at by trying to determine what the bureaucrats of the day were thinking.

One group this really affects are stay-at-home moms. We’ve had many women who stayed home, took care of the home and the children because their husbands were able to make a decent living to support them. Then somewhere along the way, mom gets sick. She develops some strange illness, hurts her back, develops fibromyalgia, Crone’s disease, take your pick. Maybe they never had insurance or maybe it got so expensive they could no longer afford it, but Mom applies for disability because she needs medical insurance. The problem is that Mom has not worked and paid in social security taxes so she is not insured for disability purposes. The next problem is that Dad works and makes more than the $12,792.55 a year that is allowed to qualify for SSI. So Mom is not insured and does not qualify for Title II and she has too much money to qualify for SSI so she gets nothing. You must qualify for at least $1.00 of SSI in order to get the insurance. I have had more than one person tell me, "I don’t need the check, I just need insurance." To me this is an injustice that has been overlooked for far too long. The way to fix it–get divorced. This has actually happened and not "just so they could get benefits", but actually caused people to get divorced. Studies have shown that money problems are the number one cause for divorce and when you factor in health problems, it is no wonder that divorces are caused. One of our clients needed a certain type of treatment that was horribly expensive. She had won her disability case but didn’t qualify for SSI and was in that two year waiting period without insurance. She actually did move out and get divorced, and gave away her rights to all her property so she could get medical treatment. I just see so much injustice which all seems to be centered around our lack of medical insurance. I believe that many people would never apply for disability if they had medical insurance. There are also people who would be able to work if they had medical insurance. 

There are many disability claimants who do improve after getting medical insurance. After receiving the proper treatment and medication you do get to feeling better. Some people feel like they can work at this point. If they do work and continue to make a significant amount of money as determined by the SSA, then the they will lose their disability and thereby lose their insurance. It becomes an endless cycle that goes something like this:

 

I could work with my medicine;

If I work I lose my insurance;
If I have no insurance I can’t afford my medicine.
If I can’t afford my medicine, I can’t work. 

Having medical insurance has become a right for the rich and for the very poor, but for the middle class, the biggest majority of people, we have been hung out to dry