Working as a long-term substitute teacher and with a baby on the way, 31-year-old Tom Kelley figured he was young enough and healthy enough to “coast a little” without coughing up scarce cash for health insurance for a while.

Then the Lewiston man noticed something unsettling, went to his doctor and learned that he really ought to have an ultrasound test that would likely help determine what was going on.

Kelley made some phone calls and learned the test would cost somewhere between $500 and $1,500.

Fortunately for him, this happened during a window of time that anyone could sign up for health insurance through the Affordable Care Act so, with days to spare, he picked up a $26-a-month policy.

It turned out to be a wise move. Diagnosed with cancer, Kelly has had surgery and a CAT scan already and is nearing the end of a round of chemotherapy that, with luck, will cure him completely.

Now with a three-week-old daughter, Ada, he has shelled out a total of $800 in addition to his monthly policy payments, a drop in the water compared to the many thousands of dollars in medical bills he’s racked up.

“I’m glad I got insurance and I don’t know what I would have done without it,” Kelley said Friday.

As he watches politicians in Washington wrangle with a proposed overhaul of the health care system — one that could make it harder for people with pre-existing conditions to get affordable care — Kelley said he’s worried about what could happen.

“It’s frustrating” he said. “They (those in Congress) all have insurance. Sometimes I think they really can’t relate to the average Mainer.”

A grassroots group of more than 400 health care professionals, Maine Providers Standing Up for Healthcare, is trying to hammer home the idea that Republican efforts to revamp President Barack Obama’s ACA threaten to leave tens of thousands of Mainers who now have insurance out in the cold.

A handful of doctors and nurses connected to the group that formed this spring said they’re worried the proposal will wind up forcing some rural Maine hospitals to close, crimp efforts to help opioid addicts, worsen an already troubling infant state mortality rate, make mental health care scarce, hurt seniors who rely on MaineCare and cause many people to put off medical care until their problems become more dangerous and expensive.

“People don’t realize how crucial Medicaid is,” said Julie L’Heureux, a nurse.

Vulnerable Mainers will be “at great risk” if backers are successful in pushing the Senate bill into law, Dr. Elizabeth Rothe, a family practitioner in Lewiston, said during a press conference Friday at Central Maine Medical Center.

One of her patients, for example, has a 10-year-old daughter on MaineCare with cystic fibrosis who requires $15,000 worth of prescription drugs every month. If the GOP allows insurers to have lifetime limits on how much can be spent, Rothe said, that girl could wind up “very sick” or perhaps die.

Jaime Johnson, a labor and delivery nurse in Norway, said her son Finley, 7, “has a pre-existing condition from birth” because of a congenital heart problem that’s already required him to undergo three major surgeries.

She said she’s concerned having a condition like Finley’s will land children in a high-risk pool that’s so expensive that parents will be forced to delay proper treatment or extend waiting periods between necessary surgeries.

“This may not kill my son immediately,” she said, “but it could in the end cost him years of life.”

A GOP-backed Senate bill unveiled this week, which aims to return more decision-making to the states, would make drastic changes to the ACA, including a major reduction in Medicaid spending and the elimination of most of the taxes that undergirded Obamacare’s financing. It would also potentially make it more difficult for people with pre-existing conditions and low incomes to get coverage.

Dr. Peter Shaw, a retired cardiologist, said the Senate proposal puts many ordinary people in danger “to pay off the plutocrats” whose taxes would be reduced under the proposed legislation.

Though retired, Dr. Charles Radis said the country’s health care system “is in drastic need of surgery.” He insisted that what’s required is to repair Obamacare, not repeal it.

But supporters of the overhaul argue that Obamacare is stumbling in many states, with too many rules and too little concern for the bottom line.

Maine’s two senators, Republican Susan Collins and Independent Angus King, are both skeptical about the Republican measure they may be asked vote on next week.

For Kelley, the important thing is that people can get affordable insurance.

When he first realized that he faced a lot of medical bills ahead, he said, he worried that it could be “extremely difficult.”

“Before I went bald, I had a few more gray hairs” from the fretting, he said.

His experience has made him appreciate the need for insurance in a way that he never could have while he was healthy.

That’s why it worries him that the GOP bill seems to make the problem worse for millions of people instead of making it better.

Chris Hansen, president of the American Cancer Society Cancer Action Network, said the Senate measure “could greatly harm millions of cancer patients, survivors and those at risk for the disease.”

He said a provision in the Senate bill allows states to waive essential health benefits, jeopardizing protections for those with pre-existing conditions.

“Without guaranteed standard benefits, insurance plans would not have to offer the kind of coverage cancer patients need, or could make that coverage prohibitively expensive,” Hansen said.

In addition, he said, “plans could also once again set annual or lifetime caps on care forcing individuals to choose between their life and life savings.”

Radis said Collins ought to show “true leadership” and break with her party on the proposal. Collins has denounced the House version of the bill, but is waiting for a Congressional Budget Office analysis of the Senate rewrite before making a decision on it.

Given that the Senate bill appears to be “just as poisonous to the health and wellness of Mainers as the bill that passed the House,” Dr. Sam Zager, a Portland family physician said, Collins “must vote against any bill that reduces meaningful coverage.”

“She seems to be coming around,” Zager said.

Margaret Craven, a former Democratic legislator from Lewiston, said Collins and her colleagues need “to stop undermining and ruining the ACA” and to listen to medical experts who are speaking out.

“I’m more inclined to trust what doctors say about health care than a politician,” Kelley said.

Kelley said if Collins sat at his dining room table, he would tell her “to do the right thing for her constituents.”

Copy the Story Link

Comments are not available on this story.