[Congressional Record Volume 140, Number 36 (Friday, March 25, 1994)]
[House]
[Page H]
From the Congressional Record Online through the Government Printing Office [www.gpo.gov]


[Congressional Record: March 25, 1994]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]

 
                    FACES OF THE HEALTH CARE CRISIS

 Mr. RIEGLE. Mr. President, I rise today in my continuing 
effort to put real faces on the health care crisis confronting our 
Nation. I would like to share the story of Tracy, from the Detroit 
metro area in Michigan. Tracy has asked that I not use her full name, 
because she fears discrimination from employers if her health condition 
is known. Tracy is uninsured, does not have a doctor, and needs surgery 
that will cost between $4,000 and $5,000 and then continuing medical 
care.
  Tracy is a single 39-year-old woman with no children. In August 1992, 
she was diagnosed with endometriosis which is a condition where the 
cells lining the uterus grow uncontrollably outside the uterus. These 
tumors can grow anywhere in the abdominal cavity and can result in 
severe pain for some women. There is no known cause or cure for this 
condition, but there are treatments that can slow the growth of these 
cells.
  Tracy suffers from a great deal of pain as a result of this illness. 
The nonsurgical treatments have failed to ease her pain or control the 
progression of the disease.
  Tracy has had various part-time and temporary administrative jobs 
over the last few years, which often did not provide any health 
insurance coverage. The last time she had employer-sponsored insurance 
was in 1989. She held a full-time position with a small trucking firm 
that transported paint. The combination of exhaust and paint fumes, 
however, caused her bronchitis to flare up. After 8 months on this job 
Tracy became so incapacitated that she had to leave. It was one of the 
few jobs in her 20 years of employment that offered any health 
insurance coverage at all. Since she left that company she has worked 
in various positions, without any employer provided health insurance.
  In June 1992, Tracy purchased a major medical insurance policy with a 
monthly premium of $125. Her family was concerned that Tracy's job did 
not provide coverage and helped her purchase this individual policy. 
When Tracy bought her insurance she was not ill. She had never been 
diagnosed as having endometriosis, nor had she ever received any 
treatments for the condition. Tracy started feeling pelvic pain in late 
July and sought medical advice. In August she had outpatient 
laparoscopy surgery to diagnose and treat her condition. Her doctor 
determined that she had endometriosis.
  The surgery and medical care cost over $4,000. Although Tracy's 
insurance company paid a portion of the bills, it denied her claim for 
hospital services because they classified her endometriosis as a pre-
existing condition. Tracy has been fighting the denial from the 
insurance company for 2 years. The $3,000 hospital bill for the surgery 
remains unpaid. The company has said that it paid a portion of her 
medical charges in error.
  The health insurance company stated that Tracy has not proven that 
her endometriosis did not exist before the policy went into 
effect. They place the burden on Tracy to prove that she was not ill. 
Tracy did not renew her health insurance policy, because it seemed 
ridiculous to pay a premium when the company refused all her claims 
related to her condition.

  Because of her chronic bronchitis and the endometriosis, Tracy is not 
able to work full time and relies on her family for support and to pay 
her medical costs. For the 20 months since the endometriosis was 
diagnosed, Tracy has been paying for all of her treatments and doctor 
visits out-of-pocket. One 6-month hormone treatment cost over $2,500 
for the prescription and the specialist office visits, all of which 
Tracy had to ask her parents to pay.
  As if this financial burden were not enough, Tracy has also faced 
discrimination and barriers to care because of her uninsured status. 
Her doctor, who had been treating her since 1992, has informed her that 
his office is no longer seeing uninsured, self-pay patients. Tracy is 
not delinquent in paying her doctor bills. In fact, her bills are 
completely paid. But because the medical practices does not want to 
take the risk that an uninsured patient will not pay his or her bill, 
the physician will no longer see her as a patient. Under the current 
health system, Tracy will continue to be faced with this sort of 
discrimination--whether it comes from a provider or from an insurance 
company in the form of a preexisting condition exclusion.
  Tracy is trying to work part time, but the pain of her endometriosis 
is sometimes overwhelming. The nonsurgical treatments have failed to 
help her and she is facing the prospect of another surgical procedure, 
again at a cost of $4,000 to $5,000. But she has no doctor and no 
insurance. She is desperate to find a new doctor who can control her 
pain, but she does not want to face the prospect of being turned down 
as a patient because of her uninsured status.
  At this point she is considering buying a health insurance policy 
that she knows would not cover her treatment costs for this disease, 
but would at least enable her to say she has insurance and therefore 
gain access to a physician.
  Mr. President, we must enact comprehensive health care reform to 
provide a guarantee of coverage for all Americans so that people like 
Tracy receive the care they need without discrimination. Today, when 
people like Tracy are forced to leave the work force because of an 
illness they give up the health coverage they need. When you lose your 
job it means you lose your health insurance. If you do not work for the 
right kind of company, or work part time, you often do not have 
coverage at all. We need reform so that Americans have the security of 
ongoing coverage no matter what their employment status or their 
ability to pay.
  Without health care reform, individuals, like Tracy, who suffer from 
chronic conditions, find it impossible to buy insurance because of the 
pre-existing condition clauses. And health insurance companies have 
incentives to deny claims for medically necessary care, because it is 
cheaper to encourage sick people to give up their coverage.
  Mr. President, we must enact health reform to ensure that individuals 
like Tracy get timely preventive care and medical treatment and have 
access to the providers they need. I will continue to work with my 
colleagues in the Senate and with the White House to make sure that 
health care reform becomes a reality this year.

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