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Patricia Cox reviews medical bills Sept. 19 at her home. Photo by Mike May/Staff.

Bellevue woman grateful for some aspects of Obamacare

After 26 years working her way up to academic adviser at Bellevue University, Patricia Cox began to feel greater pressure for speed in her work, made more difficult by growing vision and motor control problems due to her lifelong struggle with cerebral palsy.

She eventually faced a fearsome and stressful inevitability – retiring earlier than planned to live on a limited income and losing her employer’s health insurance.

Compelled to resign in April 2016, she applied for Social Security disability benefits, which she received last October. But Cox, 55, is ineligible for Medicaid, and applying for Medicare for her health insurance needs required a 24-month waiting period.

When she was able to purchase coverage through the health insurance exchange established by the federal Affordable Care Act (ACA), often called Obamacare after former-President Barack Obama, "… it was a godsend," she said.

In some ways, the ACA is "… very much in line with church teaching, especially with Pope Francis’ emphasis on mercy. I always think of the parable of the Good Samaritan," said Cox, a member of St. Mary Parish in Bellevue.

"Some people pass by, they don’t want to get involved or they don’t understand, but there’s someone in the road that needs help," she said. "They need to be picked up and cared for, and to some extent, that’s me, but for a lot of people with even more chronic conditions than mine, the parable fits so well."

Cerebral palsy often is caused by brain damage before or during a baby’s birth.

Delivered two months prematurely after her mother’s difficult pregnancy, Cox suffers from unsteadiness, vision impairment and problems with fine motor skills. She can easily fall, as she did in 2015, breaking her right leg.

But she does not exhibit the severe mobility issues, curled hands and arms, and speech problems of some cerebral palsy sufferers.

For Cox, the greatest benefit of the ACA has been her ability to get affordable coverage given her pre-existing condition, as well as the lack of annual caps or lifetime limits for coverage.

Despite its benefits, the ACA has been a contentious issue since its inception in March 2010 – on both fiscal and moral grounds – prompting numerous Republican efforts to repeal it.

The U.S. Conference of Catholic Bishops has spoken out concerning its flaws, including the mandate that plans include coverage for contraception and abortifacients. They urged senators in a July 20 letter not to repeal the ACA "… without a concurrent replacement plan that protects poor and vulnerable people, including immigrants, safeguards the unborn, and supports conscience rights."

And, in a Sept. 21 letter, the bishops praised the most recent unsuccessful attempt – the Graham-Cassidy bill – for its exclusion of coverage for abortions and restriction on funding for abortion providers, but cautioned against per capita caps on Medicaid.

"Our nation must not attempt to address its fiscal concerns by placing an insufferable health care burden on the backs of the poor," the bishops said.

As the debate continues, Cox and others with pre-existing conditions and limited incomes hope for an affordable solution.

Certainly she is not alone. As many as one in two Americans has some kind of illness or condition that insurance companies considered a pre-existing condition before Obamacare. For Americans between the ages of 55 and 64, the percentage is even higher: about 86 percent.

Thus far, Republican plans to repeal and replace the ACA have placed more control in the hands of the states, allowing them to waive coverage requirements, Cox said.

"Once the essential benefits can be waived, you no longer know what’s in your plan," she said. "It would be so frightening to try to choose a plan that covers what you need. The government needs to find a better solution so that everyone can be affordably covered with good plans."

Currently, Cox spends half of her limited monthly income on rent for a one-bedroom apartment. She also qualifies for a significant subsidy under the ACA, so her monthly insurance premium is less than $54.

She has a good Aetna insurance plan with a $775 deductible and $3 charge for prescriptions.

"When I went to the urgent care, I had a $5 deductible, and so it’s very affordable for me right now," she said.

"But it’s been tough," Cox said. "It’s a scary place to be. Looking from the bottom of society up is not easy."

And the uncertainty of the ACA’s future due to congressional attempts to repeal it doesn’t help. "This was something for me to hold onto, but now I’m out on a ledge," she said. "I don’t know what’s going to happen."

Although she will be eligible for Medicare beginning next October, Cox’s choices also will be at least temporarily limited to a single provider – Medica Health – when Aetna leaves the exchange next year in Nebraska.

Cox believes the Catholic Church should speak out still more forcefully and use its moral authority to help guide the debate. "The church is such an important voice and health care is such an important issue," she said.

"My Catholic faith has taught me to see the most vulnerable in our society and to care," Cox said. "When I had a job, I never thought I would be among the vulnerable, but now I am. I still feel very fortunate, though. God has been very good to me. Many others don’t have even what I have."

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