ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Monday, October 14, 1996 TAG: 9610140099
SECTION: VIRGINIA PAGE: A-1 EDITION: METRO
SOURCE: SANDRA BROWN KELLY STAFF WRITER
AFTER YEARS OF PAYING TO INSURE themselves and employees, a Roanoke couple find once again that a policy doesn't cover all cardiac problems - this time, a transplant to replace her failing heart.
Twice in three years, Louise Francisco has become a symbol of the debate on national health care reform.
The Roanoke woman was still operating New Style Hair Salon in Roanoke County when in 1993 she wrote Hillary Rodham Clinton about how hard it was for small-business owners to afford health insurance.
Last week, Louise mailed another letter to Clinton asking for help in getting a heart transplant ``so I can be healthy again.''
Louise, 60, found out two weeks ago that she needs a new heart. The muscles in her heart have thickened so much that they're impeding the flow of blood through it. But before she can get on the United Network for Organ Sharing waiting list, she has to raise a $15,000 down payment.
The transplant surgery and follow-up medication could cost another $170,000.
Louise and her husband, Harold, pay $456 a month for basic health insurance with Optimum Choice, but their policy doesn't cover heart transplants.
``You would think that the government would have done something by now to prevent this sort of thing from happening,'' Louise wrote to Clinton.
Louise said she isn't upset at the Clintons. She ``appreciates'' what they've done for health reform.
She isn't mad at her insurance company, either.
Optimum Choice is ``excellent,'' she said. ``It's taken care of everything.
``I just wish we'd known that a transplant wasn't an operation.''
The Franciscos' policy states that it covers ``all operations,'' but certain transplants are excluded. For another $14 a month, the couple could have purchased special transplant coverage, the company said, but Harold Francisco doesn't recall the insurance agent mentioning the option.
Maybe their experience will encourage others to find out what their policies actually cover, Louise said.
* * *
Harold and Louise Francisco have had to jump from one insurance policy to another to maintain coverage through the years, she explained during a national telephone conference Clinton held in August 1994 with small-business owners.
One policy was canceled, Louise said, because the insurer got a claim for Harold's treatment for chest pains. Doctors determined the pain was coming from a hernia, not a heart attack, but that didn't influence the insurance company.
Next, the couple bought a group policy for themselves and two employees of their Harold's Flowers by Louise shop. But as annual rates increased, the employees dropped out of the group, causing the premium for Harold and Louise to rise to $854 a month.
The Franciscos couldn't afford that, so they bought a limited-coverage policy through the American Association of Retired Persons for $270 a month.
Then they had an opportunity to get the Optimum Choice insurance through Harold's shop.
Louise had no idea she suffered from hypertrophic cardiomyopathy when she and Harold bought the Optimum Choice policy. She might never have found out if not for customers who noticed she was breathing hard while she styled their hair.
The customers kept prodding her, so Louise went to see her family doctor. He didn't find anything wrong.
But soon, she began to have trouble climbing stairs.
``When I brought the laundry up from the basement, I'd have to stop at the top step because I couldn't go no farther,'' she said.
She also had a bad cough.
Then one day, she wasn't able to do more than a quarter-mile of the two miles she regularly walked on the Ridgewood Baptist Church track across from her house.
She went to see another doctor, who immediately suspected heart problems.
Hypertrophic cardiomyopathy is a genetic disorder in which defective cells in the heart muscle cause the walls of the heart to swell. In severe cases like Louise's, the swollen walls obstruct the flow of blood into and out of the heart.
Louise's mother died of a heart attack at age 71. Two of Louise's brothers had fatal heart attacks when they were in their 50s.
The condition is considered rare, however.
Until the heart problem was diagnosed, Louise had almost no health problems. She's never had major surgery.
``I've still got everything I come with,'' she said. ``That's why this is such a shock.''
Even now, her doctor have told her she has good, clear arteries.
* * *
Doctors at Lewis-Gale Medical Center in Salem and at the University of Virginia heart transplant center told Louise last November that she had to quit working around the hair sprays and dyes used in the beauty shop.
She finally closed the business at the end of the year and in January applied for Social Security disability payments.
Louise waited six months for her first check, and she did not get back payments. She receives $431 a month. The couple's only other income is from Harold's shop, which he runs almost single-handedly.
They sold their home several years ago because Harold no longer felt like doing the yardwork. He takes insulin pills daily for diabetes.
The money from the sale of the house was invested in the flower shop so that Harold could quit a job that required long hours of driving delivering coffins in a several-state area.
The Franciscos rent their brick ranch home on Deaner Drive from a daughter for $471 a month. Family members do the yardwork, and since Louise's illness, they also help with the housework.
In the spring, a pacemaker was installed in Louise's heart to make it work more efficiently. Even so, her heart's function has dropped from 40 percent of normal to 20 percent.
Louise must stay hooked to an oxygen tank at night and most of the day, except for a few hours when she's having a really good day.
Sometimes she doesn't have enough energy to prepare breakfast, she said. Days when she can fix breakfast, she often has to go back to bed afterward and rest for hours.
``I get shaky,'' she said.
She takes 10 medications to ease her nausea and shortness of breath.
Harold and Louise view themselves as typical of hard-working Americans who raised their families and pay their bills. They don't have extra money, but they don't qualify for government assistance.
``I do not think that I fall in the indigent category, but I am close,'' Louise wrote in her letter to Clinton.
``After working 31 years, you would think that a small business owner would not have to worry about getting the money together for a heart transplant,'' she wrote. ``If I had sat at home and collected welfare benefits, I would not have this problem because I would have been considered indigent, and I would be on my way to having a new heart.''
That's not a certainty, but Louise has been asked to come to the Medicaid office today for an interview as a follow-up to her application for assistance.
Louise's family and friends aren't waiting for official help; they're already rallying to raise the money she needs.
Sunday, her church, Mason's Cove Church of the Brethren, took up a love offering for Louise.
Also, Roanoke County Sheriff Gerald Holt said his department expects to set up a transplant fund for Louise. Her daughter and son-in-law, Vicky and Steve Huff, are Roanoke County deputies.
The Franciscos have two other daughters, Linda Shutters of Roanoke County and Joan Berry of Ventura, Calif. The entire family is trying to figure out how to pool finances to get Louise a new heart.
``They think I get down, but I don't,'' she said. ``I think God takes care of us. He has to give the doctors the knowledge to do their jobs.''
LENGTH: Long : 145 lines ILLUSTRATION: PHOTO: ERIC BRADY/Staff. Louise and Harold Francisco, with theby CNBhelp of family and their church congregation, are trying to raise
the $15,000 down payment for her to receive a heart transplant.
color.