Life, Liberty and the pursuit of Happiness
Angelina Ortiz’s family income must not exceed $41,304 annually. If it does, she and her brother would no longer qualify for Colorado Childrens’ Health Plan Plus, and the family would be forced to pay $1200/month for Angelina’s lifesaving medications. Her condition? Asthma. The ubiquitous respiratory ailment that can range in severity from a minor tight-chested feeling after exercise, to full-blown attacks that block the airways and require a trip to the emergency room. I don’t know the details of Angelina’s medical history, but I would hazard a guess that if her medications cost $1200/month, she probably has a severe case of asthma. Assuming that no one in the Ortiz family smokes, and that Angelina does everything possible to limit her exposure to allergens and asthma triggers (I’m sure she does, given the severity of the situation), there is not much this family can do besides make sure that Angelina takes her meds, and make sure that their CHP+ policy stays in place.
What will she do once she is no longer considered a child? If she goes to college, how will she pay for her medication? Will she qualify for Medicaid? Maybe, while she is a student, but then what? Once she starts working, what will her options be? She can get a job that pays low enough wages to qualify for Medicaid, or she can take a job that offers group health insurance. Those are really the only realistic options. She can’t be self-employed. She can’t take a job – even if it’s her dream job – with a company that doesn’t offer group health insurance. With a $1200/month medication bill (and likely some ER visits in her history), she won’t be able to get individual health insurance in Colorado with most companies, and the rare few who might consider her would exclude her asthma. Cover Colorado, the state high-risk pool, is an option, but the price is still prohibitive. For a 21 year old female, the rate I found for a $1000 deductible policy is $260/month. The policy has an annual out-of-pocket of $2000, plus the premiums of $3120. That’s over $5000 that she would have to spend on medical expenses if she were to finish school and get a job that didn’t offer health insurance. For the average 21-year-old, that’s a major chunk of money.
Because of a medical condition that is probably out of her control (I say probably because I don’t know the specifics of her condition or lifestyle), Angelina doesn’t have access to the same American Dream that a healthier person does. Why in the world do her meds cost $1200/month? I wonder how much of that money goes towards big pharma marketing, and perks for doctors from the sales reps? How much goes to the FDA to get a new drug tested? I guess for Angelina, it really doesn’t matter. What matters for her is that she has to find a way to always qualify for either state-funded Colorado health insurance or an employer group plan. If a sales rep for a pharmaceutical company is taking some doctors out to a $1600 dinner tonight, I guess she won’t know about it anyway.
As a resident, I’m racking my brain as to what combination of asthma medicines alone could amount to 1200 a month, I even got some old books out to try to jog my memory. She must be on 2 or more new serious inhalers (advai e.g), but even then I don’t think those run more than 300 a month. And the basic asthma stuff like albuterol and ipratroprium don’t cost much. I’m skeptical about the costs thrown about in this story.
But life is not fair. Not every playing field in life is level and I’m not sure you should take from others to try to level them all.
Thanks for your thoughts Glyph. I must admit, I too was skeptical of the $1200/month drug cost described in the story I cited. I’m not in the medical profession, but I work with insurance underwriting issues every day, and asthma comes up quite often. I have never had a client with more than about $400/month in Rx expenses for asthma. But since the story said $1200, I had to go with that for this article.
When I thought more about it, I decided that it didn’t really matter if the drug expense was exact for this patient – because it could easily be the case for a number of other conditions. The point I was making is that when someone has a disease that is beyond their control (ie, not related to being obese or tobacco use, etc.) and requires very expensive care, that person automatically has fewer opportunities in life than those of us who are healthy. Something worth thinking about.
This article only shows the reality(life) of what would it takes to be when you have that kind of condition.
By the way, I just want to add something, if there is one in the family that is asthmatic and then one member in the family is into smoking, surely it can affect the condition of the asthmatic patient. The precautions and medications will be useless. Therefore, the member of the family should also be disciplined.
Jul 18th, 2007 at 11:58 am
[...] at Colorado health Insurance Insider writes about Angelina Ortiz, who has asthma and requires meds costing [...]