Medicaid, Medicare, and the Affordable Health Care Act

"We should defund Obamacare."

If we truly care about caring for those who can't care for themselves, America would fully fund the expansion of medical social services.  There are right now millions of Americans being denied medical attention, and the care that they eventually seek is the most expensive possible, at the ER.  It is costing us too much now not to do more.

I was disabled after a drunk driver decided I didn't need to play basketball anymore.  After a spinal cord injury to C-4,5, and 6, I am now a quadriplegic confined to a wheelchair.  Because I technically worked, and payed into social security before my accident, I qualified for Social Security Disability. In Texas, this means I qualify for Medicaid- Full Medical, One Eye Visit a year, and 3 prescriptions a month.  That's cool, I can get by.

Recently, my Dad was diagnosed with cancer, and was so diminished physically that he to now qualified for this same Disability Program.  Concurrently, I now qualified for another benefits program, as a survivor or beneficiary of someone who is disabled, which means $75 more each month.  This had a negative effect on my status in the Texas system.  I was simply no longer qualified for the Medicaid program, but I could re-apply.  This process takes from between 30-45 days, AND the program I am applying for doesn't cover prescriptions or eye exams, both of which I utilize.  The 'good' news that in November of 2014 I qualify for Medicare, which costs $100, and only covers 80% and no prescriptions.  As of July 31st I am without coverage of any kind...all because my Dad got cancer.  (*ETA:  I just found out that I qualify for another program that will return me to my original coverage, but now I have to re-apply every year, and failing to do so in a timely manner could again endanger my coverage.)

We've got a great system!  Unfortunately, I find myself in a crack.  The Affordable Health Care Act is intended to have states expand Medicaid and fill in these cracks, but MY Congressman, Mac Thornberry voted some 40 times to abolish it.  My next door neighbor, newly elected to the Texas State Legislature winner of the Most Conservative  Republican, Drew Springer, has not responded in a manner that leads me to believe he cares about amending things either.

In places where the Act is being used, rates are falling, people are getting rebate checks back, and more claims are being paid out.  It is all because there are now more people's premiums going into the kitty, and the AHCA forces health insurance companies to pay out 80% in claims.  Among others changes, it also  forces companies to cover pre-existing conditions, which means terminally ill-patients won't show up at ER's for treatment.

If republicans are pro-life, why aren't they pro-health care?

When Nationwide is NOT on My Side

"Please be advised I will not be accepting your last settlement offer to settle your bodily injury claim at $30,000.00. -Nationwide"

Here's my "insurance settlement narrative letter"...NOT "a better liberal argument."  :)

      07-12-13

Nationwide

One Nationwide Plaza
Columbus, Ohio 43215-2220

ATTENTION:  Claims Department, Claim # XXXXXXXX

To Whom it May Concern:

On April 22, 2013, my body and my life took a big hit and a meaningful setback.  *Driver's Name*omit* error cost me months of pain and a loss of my personal independence.  

At impact the airbag deployed, striking my inner right shoulder, as I was attempting to brake, so it took the full force of the airbag deployment.  The immediate result was a numbness and a ringing in my ears, as though I had just been near an explosion.  When the EMT's arrived, I was still numb and my ears were ringing, but I didn't feel as though I had a concussion.  Having played contact sports in high school, I was no stranger to that state.  My immediate worry was that I had another spinal cord injury, but after closely checking all my motor skills, I surmised I was fine, after all, there was no blood.  My first mistake was refusing to go to the ER with the medics.

Home was only about 15 minutes away, and when I arrived there I did as I would normally do.  I started cooking dinner after washing up.  About half way through my preparations, I began to feel really sore, as the numbness wore off.  I took a couple of ibuprofen, ate, and then went to bed.  When I woke up the next day I felt like I had played the longest hardest football game of my life.  I made an immediate appointment to see my general practitioner, who was out for the day, so I  saw one of her colleagues.  At this point it hurt to move both my head and arms.  She wanted to inject me with steroids, but I suffer an ocular condition that causes my retinas to leak if I am administered them, so I elected for a "Toredol" shot, which she assured me would have similar restorative properties.  She instructed me not to use it, continue taking ibuprofen, and ice and compress it when possible.

Last semester, I took an Injuries: Care & Prevention class, and I made an "A,"  I also logged 6+ years of varsity team sports through out my life.  Not including my spinal cord injury, this one has been the hardest to rehab.  When you twist an ankle, you simply use crutches.  When you break a collar bone, you wear some sort of suspension apparatus, and you don't use it; injure your hand, and you get a splint.  Each one of these are intended to immobilize and rest the afflicted area.  In most cases, bracing is available and thusly utilized.  This injury offered no such remedy.  In order to 'properly' care for this injury, in my opinion, I should have been checked into a rehab facility and had someone else lift me in and out of my chair.  I should have had my arm in a sling, and done no weight bearing for a minimum of 4 weeks.  Given I was in the last weeks of a full schedule of criminal justice studies, wherein I had all "A's," checking into a hospital was just not a viable option.  

Instead, I employed as medically instructed, over the counter anti-inflammatories, clinically administered non-steroidal injections, sliding boards (a loading aid), help from my partner, ice packs, and an ace bandage.  One month to the day of the accident, my regular physician and I decided to take drastic measures and inject steroids directly into the joint.  This posed a hazard to the joint itself and my very eyesight.  We decided to do so because other options were even more dramatic and evasive.  The NP employed 3 syringes each containing about 10 cc of Cortisone.  These injections were intended to both damage the tissue and inject medicine to induce healing.  

I went to bed that night feeling little to no pain, unless I utilized my right arm.  I awoke the following morning feeling like I had a new shoulder.  I rolled over and up, reached for my chair, and it may have been because it was still dark or my chair may have been on top of a pair of jeans, but my chair began to tip and as soon as I tried to catch myself and put weight on my shoulder…it was like there was nothing there.  It could hold no weight what so ever.  I fell straight to the floor as the full weight of my body crushed my twisted left foot beneath me.  My ankle popped and I rolled backwards and off of it.  I slowly dragged myself to the living room and did my best to roll up and unto the couch. There I received help to ice my ankle, that was now beginning to swell.  I eventually summoned the strength and went to the ER, had it x-rayed, and they sent me home with an Unna-boot treatment and a new ace bandage.  It was just severely sprained not broken.

Transferring was now however more difficult than ever.  Not only would my shoulder hold little to none of my weight, buy my left ankle was also recoiling from any pressure or weight bearing.  I took the next few weeks and stayed completely away from any undue transfers except for my transportation to and from physical therapy.  I neglected my grape vines, social outings, and other outside duties as my world shrank to the size of a small 4 room apartment.  The month of June was mostly spent icing both my ankle and my shoulder and going nowhere.

The month of July has seen new feats of both strength and range of motion.  No more do I wake up aching. I can do most of my transfers now, independently and sans any load aiding devices.  The only pain I encounter is when I try to reach straight up, or if I tried to get from the ground directly into my wheelchair.  Feeling like my final healing was at hand and my therapy was drawing to a close, I offered to settle my personal injuries portion alongside my property damages claim.  I sought to offer what I found to be an industry standard of 3X the medical costs incurred up to July 1st, but this offer was initially rejected before I eventually rescinded it.  

After another week of what I deemed successful therapy, and feeling almost entirely pain free, on July 12, I attempted to return to my normal gardening activities.  So, I went outside and tried to hoe a few weeds from around my peppers, when my shoulder began to ache tremendously, so much so that I had to stop the activity within a minute or so.  I've noted that I am in a wheelchair, but I may not have said where my paralysis starts?  Just at my pectoral region I have no muscle control below there, so I sort of sit atop a jelly stump.  Before my accident I was right handed, but since the paralysis now affects it, I use my right hand to 'hold me up.'  No sooner than I took 4 or 5 good swings with my left hoe hand, that my brace acting right handed shoulder began to hurt.  It was the jarring impacts that I was just not yet ready for… 

This letter is intended to provide Nationwide with a clear understanding of exactly what kind of injury I received, the treatments I have had administered, and the effect this event has had on my life and my body.  While I have improved with therapy, what I fear is that my shoulder joint itself may never be as impact resistant or wear tolerant as it once was.  

When I began preparing my settlement offer, I looked to the Internet for guidance and direction as to how to affix a value to one's pains and suffering.  There were of course no hard and set in stone rules or clear guidelines for specific injuries.  Settlement offers can range from 2X to 6X medical damages, but do any of these reflect actual damage to specific people's lives or bodies?  The maximum amount Nationwide is required by your policy holder's limits to pay is $30,000.  If a starting NFL quarterback was hit like this, would a mere $30,000 come anywhere near covering the loss of his livelihood?  Is that hypothetical shoulder more or less valuable than my own now?

Imagine, if you could possibly, having no use of your legs, and then sustaining an impact injury to half of your remaining operative limbs?  I can not begin to tell you how arduous the path back to personal independence was after my accident back in 1994.  Losing it again now, even if only for a matter of weeks, is a burden I wish for no one, but it seems to me almost obtuse to try to affix a cash value to these sincere losses.  Do you know what it is like to be stuck on the floor for hours…waiting for help or assistance to arrive?  Have you ever been limited to a room or a house for weeks without the ability to move about pain free?  What is that worth in dollars and cents per hour or per day, and is it the same for everyone?  

This accident has cost me greatly.  I lost the one thing I invested everything in, and my body itself suffered periods where I was unable to function independently, safely.  I am even now, unable to return to my normal daily functions without pain, some two and a half months after the accident.  What is this 'worth' in actual cash value, generally or specifically speaking?  

To be honest, I don't believe Nationwide is in business to fully appreciate people's losses, and return them or their property to pre-accident levels.  I think it is more likely that you act on behalf of your shareholders and their bottom line.  With both of those notions in mind, I'd like to request, nah demand, that Nationwide ignore these 2X or 6X medical bills industry standards that clearly don't apply to my specific damages, and award me the maximum limit (*$30,000) within *Driver's Name*omit* policy in an effort to see me as a person who suffered truly incalculable losses of liberty and freedom as well as both great pain and suffering.  While $30,000 isn't in any way 'equal' to my losses, it would serve as an attempt to give me back a portion of what I lost, that is so precious to me…the sheer ability to get out and live life.  Moreover, my therapeutic needs may well extend beyond the $10,000 in PIP my policy offers, then what?  My Medicaid coverage does not extend to automobile accidents, so this settlement agreement would help to cover such future needs.

The FACT is that because of your client's actions, my world is now smaller, and I can get out and do less with more pain.  Even though I have gotten better, I may have received damage that I will never fully recover from, nor will I have coverage to pay for future treatments.  I seek an immediate settlement, please respond to this settlement offer within 15 days of receipt of this letter.

Thank You,

XX
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Their last offer:  $8300.

:(