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life & feature12 the liberatorapril 26, 2010 13the liberator

april 26, 2010

Get Well Soon

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ATHLETES FACE INJURIES, INSURANCE ISSUES

NAME POSITION

7309 LAZY CREEK DR.

AUSTIN, TX 78724

TEL: (512) 414-5272 FAX: (512) 414-6050

Standing on the outer edge of the wrestling mat, LBJ senior Emiliano Guajardo waits for the second round of his match to begin. !e referee blows the whistle; Guajardo reaches around his opponent, grabs his leg and slams him down on the mat. And then, suddenly, Guajardo blacks out.

“In doing [the takedown move], my head happened to get caught behind [my opponent],” Guajardo said. “So his weight, my weight and the throwing force went down all at once on my head, and I went unconscious.”

According to Guajardo, this was the third time he lost con-sciousness during a wrestling match, and his parents felt that medical attention was necessary. A"er visiting #ve doctors and undergoing multiple tests, including an X-ray, an MRI and a CAT scan, Guajardo was diagnosed with minor brain trauma and memory loss. His father, Miguel Guajardo, said that both the physical and monetary cost of his son’s injury have caused him to rethink E. Guajardo’s continued involve-ment in wrestling.

“I understand the nature of sports, and I understand that contact is part of [wrestling],” M. Guajardo said. “However, you never anticipate this kind of injury. Our insurance was able to pick up a good amount, but there were still co-pays. Anything that is out of the normal family budget is a strain. We will do whatever we feel is necessary though.”

Compared to some, E. Guajardo was fortunate. LBJ ath-letic trainer Sue Torres said that many athletes sustain serious injuries but are unable to obtain treatment due to a lack of health insurance.

“[I had a student] whose parents both had full-time jobs, but were trying to buy a house, so they couldn’t a$ord any de-pendents [on their insurance],” Torres said. “He sprained his ankle really bad and couldn’t a$ord to get it checked out. He signed up for a free physical and got checked out by a doctor. !ey got it worked out luckily to be X-rayed for free.”

Torres said she has seen individuals resort to unusual means to treat their injuries as an alternative to receiving medical care.

“I had a friend who had a 19-year-old son without any [health care] coverage,” Torres said. “He was in extreme pain, which I thought was caused by a kidney stone. !ey couldn’t go to the hospital, so she asked me if I thought that he could just tough through [the pain]. I told her that he could, but it would hurt a lot. She ended up giving him medication that was meant for their dog to get through the pain. It is crazy that [people] have to do that in the U.S.”

!e recently passed health care law states that, for those who cannot a$ord health care, subsidies will be provided to ensure that bene#ts can still be received. Torres said this will provide more accessible health care to her students.

“It totally amazes me that in the U.S., arguably one of the richest nations in the world, we have one of the poorest health care systems,” Torres said. “We are on the right track with this proposal, de#nitely on the right track.”

E. Guajardo said that while he recognizes he is taking a risk by wrestling, he will not give up playing the sport he loves. He hopes that the recent litigation will help decrease the cost of health care so that he can continue to wrestle.

“I love wrestling, and that’s what I do,” E. Guajardo said. “I hope to continue wrestling in college, and I know that inju-ries are going to continue to pop up. !ank God I have health care to cover it.”

PRICEY CO-PAYMENTSBURDEN CANCER SURVIVOR

NAME POSITION

7309 LAZY CREEK DR.

AUSTIN, TX 78724

TEL: (512) 414-5272 FAX: (512) 414-6050

For months, LASA senior Lee McClenon had noticed a strange lump growing on her cheek. !inking it was simply an in%ammation of her salivary gland, she decided to visit a doc-tor. A"er running several tests, the doctor gave McClenon a diagnosis—she had cancer.

“It was completely a surprise when I found out,” McClenon said. “It’s not something you ever think is go-ing to happen to you. [!e tumor] was on my cheek, so [the doctors] originally thought it was something really basic. Fi-nally, we realized it was cancer.”

During her eighth grade year, McClenon was diagnosed with Rhabdomyosarcoma, a form of cancer most commonly found in children. McClenon’s family has health insurance, and they could a$ord the chemotherapy and radiation pro-cedures required for her recovery. However, McClenon said that her cancer treatments were extremely expensive.

“My dad once got an invoice from the clinic, which listed all the procedures and treatments I had ever had for cancer,” McClenon said. “Everything cost almost $1 million. !ere are so many prices that seem so in%ated. A blood test could cost $250, which only takes 10 minutes to do.”

Due to these expenses, many people who do not have in-surance cannot pay their hospital bills. However, McClenon said her family was lucky because both of her parents had health insurance through their employer, the University of Texas.

“Cancer a$ects everybody equally, no matter how much money you have,” McClenon said. “I saw lots of people in the clinic that were destitute, that didn’t have any health insur-ance. !ere aren’t many options for them. !ere are social workers that can help #nd charities to help pay for medical costs, but it’s still really hard.”

Even with dependable health care, McClenon’s mother, Lizanne McClenon, said that the family still experienced considerable #nancial struggles during her daughter’s cancer treatment.

“Initially the cost was not a concern,” Lizanne McClenon said. “We felt that we could realistically manage that. Yet, even with very good health care, the co-pays add up, and we had to reach out to my father-in-law for assistance. It was very di&cult.”

Lee McClenon had to make weekly visits to the Dell Chil-dren’s Medical Hospital for cancer treatment, and during one such visit, she met a woman whose 3-year-old son was #ght-ing a life-threatening disease.

“!ere are so many people struggling, trying to support their children while they’re in the hospital,” Lee McClenon said. “One single mom worked during the day, then had to take o$ from her job to see her child who was sick. !at’s time away from her job, but her kid is sick, and she can’t leave him alone.”

Lee McClenon said she supports the recent health care reforms, and thinks that the bill will help make health care more accessible to individuals without insurance. However, she said she remains uncertain that the bill will be as e$ective as hoped.

“I think that the e$ect of the bill will be a positive one,” Lee McClenon said. “However, I think that the political system is very convoluted, and the way the bill [turned out] is not the same as it was when it was #rst proposed. It [got] melted down into being something that isn’t the reform that every-one wanted and needed.”

COST OF CHRONIC ILLNESS TAKES TOLL ON FAMILY

NAME POSITION

7309 LAZY CREEK DR.

AUSTIN, TX 78724

TEL: (512) 414-5272 FAX: (512) 414-6050

During her freshman year, LASA senior Gabriela Martinez was diagnosed with von Willebrand syndrome, a disorder that pre-vents blood from properly clotting which causes excessive bleeding. While Martinez said she has learned to live with her illness, dealing with the current health care system

remains a struggle.“It’s always a battle,” Martinez said. “Anytime I want to get

anything done, I have to get a doctor. !e insurance people have to talk to everyone, and it’s this whole big deal. Every-thing has to be approved to the point that it’s just ridiculous.”

Martinez said that, even with health insurance, the %aws of the health care system cause many complications for her and her family.

“I’ve had moments where I have to get referrals to doctors and they refuse or try to refuse service and we have to go through a bunch of legalities,” Martinez said. “I had back sur-gery a couple years ago and we got the bill from the hospital, which was like a quarter of a million dollars. We were like, ‘Why are you sending us this bill? Doesn’t the insurance cover this?’ !ey didn’t want to cover the bill until we told them it was their fault.”

According to Martinez, these experiences happen fre-quently. Martinez said that the recently health care reform will provide a more patient-oriented system.

“With the new health care bill, it would cut out the prob-lems with getting referrals,” Martinez said. “With me, I have to go to my primary care provider to get referrals to di$er-ent doctors. !en they have their own insurance people who have to talk to my insurance people. !e new bill would cut out some of those steps and make it easier.”

Currently, 47 million Americans lack any form of health care, meaning that all their medical expenses must be paid out of pocket. A number of these uninsured Americans are full-time students, recently o$ of their parent’s coverage and without coverage of their own. Martinez said that universal health care will eliminate this problem for her.

“Once I’m o$ of my parent’s insurance, I’m one of the most probable people to be denied insurance because of all my health conditions,” Martinez said. “!ey just don’t want to deal with people like me. !e way [the bill] had been origi-nally presented would be really good because I wouldn’t ever be denied health care.”

!e new health care law also states that doctors can no longer deny coverage to patients based on their insurance company, an issue that has caused problems for Martinez in the past. She said such di&culties with the current health care system have convinced her that reform is necessary.

“!e biggest deal is when your insurance doesn’t cover everything it says it does,” Martinez said. “When people try to convince you to go to [another doctor], and you can’t, it’s really frustrating. !ere are so many problems with our cur-rent health care system, and something needs to happen to change that.”

Martinez’s mother, Holly Gordon, said she feels relieved a"er the passage of health care reform. She has been voting for a system like this since the Clinton administration and to #nally have this bill pass was overwhelming.

“With the new system there will be so many opportuni-ties for people like [my daughter],” Gordon said. “I feel very hopeful. I’m just so glad that we are #nally moving away from having the insurance companies running our lives.”

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On March 23, President Barack Obama signed the health care reform bill. This controversial new law expands coverage to roughly 32 million uninsured individuals. The Liberator examines the current and future state of the American health care system.

Insurance Exchange

!e government will set up 50 new “exchanges,” or insurance marketplaces, by 2014 where individuals without coverage and small businesses can shop for insurance by comparing prices and bene#ts.

Breaking Down the BillKey facts to know about health care reform

Abortion Regulation

New insurance exchanges can o$er plans that cover abortion, but individuals with those plans must pay their bills with two di$erent checks—one check for abortion coverage, and another check for all other insurance costs.

Paying for the Plans

Tax on high-cost health care plans (over $10,200 for individuals and $27,200 for families) starting in 2018. Medicare cuts will also provide billions of dollars, along with additional taxes.

Employer Mandate

Employers do not have to provide coverage, but beginning in 2014 #rms with 50 or more workers will be taxed $2,000 for each employee without insurance. To help mid-size businesses, the #rst 30 workers will be exempt from the tax.

-Philip HuangMedical Director of the Health

& Human Services Department

Preventive Medicine

“Evidence-based prevention means that we’re making sure that what you’re putting your money towards actu-ally works. When we look at populations, some treatments work, some don’t. !ere’s a lot of waste in the systems, so we help try to improve that by fo-cusing on prevention.”

Receiving medical check-ups before health problems arise is referred to as pre-ventive medicine. !e bill allocates $43 million to pre-ventive medicine residency training programs, which will conduct studies regard-ing the best and most cost -e$ective way to treat many medical conditions.

No Public Option!e bill does not create a new government-run insurance plan. Instead, it allows private #rms to provide national insurance policies to all Americans, regardless of which state they live in. One of the plans would operate on a nonpro#t basis.

“Fewer and fewer people are in-sured, and the people who are insured have less and less in-surance coverage. !at’s one of the major problems with health care—how do we get these peo-ple insured? !e problem is that the insurance companies can’t lower rates unless they have a larger pool of people who are insured.”

-David HilgersChair of the Health Law Section of the American Bar Association

Insurance Regulation

“Now, you’ll be able to stay on your parent’s policy until you’re 26. !at takes away a lot of the problems from the previous system. A lot of young people bet they will not get sick. Ninety-#ve percent of young people don’t get sick, so they think, ‘Why pay for insurance?’ But the top 2 percent who get sick don’t have insurance. If you don’t have the well people buy insurance, then no one can a$ord to pay for their health care costs.”

-David HilgersChair of the Health Law Section of the American Bar Association

Children can now remain on their parents’ insur-ance plans until they are 26 years old. Also, some-one with a pre-existing condition cannot be de-nied coverage. !e life-time and annual maxi-mum cost ceiling has been eliminated, ensuring that people will not be forced into bankruptcy due to medical costs.

Now, most Americans are required to have a minimum level of health insurance or pay a penalty (the greater of $695 or 2.5 percent of income). Households with incomes below the tax-#ling threshold are exempted from the mandate.

Individual Mandate

“!e problem is that while the idea of forcing every American to buy health care is very appealing, it’s uncon-stitutional. Because they’re going to mandate that ev-erybody buy a product. Where in the Constitution does it say that Congress can tell you that you have to buy a certain product?”

-Ronny RisingerLASA government teacher

Austin Regional Clinic (ARC)6835 Austin Center Blvd.

Austin, TX 78731(512) 346-6611

!e ARC opened its doors in June of 1980 as a practice of just three doc-tors. Today, the ARC’s 18 locations, which collectively employ around 250 doctors, care for the health of almost 15 percent of Central Texans. Under founder and CEO Norman Chenven, the clinic accepts patients covered by more than 40 private and government insurance plans.

“I wanted a large medical group that essentially provided one-stop shop-ping for medical care. I wanted to provide access for people so that they could get in when they needed to be seen. Providing good health care requires a lot of coordination between specialties.”—Norman Chenven

Manos de Christo Dental Clinic1201 E. Cesar Chavez

Austin, TX 78702(512) 477-2319

For the past 22 years, the Manos de Christo Dental Clinic has remained the only reduced-fee, full-service dental clinic for the uninsured in the Austin area. !e clinic was created when a Presbyterian pastor realized his congre-gation was requesting jars of baby food for themselves a"er pulling their own teeth out. Now, Executive Director Julie Ballesteros supervises the clinic, which provided care for more than 3,700 people in 2009, including proce-dures such as #llings, crowns, X-rays and sealants.

“If you don’t take care of your teeth all of the time, you will eventually have problems, which is what happens with the majority of our clients. !ey ig-nore their pain—they make sure that their children are getting taken care of, but they ignore themselves and don’t come to us until they are in pain, which, by then, there’s all kinds of problems. We want you to keep your teeth and your beautiful smile.”—Julie Ballesteros

!e Family Wellness Center2901 N I.H. 35

Austin, TX 78722(512) 232-3900

Operated by the University of Texas at Austin School of Nursing, the Family Wellness Center provides primary health care services to uninsured, low-in-come Austinites. Since its establishment in April 2007, the center has cared for around 2,000 patients. Lisa Doggett, as director and physician for the clinic, treats families, trains nursing students and oversees general operations.

“At our clinic, we are very tuned in to making sure that people get the recom-mended preventative testing, that they follow screening guidelines for things like breast cancer and get regular mammograms, colon cancer screening, cer-vical cancer screening, and we check blood pressure at all of our visits. We talk to people about other things they can do to improve their lifestyle and stay healthy, like diet and exercise, and mental health as well.”—Lisa Doggett

Health and Human Services Department (HHSD)15 Waller Street

Austin, TX 78702(512) 972-5000

In his position as Medical Director of the Public Health Services branch of the HHSD, Philip Huang supervises many of the local public health prevention programs, including immunization, sexually transmitted disease and tuberculosis clinics. !ese programs work to suppress the spread of infectious disease and support those who can-not pay for insurance by providing access to a$ordable health care.

“Public health deals with the populations of people rather than the in-dividuals. We look at all the data, see where there are health problems, see which areas have them and which ones we’re dealing with, then we use that information to try to identify problems that can address and prevent those health problems.”—Philip Huang

Subsidies for Individuals

Beginning in 2014, the government will provide tax credits to middle- and low-income individuals to help them purchase insurance through the exchange marketplaces. !e tax rates will be calculated on a sliding scale, with health plans covering up to a maximum of 94 percent of the cost of bene#ts.

“A lot of these people that are uninsured, they’re not poor. !ey’re driving a nice car. !ey have a car payment that’s $400 a month. You know where that $400 a month needs to go? Insurance. People are making choices, lifestyle choices. [!ey have decided,] ‘I will forgo insur-ance to drive a nice car, have a cell phone plan that costs $100 a month’—that’s choice. And why should we, the public, subsidize somebody’s choice?”

-Ronny RisingerLASA government teacher

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infographics compiled by Abigail Cain, Alana Hauser, Katie Pastor & Rebecca Pittel

Healthy Measures: Medical service options in the Austin community