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Health Care Reform: Up Close and Personal

Three AFSCME members make the case for quality affordable coverage for all.

Three AFSCME members make the case for quality affordable coverage for all.

In his September address to Congress, Pres. Barack Obama pointed out that there are now more than 30 million American citizens who cannot get health care coverage and that 14,000 Americans lose their coverage every day. He also said that even among the insured, more and more Americans “have never had less security and stability than they do today.”

By Jon Melegrito

Candice Cheney is one of them. A psychiatric supervisor at the Central Louisiana State Hospital and president of Local 3074 (Council 17), she is among scores of men, women and children who suffer because insurance companies deny payment for care.

Struggling with a life-threatening disease, Candice fights for health care reform so that people like her will get insurance that fits their needs. As Pres. Gerald W. McEntee explains it: “AFSCME has committed unprecedented resources and energy to this effort. Premiums have grown four times faster than wages, and health care costs have become an obstacle in almost all of our contract negotiations. As a result, we often have to give up wage increases in order to maintain decent health care benefits.”

As Washington considers the President’s proposals to overhaul the health care system, the stories of Candice and two other AFSCME members add a human dimension to the fight for reform.

I Just Want to Get Well

Candice Cheney

CANDICE CHENEY | A state worker in a psychiatric hospital, Candice desperately needs treatment for a life-threatening disease but was denied payment by her insurers. She is fighting for health care reform so that others with a similar condition will benefit from health plans that meet a patient’s needs. Photo: Kenneth Wilks 

 

As a high school student, Candice wanted to play softball and volleyball. Her mind was set but not her body. “I couldn’t even watch the games because I’d run out of breath just trying to climb up the bleachers,” she recalls.

Candice, 47, suffers with chronic, genetic obesity. She’s tried every medical remedy with no success. Four years ago, her primary care physician, Dr. Richard J. Holcombe of the Freedman Clinic, diagnosed Candice as “functionally disabled.” In 2007, he drafted a letter recommending gastric bypass surgery to reverse what he called “life-threatening morbid obesity.” The procedure, he wrote to the insurance company, “will be ultimately life-saving.”

As a state worker, Candice has been covered for 26 years by Group Benefits, her employer’s health insurance plan. According to the company website, Group Benefits is “a leader in improving and preserving quality of life.” But when Candice sought pre-approval for the $40,000 procedure, she was denied. A representative told Candice the surgery was not a medical necessity but a “cosmetic” procedure.

“What good is health care if I can’t get the treatment I need to be healthier and have a better quality of life?” Candice wonders with dismay. “But I can’t fight them. They’re too powerful.”

The effect of obesity on her health has been devastating. Linked to her condition are other medical risks: heart disease, a sleep disorder, high blood pressure, osteoarthritis and depression. “I’m doing everything right, controlling my diet and doing regular exercises,” Candice explains. “But I can’t take weight-reduction pills because of my heart or do aerobics because of my lungs and legs. I’ve hit a wall.”

Despite bouts of depression and a weakening heart, Candice remains strong in her resolve not only to save her own life but “to fight especially for those who feel there’s nothing else for them.”

When AFSCME’s “Highway to Health Care” bus stopped at Southern University in Baton Rouge this summer, Candice mobilized her members and gathered signatures from hundreds of college students who support health care reform. She has gone on local radio stations, spoken in churches and community meetings and made hundreds of phone calls to get others involved in the campaign. “I’m not going to stop until we win,” she declares.

Candice knows that President Obama’s initiatives may not have a personal and immediate impact on her. “But if somebody else with my condition will benefit, my own efforts to change the system would not have been in vain,” she says.

Candice’s brother suffers the same life-threatening disease. But his health plan covered weight-reduction surgery. “I hope that with these changes, patients with the same illness will be treated fairly and uniformly,” Candice says.

AFSCME supports the U.S. House of Representative’s reform bill which calls for “comparative effectiveness research” of various treatments to figure out what works best for each patient. If this research determines, for instance, that a certain procedure is more appropriate, it will force private insurers to adopt the same best practices. And it would fix inequities in treatment like those experienced by Candice and her brother.

“If we achieve all this through reform, then I would consider it a personal victory,” Candice says.

Candice knows gastric bypass surgery will significantly improve her life expectancy. “All I want is to have a better chance of enjoying good health and a longer life,” she says.

A Saving Grace

Amy Day

AMY DAY | “Sometimes I feel like my life’s hanging on a thread,” says Amy, who cares full-time for her 10-year-old son who has cerebral palsy. A single parent and chairperson of the UDW/AFSCME chapter in El Dorado County, she led the bargaining team that fought for medical benefits. “Our union contract is my only saving grace,” she adds. Photo: Jean Dixon

my Day and Rosemarie Nguyen are among California’s 300,000 home care workers. They provide personal care assistance to 400,000 elderly and disabled clients who prefer to have greater control of their lives by living in their own homes—or sometimes, the homes of the providers themselves. Care-giving is often difficult and stressful and involves heavy lifting and other back-breaking chores.

Many home care workers are low income. They have no health insurance and lack access to preventive care. As a result, they’re often in poor health and have chronic medical conditions that go untreated.

But Amy and Rosemarie consider themselves fortunate. They receive medical benefits from a county-paid health insurance plan negotiated into their contracts by their union—United Domestic Workers (UDW/AFSCME). Here are their stories:

Hanging on a Thread

Ten years ago, Amy Day was diagnosed with placenta previa, a complication of pregnancy caused by the placenta being located in the wrong position. She wasn’t told of her condition during an ultrasound test. Instead of being prescribed the bed rest that is favored in such cases, she continued working. She even took a second job as a cake decorator to supplement her meager income.

Complications caused the early delivery of two-pound-nine-ounce Brendan, who was born with brain injuries that developed into cerebral palsy during infancy. For three years, Brendan underwent nine brain surgeries and numerous painful procedures. Now 10 years old and a fifth grader at a local elementary school, Brendan still requires a feeding tube and a shunt.

A single mother, Amy chose to be Brendan’s full-time caregiver. “I went through hell fighting for his life,” she says. “He needs me for his long-term care.” Amy has two other children: Lacey, 11, and Zander, 4. “I do my best to keep them all healthy,” she says. “But my own health is always on the back burner. Sometimes I feel like my life’s hanging on a thread. Our union contract is my only saving grace.”

Although Brendan’s medical needs are covered by Supplemental Security Income and Medi-Cal, California’s Medicaid program for low-income families, Amy feels a lot more secure now knowing that her family’s primary care, prescription drugs, hospitalization, dental and vision benefits are all included in a medical package negotiated into their union contract. As chairperson of the UDW/AFSCME El Dorado County chapter, Amy led the bargaining team that fought for the benefits for more than four years.

“My experience has convinced me that we need health care reform,” Amy adds. “If I lose my job and need to buy insurance on my own, I’d like the assurance that I won’t be denied because of a pre-existing condition.” Such conditions include sleep apnea, diabetes and heart disease. “It’s very important to me that we fight for the causes that make our lives better. I’m doing it for my children and all the disabled in our community.”

More Choices

Rosemarie Nguyen

ROSEMARIE NGUYEN | “I joined UDW/AFSCME because of the health insurance,” says Rosemarie who had heart surgery the same year her husband died from kidney failure. Rosemarie is worried that if she loses her job, it would be tough for her to get health coverage. A health plan may automatically deny Rosemarie’s application because of her pre-existing conditions, such as diabetes and heart disease. Photo: J.T. MacMillan

Rosemarie Nguyen is clear: “I joined UDW/AFSCME because of the health insurance.”

When it comes to health care, she has traveled a rough road. In 2003, the same year her ill husband died, she had a heart attack and needed surgery. At the time, her family was covered by Medi-Cal. It offered some protection and helped her get enough care to get back on track.

Today, as she performs home care services for an 87-year-old cancer patient, Rosemarie herself suffers with a heart ailment,
 high blood pressure, diabetes, thyroid problems, asthma and glaucoma.

“That’s why I joined UDW/AFSCME,” she says. “I’m glad we have medical benefits through our union.”

But the truth is that her health care is a balancing act. UDW/AFSCME workers get health care insurance only if they work more than 80 hours a month. If her patient’s needs change, requiring less of Rosemarie’s time, she would have no coverage at all.

Like Amy, Rosemarie is concerned that if she loses her job, her pre-existing conditions—such as diabetes and a heart ailment—would make it tough for her to get new coverage.

“I am praying that President Obama’s proposals will pass,” Rosemarie says. “For the work we do, we need security and stability in our lives.”

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