Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, August 7, 1994 TAG: 9408090001
SECTION: HORIZON PAGE: D1 EDITION: METRO
SOURCE:
DATELINE: LENGTH: Medium
Ages: James, 68; Geraldine, 62
Community: Southeast Roanoke
Occupation: James - retired truck driver; Geraldine - laid off from part-time job in the dietary department of Community Hospital
Insurance: James - Medicare, AARP
Geraldine - Teamsters, Medicaid
Problem: On his doctor's recommendation, James Simmons retired at age 63, because dust from the cement he was hauling was aggravating his asthma. When he retired, his insurance benefits through the Teamsters were drastically reduced. A short time later, his wife discovered she had leukemia. Then she lost her job at Community Hospital and, along with it, her own insurance policy.
James Simmons tried to find her another policy, but nobody would take her. He couldn't buy supplemental insurance for his wife as long as she was covered under the Teamsters policy, but it only paid a small part of the bills.
Geraldine Simmons quickly used up the 31 annual days of hospitalization covered by the Teamsters, running up thousands of dollars in bills that she and her husband could not pay. Because her disease weakened her immune system, she required a private room. The Teamsters covered only a semi-private rate, thus adding to their bills even more.
Recently Geraldine qualified for Medicaid because her disease made her disabled. But Medicaid requires them to spend $6,700 for the first six months of the year before it will kick in. Soon, that amount will rise to $10,000 for every six months, because she will begin receiving $471 per month in disability benefits.
Out of $1,213 in monthly income, the Simmonses already pay $250 per month in health care bills. They have two mortgages on their modest home and long ago depleted their savings. What's more, they may have already topped the $50,000 lifetime maximum on their insurance policy.
Geraldine won't become eligible for Medicare - which will cover almost all of her health care costs - until December 1995. By then, the Simmonses will be $38,000 in debt.
They long ago gave up their dream of traveling around the country together during their retirement. Now, they just hope they can keep a roof over their heads.
How some reform bills could affect them:
HOUSE LEADERSHIP BILL: She would be covered under Medicare Part C, a new program for people who earn less than 240 percent of the poverty level. There is no spend down for this program.
SENATE LEADERSHIP BILL: She would be eligible for subsidies to purchase private health insurance. She could not be excluded or charged a higher rate because of a pre-existing condition.
SINGLE PAYER BILL: Automatic coverage for all.
What they'd like to see:
"Universal coverage," James Simmons said. "Once you retire, you can't afford it. You just don't make that kind of money."
Talking about the bills he can't pay brings tears to his eyes and keeps him awake into the small hours of the morning.
"I lay up here at night, all these figures run through my head," he said.
by CNB