It’s a sign of how convoluted our health care system is when it’s hard to tell the horror stories from the success stories.
When I got an email from Joe Hatley of Conover, a small town about 45 miles northwest of Charlotte, I thought I was reading the former.
Hatley said he’d enjoyed my reports on Luis Lang, an uninsured Fort Mill man who needs costly surgery to save his sight. Like Lang, Hatley found himself out of work, sick and uninsured. Both men’s stories highlight gaps in the system in North and South Carolina.
But Hatley, who is recovering from a potentially deadly gastrointestinal infection, emphasizes the happy ending to his tale: His hospitalization was covered, even though he waited almost two weeks to see a doctor until his insurance kicked in.
“I didn’t want to see what little bit of income I had be spent on a doctor or hospital,” said Hatley, a registered Republican who says he’s getting more liberal as he ages. “This insurance saved my life.”
Hatley, 62, says he worked 44 years for a small neighborhood grocery store, starting as a teenager stocking shelves. Most of that time, the store paid for his health insurance, he said. As 2013 drew to a close, with insurance costs rising and the ACA exchange set to debut, his employer dropped his coverage and Hatley bought a subsidized plan.
But a month after his new policy began, in January 2014, the store cut Hatley’s hours. He quit – and without income, no longer qualified for federal help paying for his Blue Cross policy. He says he didn’t want to apply for Medicaid, but it probably wouldn’t have mattered. Because North Carolina declined federal money to expand the program to able-bodied adults whose income falls below the poverty line, Hatley likely would have fallen into the Medicaid gap, just as Lang does in South Carolina.
People whose income falls within 100 and 400 percent of the federal poverty level – that’s $11,760 to $46,680 for one person – are eligible for federal aid. The smaller the income the more they get, including help with out-of-pocket costs at the low end. But in 21 GOP-led states that have refused to expand Medicaid, dropping below 100 percent means getting no help at all, except for low-cost clinics and charity care. For many workers whose income fluctuates, medical coverage becomes hard to count on.
When he turned 62 in September, Hatley says, he started getting Social Security. That income let him buy another subsidized policy in November, to take effect Jan. 1.
On Dec. 15, Hatley got a sinus infection. He paid for his doctor visit and antibiotics himself.
On Dec. 20 he got diarrhea, which quickly worsened. His doctor urged him to come in for tests, suspecting Hatley’s problems came from Clostridium difficile, known as “C. diff.” It’s a potentially fatal bacterial infection that often emerges during or after antibiotic treatment.
Hatley says he explained his insurance situation and made an appointment for Jan. 2.
I don’t like to imagine going 13 days with that kind of gastric distress, but Hatley says he did it. “I was miserable,” he says. He showed up for his appointment and was hospitalized with severe C. diff. After six days he went home, but then returned for another week in the hospital.
Hatley has a $500 deductible. He’s not sure how much his insurance is paying but he estimates it’s around $20,000.
“I am still weak and seeing the doctors on a regular basis,” he said this week, but “I will always be thankful for the ACA and President Obama.”
As I wrote after Lang’s case got national attention, there’s something wrong with a health care system where people rely on crowd-funding to pay for medical care. And no matter how grateful Hatley is, we surely have no right to brag about a system where a desperately sick person has to choose between prompt care and devastating debt.
We can blame or bless either party. We can lament patients’ personal choices and medical providers’ high fees. But surely we can do better.