By Rosalind L. Murray
The Palm Beach Post, April 17, 2014
So much has been said about the Affordable Care Act — both bad and good. Most people, unless you are a professional, will have a difficult time fully understanding your insurance policy. Consumers (and politicians) say that no one should come between them and their doctor. However, unless a consumer pays out of pocket — there has always been someone between them and their doctor: the insurance company. It was that way before the Affordable Care Act, and it remains that way now.
As a result of being born with a congenital birth defect, I am an amputee who has worn a prosthetic since the age of 2. I have always been very active — which has been a lifesaver for me. Without that, I am at risk of high blood pressure, diabetes and obesity. I teach spinning, aerobics, Pilates and Silver Sneakers (fitness program), and hope I serve as a source of inspiration and willpower.
However, life is full of surprises — not all of them good. You see, I have employee-sponsored health insurance, yet my policy states that “(neither) wear and tear, nor theft, nor destruction, nor bio-mechanical reasons” is worthy of a new replacement device. These are policy constraints that I was not aware of, and I had assistance signing up. In other words, the only reasons that an active adult needs a replacement leg are excluded. I am speechless. I thought I was covered because the pre-existing condition clause was no longer included in insurance policies.
We all need insurance navigators because it’s difficult. Some states have made even the process of educating consumers about insurance more difficult. Most of us don’t even know which questions to ask. We know that our employers do their best to provide coverage for the average person. I used to think I was unique, but more and more people use prosthetic devices these days. A new leg costs between $50,000-$75,000, which can send families into bankruptcy.
I think about all the people in Boston injured in last year’s Marathon who now require a prosthesis. Few realize that their settlements will never be enough to cover the cost of replacement year after year unless they are old and sedentary. Prostheses are like automobiles; they do not last forever and must be replaced. It’s a device that most of us wear 18 hours a day, 365 days a year. Yet, my medical condition is not covered by my company-sponsored policy. This is neither experimental or new age — it’s my life! I would never deny someone blood pressure, diabetes or heart medication any more than I should be denied a new leg. Medical care is expensive but necessary for all of us to live our lives to the fullest. No one asks to be born with a medical condition. I am convinced more than ever that we need a single-payer system for health care. As long as the insurance companies have their place in our health care, equal access will be denied.
Rosalind L. Murray is member of the Palm Beach County Criminal Justice Commission.