Some say patients can't wait until 2014

High-risk illnesses drain accounts, postpone care
Dr. Angela Overstreet-Wright examines Janie Padgett, who is a part-time substitute teacher, at Belle Terrace Health and Wellness Center.

Sometimes, as she sleeps, Janie Padgett will stop breathing for up to 20 seconds and wake in the morning tired from constant sleep disruptions. While a sleep study diagnosed her problem, she can't afford the machine that would provide constant air pressure to treat her sleep apnea. She is also battling arthritis and depression.


"These things affect me, and I'm really not getting all of the care that I need to get," she said.

Padgett, a part-time substitute teacher for the Richmond County Board of Education, is like many uninsured patients who must hunt among assistance programs to get their health care needs met but often end up in a gap. Others, such as Tamara Rajah, are happy insurance companies won't be able to use her lupus to deny her coverage again but thinks it should happen sooner than 2014.

For Homer Clark, the legislation could start closing the "doughnut hole" in his Medicare Part D coverage that sucked $4,000 last year out of his family's bank account.

AS PRESIDENT OBAMA was signing health care reform legislation in Washington, D.C., on Tuesday, Padgett was sitting on an exam table at Belle Terrace Health and Wellness Center talking with Dr. Angela Overstreet-Wright, who is helping her file a disability claim for her arthritis.

"This is the shoulder where you're having a problem?" Overstreet-Wright asked, kneading Padgett's left shoulder.

"This is the shoulder that's giving me fits," she said.

About half of Overstreet-Wright's patients are uninsured, and for many of them it is the little things they can't afford. Many are diabetics, for instance, but can't do the necessary testing to know whether their glucose level is under control because they lack glucometers and testing supplies, she said.

"Somebody will have Diabetes Day and give you a glucometer and they won't give you strips (for testing)," Overstreet-Wright said. "Everybody gives you a glucometer; some people have seven, 10 glucometers; they can't get the strips."

Or rescue inhalers for asthmatics. A mandated change in the propellant used in inhalers meant companies stopped making the generic versions, Overstreet-Wright said. Walmart sells a $9 inhaler. but others retail for at least $50. Or it is a visit to a specialist, which the center is trying to wrangle for a patient with suspected bone cancer.

"How long do you want to wait when you know you have something bad on an X ray?" she asked.

THE LEGISLATION sets up a high-risk pool for coverage within 90 days of enactment, and Overstreet-Wright suspects her patients likely would go into that coverage pool. Within six months, it will also prohibit denying children coverage because of pre-existing conditions -- but the prohibition for adults won't kick in until 2014. That's a long time to Rajah, the chief executive officer of Skip to My Lupus support group in Augusta, who has seen it used against her clients.

"Every single one, including myself and my daughter," she said. The disease, which can attack joints and organ systems, can be unpredictable and attack suddenly.

"I believe in God; I'm a faith-based person, but four years from now, I don't know what's going to happen to the majority of my clients, myself or my child," Rajah said. "That's too much time. That's not making it a priority."

The coverage gap in Medicare Part D coverage also will be closed slowly over time, starting with a $250 rebate this year.

"That will be $250 that I don't have," said Clark, of Louisville. He used to teach building trade skills to prisoners for the Georgia Department of Corrections. He injured his back during a prison riot and became disabled. He has endured four back surgeries and requires a lot of medication.

When he started on Part D, "I went into the doughnut hole real quick," he said. "I was paying everything." Last year, "we had just about used up too much of what we had set aside," said Clark, who estimated the figure at about $4,000. And this year isn't looking much better: He already has spent $2,400 and is about $1,300 from the doughnut hole already.

For Overstreet-Wright, it is all about getting a system in place that finally covers people.

"Our patients have worked; they have contributed to our way of life; and there's no reason why one person should not get the health care that they need," she said.