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Well Child Advice: Have Health Insurance

By Dr. Kohar Jones

I meet them when they come in for their well child checks—three beautiful kids, smiling, aged 16, 12 and 7.  They’re fit, eat their fruits and vegetables, stay active.  They even brush their teeth. Their vaccines are in order, all they need are their yearly flu shots, and my signature on a form saying they can go to school. And they need health insurance.

“The kids used to be covered by my husband,” their mother says, “but he lost his job.”

She is wearing pink scrubs, on her way to work, she explains, as a nurse in a private internal medicine practice.

“They offer me health insurance through work, but it’s too expensive for me to buy,” she apologizes.  The doctor’s office is a small

business, with high insurance premiums. “If I bought it, we couldn’t make the mortgage.”

She makes too much to qualify for Medicaid and the kids aren’t covered by the Children’s Health Insurance Program in Indiana, where she lives.  So the kids are uninsured.  As is she.  And her husband.

“I hear Obama’s going to make us buy health insurance,” she says. “The house is already underwater. That would sink us.”

“I’m sorry things are so tight,” I say, and I am.  I see so much economic suffering right now.  So many of my new patients are out of work, and out of insurance, and that’s how they find me in the federally qualified health center where I work, providing a life boat to patients to keep them from drowning in debt while staying healthy.

“I think it’s important to have health insurance,” I tell her, “because you never know what’s going to happen.  But no one’s going to say you have to buy it until the health insurance exchanges are set up in 2014.  Then you can band together with thousands of other people to be covered together when you apply to insurance companies, so you can pay less for better coverage.  Like big companies now.”

“Less money for worse coverage,” she says.

“There will be standards,” I say.  “No matter which health care plan you buy, you would get the care you needed outside and inside the hospital.  Mental care.  Vision care.  Dental care.  And free preventive care.  You could come in for a visit like today, for free.”

“Then they’d make up the money by making me pay more for care later on.”

“No insurance compay would be allowed to make you pay more each year than a total of $5000 for each child, or $10,000 for the whole family.”

“I still can’t believe we’d be able to afford it,” she said.

“There will be subsidies for everyone who makes more than 400% of the poverty level,” I said.

“How much is that?” she asked.  Her kids are quiet, watching.

“It’s about $40,000 for a family of four,” I said.

She’s quiet for a moment, as she calculates.  “If my husband hasn’t found a job by then, we’ll qualify for extra help,” she says.

“And if he has found a job, then your kids will be covered by his insurance until they’re 26 years old,” I tell her.

“Unless I get my own insurance first,” says the oldest.

“Maybe through college,” says his mom.

“I’m going to study to be a doctor,” he says.

“That’s great!” I say.  “Study hard.  You’re laying the foundation now for a lifetime of learning.”

I send a little prayer that no catastrophic medical illnesses  befall him, and he can grow to be a doctor.  Maybe a primary care physician, in a health center like mine.

“And don’t forget to wear your seatbelt.”

So many of my patients don't understand the health care reforms.  All they understand is that they are going to need to buy health insurance, which they can't afford, and that scares them.  How will they keep a roof over their head, the electricity on, food on the table, if they have to shell out a few hundred dollars each month on health insurance when they're healthy anyway?

I try to remind them that health reform supports individuals and families in staying healthy, and in having the coverage they need in case of chronic or catastrophic illness.  No one will be forced to buy health coverage they can't afford without support.

I like the specific provisions that will help kids to stay healthy in the health reform law.  Already, insurance companies cannot deny coverage to kids with pre-existing medical conditions.

Starting September 23, all health plans in the private sector will provide free preventive services for infants, children and

adolescents. (Patients will not share costs).  Young adults will be allowed to stay on their parents' health insurance until age 26.

Between now and 2014, more money will go to primary care doctors such as pediatricians and family physicians to keep kids healthy.  New loan repayment programs will encourage physicians to enter pediatrics and primary care, especially in underserved communities.  $11 billion will go to federally qualified health centers to provide comprehensive primary care coverage for struggling families.

The Children's Health Insurance Program will be preserved.

Starting in 2014, health insurance exchanges will begin offering insurance in all the states.

These health reform actions will take place over time.  Together, they will ensure a healthier future for America.

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