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Insurance, health care costs put lives in limbo

The stunning cost of health care played a key role in passage of the Affordable Care Act, whose insurance marketplaces are about to open for business. Here are more Tampa Bay area residents who found their lives and finances altered by a health crisis.

At 21, Alyssa Dudley couldn't worry too much about health insurance. She worked a minimum-wage job at an assisted living home and drove a 17-year-old Honda Accord. She'd just moved into her first apartment in St. Petersburg.

"I can remember her telling me, 'I'm good to just get the rent paid and my car paid,' " said her mother, Diana Dudley.

But in July, Alyssa was shot three times, twice in the head, by an ex-boyfriend who stormed into her apartment. She suffered a traumatic brain injury and can speak only a few words now. She is learning to walk again.

At Bayfront Health St. Petersburg, her mother and hospital social workers got her qualified for Medicaid, but it doesn't cover all the intensive therapy Diana has been told her daughter needs.

"That's frustrating for me, to know her care could be hindered based on her coverage," said Diana Douglas.

How might things have been different under the Affordable Care Act?

Coverage might be more generous in a private plan, but as a minimum-wage worker, it's possible that Alyssa's income could have been low enough that she could skip buying it without facing a penalty.

But she also could have received a subsidy under the new law that might have made insurance affordable.

Lately Diana has been reading about the recovery of Gabby Giffords, the Arizona congresswoman who also suffered a brain injury after a shooting. She takes comfort in Giffords' progress. But she feels the gulf between her daughter and the politician.

"You can guarantee her family didn't have to worry about if she'd get adequate treatment," said Dudley. "I don't even care how much it ends up costing. I just don't want that to be the deciding factor."

Marlys Lenz Cox, 58, had been insured by Blue Cross Blue Shield for years under an individual policy. But in early 2011 her premiums soared to $1,100 a month — mostly due to the hepatitis C she contracted as a child from a blood transfusion. Not a big issue to her, but enough to spike her rates.

She was a substitute high school teacher who made about $70 a day. Her alimony payments dropped to $12,000 a year after her ex-husband's construction industry job tanked.

She was among the first to benefit from the health care reform law, because she got more affordable coverage under a newly created plan for people with pre-existing conditions.

Cox dropped her costly private coverage to fulfill a mandatory period without insurance to qualify for the new plan. She knew she was taking her chances, and it ended up costing her. She found out she had breast cancer — and no way to pay for treatment.

"It's one thing to be told you have cancer," Cox said. "But then to have to call all these people and beg for your life? That's the low point."

She finally got on the Pre-Existing Condition Insurance Plan, which came with a $435 a month medical premium and a $6,500 deductible. But that plan will phase out next year.

Cox plans to shop on the online marketplaces for coverage. And does she need it.

Just three months ago, she was diagnosed with breast cancer. Again.

"Once again, I'm sitting here and trying to figure out how to float a debt," she said.

Denise Campbell, 59, lost her full-time job and benefits five years ago. She later ended up in intensive care at St. Petersburg General Hospital after her blood pressure skyrocketed and her feet were so swollen she couldn't walk.

The only work she can get is part-time retail — "Sixty years old? Who's going to hire you?" she said — and she pulls in only about $600 a month. She said she doesn't even know how much she owes the hospital but tries to send a little every month.

Campbell now goes to the St. Petersburg Free Clinic for care and medications for her diabetes and blood pressure. She'll need to get someone to help her with the online exchanges, which she had not heard about, but her chances of getting subsidized coverage don't look good.

Campbell is among the million Floridians who would have been eligible for Medicaid if the Legislature had accepted federal money to expand the program.

Cox may be in the strange-but-true territory known as the coverage gap: She makes too little income to qualify for subsidies. So she can't buy subsidized insurance and she can't get Medicaid. She figures she'll continue to get her care at the Free Clinic.

Otherwise, she said, "right now, there's nothing available to me, healthwise.''

Jodie Tillman, Times staff writer

Key dates

Oct. 1: The marketplaces open for business.

Jan. 1, 2014: Marketplace policies take effect.

March 31, 2014: First annual enrollment period ends.

Insurance, health care costs put lives in limbo 09/20/13 [Last modified: Saturday, September 21, 2013 10:41pm]

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