And Then I Got Sick…

Four and a half years ago I was a single mom climbing the corporate ladder. I had a happy and healthy daughter, a secure job with great benefits and the respect of my colleagues. Life was good.

Then I got sick.

I was diagnosed with Lupus and Multiple Sclerosis and after a series of events, I was fired from my job. Needing health insurance now more than ever, I signed up for COBRA, my only option for health care coverage at the time. The monthly premiums were very expensive and my financial resources were dwindling quickly.

I was scared, I was nearly broke and I was sick.

It was a hands-on lesson in just how quickly your life can change and how quickly you can lose everything. It was also a tough dose of reality to learn that insurance companies aren’t out to protect you. They’re out to make money. And you aren’t guaranteed health care in this country no matter how sick you are.

When I could no longer afford COBRA, I applied for and received TennCare, Tennessee’s health care program for the poor, disabled or uninsured. At the end of the year, an administrative error made by the TennCare Bureau accidentally kicked me out of the program. I went without health insurance and health care for nearly six months. After months of wading through administrative red tape, I was allowed back into the program. I qualify for TennCare because I am uninsurable.

Just when I thought I finally had some peace of mind and my health care needs would be met, I learned of Governor Bredesen’s plan to reform the TennCare program by making drastic and life-threatening cuts.

The Governor’s proposal is radical and unprecedented. If this is passed, other states and private insurance companies will follow suit. We will be stripped of our rights and people are going to die.

He’s on a mission. And so am I.

I’m literally fighting for my life and the lives of everyone in this country. And I’m asking you to join with advocates and me to help stop this from happening before it’s too late – for all of us. How Governor Bredesen’s Reform is Going to Harm–or Kill–Me and Thousands Like Me

Under Governor Bredesen’s TennCare reform, enrollees will be classified into groups. The group you fall into determines your benefit limits. Regardless of the group, all enrollees will be subjected to–and adversely affected by–the new “medically necessary” term.

I belong to the “able-bodied” class, which is above the poverty level. This means I will:

. Pay a monthly premium

. Pay co-pays for doctor visits and prescription drugs

. Be limited to 10 doctor visits per year (I have just had my 18th doctor visit this year with additional visits pending)

. Be limited to 10 labs/x-rays per year (I’ve had over 22 with more are scheduled)

. Be limited to no more than 6 prescriptions per month (At times, I have exceeded 9 per month)

Note: In June, I had my 10th doctor visit and labs/x-rays. Under the proposed reform I will have no coverage for the rest of the year! But I will still have to pay the monthly premium! The Governor’s Story

After graduating from Harvard in the 1960’s, Phil Bredesen took a job as a computer programmer but had a desire to get into public office. In 1972 he entered the race for a Massachusetts state Senate seat and lost.

In 1975, Bredesen and his wife moved to Nashville after she accepted a nursing job in the city. The connection to the medical field would prove profitable for Bredesen. He began working for Hospital Affiliates International selling hospital contracts. The board for Hospital Affiliates International gave Bredesen the capital to start his own company, HealthAmerica, a firm that bought failing HMOs and repaired them. Bredesen put $10,000 into the business; when he sold it in 1986 he was a millionaire.

Needless to say, Governor Bredesen has a significant financial interest in HMOs. The Big Picture

HMOs are winning big from the existing political system. A recent study found HMO profits increased 52 percent last year alone, meaning an extra $2.3 billion was pilfered from American consumers. These are the same companies that since 2000 gave at least $13 million to President Bush and key Republicans in Congress, and who have seven former or current executives in the president’s “Pioneer” club (those who gave him $100,000 or more).

Those campaign contributions bought policies that favor their agenda or actually remove the government from the market entirely. HMOs: Getting Away with Murder?

Yep. And murder is legal now.

On June 22, 2004, the Supreme Court ruled that patients cannot sue HMOs for denying needed health care–even when improper denials have tragic consequences. This means that HMOs get off the hook from any liability and will no longer be deterred from making improper decisions that could severely harm patients.

LORI SMITH can be reached at: