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Sick and poor: Life with a pre-existing condition

Gainesville family has struggled to find affordable health insurance

POSTED: September 22, 2013 12:09 a.m.

Health problems dominate life at Nicole Walker’s house on a dead-end street in Gainesville.

Walker’s children, Isaiah and Kendra, have state-paid health insurance that pays for their medical care, but she and her husband don’t have health insurance.

The mother of two has several medical conditions, including Type 1 diabetes, depression, anxiety, high blood pressure and a heart murmur. Her diabetic supplies, which include an insulin pump and other medications, can cost more than $1,000 a month, she said. Her children have physical and developmental disabilities.

“There’s been times when me and (my husband) go without food just so we know our kids have been fed,” Walker said.

Because of her pre-existing conditions, she said she either can’t find private health insurance or the cost of coverage is unaffordable.

She said she doesn’t know much about the new health care law, but has hope that her family may qualify for a government subsidy on the heath care exchanges that go live Oct. 1. Her husband’s employer is a very small business and doesn’t offer insurance.

The Affordable Care Act, which was passed in 2010, was designed to help more uninsured people get affordable health insurance. It uses a public-private model that allows people to use online “marketplaces” to sign up for coverage.

The controversial law prohibits insurance companies from denying coverage for pre-existing conditions; allows adults younger than 26 to stay on their parents insurance; and provides subsidies to low-income households to help them get insurance. It also requires everyone to buy insurance or pay a penalty.

The law had mandated states cover anyone in households earning up to 138 percent of the federal poverty level, but the U.S. Supreme Court struck that provision, making it voluntary instead. Georgia declined to expand Medicaid, citing the costs, and is letting the federal government set up its exchange.

Walker, 30, was on Medicaid, but the family recently become ineligible because of her husband’s income as a mechanic. She estimated the family of four lives on about $32,000 a year, which would be about 136 percent of the federal poverty level.

Walker stays at home with her kids.

“Me and the kids need coverage every day, so I know it’s really hard for me to get insurance and I know I can’t afford it right now,” Walker said. “That’s why I was hoping that I would be able to keep the Medicaid.”

The health care law’s requirement that companies with 50 or more employees cover full-time workers has been postponed until 2015.

However, all individuals are required to get health insurance or pay a penalty. Walker said she doesn’t like the individual mandate, but likes the benefit for those with pre-existing conditions, as well as the subsidies.

“I understand that everybody should have health insurance, but at the same time, we’re going to be fined if we don’t get it,” she said. “I can’t pay my bills, so how would I be able to pay for something else out of my pocket?”

The Walkers may find the resources they need in the exchanges, now called health insurance marketplaces. Open enrollment starts next month and takes effect Jan. 1. There are four categories of plans, from bronze to platinum.

The Henry J. Kaiser Family Foundation, a nonprofit organization focusing on major health care issues, offers a calculator at kff.org where families can get a rough estimate of what coverage on the Georgia exchange might cost. Although there are four people in the Walker household, the kids are covered by PeachCare for Kids, state-provided health care for children who do not qualify for Medicaid and who live in households with incomes at or below 235 percent of the federal poverty level.

If the parents enroll just themselves, they could choose a bronze plan with a subsidy covering the entire premium, but have more out-of-pocket expense. A silver plan could cost about $4,500 a year in estimated out-of-pocket costs, including the premium.

Walker’s husband is the only relatively healthy one in the family. She said she hopes they can find a way to get coverage for every member of the family.


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