TMC PULSE

t m c » p u l s e | m a r c h 2 0 1 7 11 With the Affordable Care Act in the process of being repealed—or revised—Pulse offers two health care snapshots. Obamacare failed to help one patient, but the other found coverage for a pre-existing condition. qualify for discounts. Fuentes fell into that group. "I felt terrible," Fuentes said. "In a government office, how can you treat someone like that? … With the money I make, I know it is impossible, com- pletely impossible, to pay for an MRI or surgery or a dentist." Fuentes was approved for Medicare Part B, but was unable to afford the premiums based on her monthly income. "When I applied for Medicare, they wanted me to pay $140 per month and that only includes consul- tations—not prescriptions or surger- ies," she said. "I can't afford that. The rent on my apartment goes up every six months. How am I supposed to pay for things on top of $140? I can't." Because her late husband served in the Vietnam War, Fuentes receives a pension from the Veteran's Administration. Although it is not enough for her to afford the monthly Medicare premiums, she is exempt from the federal mandate to obtain insurance and did not owe a fee. But she was in a bind. No lon- ger able to attend regular medical appointments or see the doctors who had been treating her for the past decade, Fuentes scrambled to find health care. "To me it is very important to have a regular doctor," Fuentes said. "I feel like I am going blind because of my cataracts and glaucoma, and I need to have regular check-ups on my liver because I had Hepatitis C in the past. I was cured, but I still need to see a doctor." A friend recommended San José Clinic, a multidisciplinary Houston charity care clinic that serves the uninsured and underserved. "It was a blessing," Fuentes said. "It was my saving grace. I've been coming to San José since March 2016." At the clinic, Fuentes receives pri- mary care, dental care and specialty care. She is able to have lab work done, has access to a full pharmacy, and can be seen by optometrists. "This clinic gives me help, but because of the money I make I have to pay $35 for a visit and $10 for medi- cine in the pharmacy," Fuentes said. "But it is good. I am very happy with my doctor, Dr. Sherri Onyiego. … The only thing I don't like is that there are many things this clinic doesn't have. The eye doctor only comes once or twice a week, so the appointments are very late." Through volunteer support, community partnerships and generous donations, San José Clinic cares for many of the 150,000 Harris County res- idents who fall into the coverage gap. "To me, the most important thing in life is respect in human beings," Fuentes said. "I respect people when they respect me. And as a noble, peaceful person, I think that I deserve good health care." — By Britni N. Riley said. "Your heart is barely beating. There's no reason you should be alive." Up until that point, Trahan did not have a pre-existing condition. But after undergoing an emergency triple bypass to repair her heart, she would forever live with a compromised heart that requires medication and routine checkups. Prior to the Affordable Care Act, Trahan and other patients could legally be denied insurance and specific treatments at any moment because of pre-existing condi- tions. But through the marketplace exchange created by the ACA, Trahan purchased an affordable Blue Cross Blue Shield plan in 2015 that covered all of her medical needs and allowed her to see specialists to treat her pre-existing condition. Her condition improved and she went back to logging miles on the running track. "The only thing that saved me was that there was a non-pre-existing clause," Trahan, now 54, said. Although her monthly bill of nearly $700 was expensive, she was still able to get the health care she needed without the risk of being turned away. She considers herself a success story of the ACA, but she was only able to enjoy the compre- hensive health care plan for a year before a host of insurers pulled out of the Texas market in 2016. Those that remained upped their rates. Trahan was offered a more expensive HMO with Blue Cross Blue Shield that came with a monthly cost of nearly $1,000, a higher copay and far less coverage. She opted, instead, for a community health plan that still restricted her to local physicians and limited coverage. "Surviving what I survived— endless days of being intubated, not knowing if I was living or dying—all of that is so traumatic, certainly, but just being on the phone with the insurance company is traumatizing," Trahan With the money I make, I know it is impossible, completely impossible, to pay for an MRI or surgery or a dentist. said. "Being told 'No.' Being told, 'Your policy doesn't cover that.' Being told, 'That's pre-existing.' Being told, 'That's not an option for you.' Being told, 'You can't go to this hospital.' Being told, 'You can't see these specialists.' That is more traumatic for me than going through all of what I've been through." — By Shanley Chien Credit: Courtesy photo

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