Tuesday, October 11, 2016

The Elephant in Our Echo Chamber

Much of what is written in this blog relates to the criminal justice system I live and work in daily. The other system I live in daily is that of my youngest child, Zane. He is 12 years old, non-verbal with cognitive and physical limitations. One of his legs is significantly shorter than the other, causing gait and fall issues. This is compounded by both seizures and the autistic compulsion to contort himself into awkward positions. He is also symptomatic of scoliosis.

I may be a lawyer, but I also wear the hat of small business owner. I have one full time employee and 2 part time employees. I am the sole source of medical insurance for Zane, my dependents and my full time employee. My medical insurer is Blue Cross Blue Shield of Texas (BCBS) and has been for 18 years.

Since Zane's birth in 2003, BCBS has hiked my insurance premium every year - often the maximum allowable under my plan. I will not bore with why I am effectively tied to BCBS, but I am.

Yet I am lucky. I have health insurance. This does not obscure the larger problem of which I write. This past Sunday the Houston Chronicle ran a story by Jenny Deam (warning: some links may be behind a pay wall). The lede to the story:
As Texas' largest insurer [BCBS] eliminated hundreds of thousands of coverage plans for some of the state's sickest patients and asked for double-digit rate increases last year, its Chicago-based nonprofit parent company rewarded 10 top executives with a combined $48 million in bonuses.
This post is not, necessarily, an attempt to bash executives with the BCBS parent company, Health Care Services Corporation (HCSC). There is more from the story by Ms. Deam that leads to my point further down.
When 2016 arrived, Blue Cross and Blue Shield of Texas, HCSC's second-largest division, raised rates 20 percent and eliminated 367,000 plans, including 88,000 in Houston, that gave in-network access to many of the state's top-tier hospitals and specialists. The company said the benefit had become 'unsustainable.' 
Now, with just weeks to go before enrollment opens for 2017, HCSC's five Blue Cross and Blue Shield companies have asked state regulators for another round of rate increases, some as high as 82 percent, for ACA [Affordable Care Act] individual plans.
HCSC is a non-profit corporation.

We have a health care affordability crisis in the United States. It is the elephant in our societal room. This is a public policy issue that must be argued about on the merits or it, along with other policy issues percolating without discussion or real resolution, will result in our driving ourselves off a societal cliff.

That's right. Affordable health care. In an presidential election year in which personalities are at the fore, the silence of debate - and policy proposals - is deafening. In the 2 presidential debates thus far held, health care has been asked about once with no substantive policy discussions about what can realistically threaten all but the most affluent with possible bankruptcy.

I count my blessings. Others are not as fortunate. From another story by Ms. Deam, dated June, 2016 in the Chronicle:
The boy and his dad sit in the glow of the nursery lamp, their shadows wide as they rock together in the big chair. Bedtime is coming. But first there is the machine. 
A switch is flipped, and the medical contraption roars to life with an insistent whine. It looks like a Shop-Vac whose ribbed hose snaps into a special vest slipped over footie pajamas. The power of the machine makes every inch of 11-month-old Jack Faught shake in the hope of loosening mucus in his airways.
I can relate to these folks and their daily experience.
Since last spring, first-time parents Austin and Kyra Faught have stumbled, fallen and risen again after learning their child has cystic fibrosis, a lifelong disease that damages the lungs and pancreas. Left untreated, it could kill their son. If poorly treated, his life could be shortened. Their vision of parenthood forever changed, they threw themselves into battle against his sickness. 
Here is their problem:
Three weeks ago, a new fight landed at their doorstep, one that came with just as many tears and sleepless nights, waged not with medicine but phone calls and fax machines. It was with their insurance company as they begged to let Jack stay at Texas Children's Hospital, home to Houston's only accredited cystic fibrosis center and the team of specialists who were helping to keep him alive. 
Their story is part of a larger one being played out across Houston and the nation as the insurance industry reacts to its changing landscape by moving customers into narrower plans. At a time when millions of lower-income Americans are enjoying insurance coverage, some for the first time, an untold number of middle-class families are discovering that the kind of health care they want and need is slipping from their grasp. 
On the final day of 2015, tens of thousands of Blue Cross Blue Shield of Texas health insurance customers, including the Faughts, saw previous plans expire. Those with serious illnesses had been fretting for weeks over what such a change would mean, especially as word seeped out that the city's top hospitals would no longer be covered. 
How about those who have special needs children and unable to afford health insurance? Sorry, they are SOL. From a September story in the  Dallas Morning News, with a link to a longer story in the Austin American-Statesman.
Texas can proceed with millions of dollars in cuts toward the state's Medicaid program that provides therapy to disabled children. The Texas Supreme Court announced Friday that it declined to review a lower court ruling that would have allowed the cuts to move forward, the Austin American-Statesman first reported.  
Last year, the [Texas] Legislature approved $350 million in Medicaid cuts, mostly toward therapy providers for disabled children. Opponents of the cuts warned that they would disrupt care for tens of thousands of disabled children, especially in rural areas of Texas.
I am not banging on the Supreme Court of Texas for their decision. That recourse to the courts was sought exposes the problem. The problem is at root one of the state legislature's making. This is a policy issue to be fought at either the state of federal level. That is part of the debate we ought to be having - should health care coverage even be a state level issue.

My father has been a practicing obstetrician in the Houston area from more than 50 years. He sometimes says he has delivered half of Houston's population since 1964 - and he is only half joking. He sees the problems from the health care provider standpoint as it has worsened over those years. I see it from the end user standpoint. He and I disagree remarkably about the policy solution, but we both understand it is crippling regardless of whether it is the consumer or the provider. We must engage.

And thank you Jenny Deam for doggedly persisting in your reporting. Journalists like Ms. Deam and the Chronicle are grappling with reduced resources and the ability to report on important issues such as this. It is another problem we as a community must confront.

Another elephant in our echo chamber.

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