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Husband's Employer-Based Insurance Ended. Joann Left Uninsured, Untreated, Nearly Blind in One Eye

Theresa BrownGold's painting "Joann" for her art project, Art As Social Inquiry.

(Interview 2/2011. Oil on linen, 40 ins. x 30 ins.)

Update 2021

Joann died in 2021 from congestive heart failure. She was 75. Her daughter believes she was misdiagnosed with asthma for two years. At one point Joann swelled up and was rushed to the hospital. Joann's daughter said, "Doctors took 20 lbs. of fluid out of her. Her liver was failing. And they found no signs of asthma."

Joann lived for 2 more years. She was on oxygen 24/7. She was in full possession of all her faculties. "Her eyes got worse, "her daughter said. "She had a hard time getting up. She had a hard time with everything. She refused to go to the hospital. My mom said, 'I want to be with your father.' " Joann's husband was 55 years old when he died.

Joann's insurance covered all her medical expenses. She enrolled in traditional Medicare when she turned 65. I asked her daughter if Joann was a dual-eligible, meaning that Joann's small income also qualified her for Medicaid coverage. Medicaid would pay for whatever out-of-pocket expenses Medicare did not cover. Joann's daughter could not confirm this for me. But she added that her mom also participated in the PACE program. From the PACE website:

"PACE covers all Medicare and Medicaid-covered care and services, and other services that the PACE team of health care professionals decides are necessary to improve and maintain your health."

Joann's portrait has made the rounds. I've taken her to rallies in Harrisburg. Outside Representative Michael Fitzpatrick's office. In front of the US Capitol in 2012. She was the subject of a WHYY video feature about Art As Social Inquiry. Her portrait was a finalist for a 2011 Independent Lens art competition.

Joann lost her health insurance when her husband got injured at work. His new medical coverage came through his employer's workman's compensation insurance.

Joann's health insurance was linked to her husband's employer-based health plan not workman's comp. Without her husband enrolled in his employer's group plan, Joann had no

policy on which to be listed as a dependent.

Joann said she always opted to pay extra through husband's work for the better insurance. She said, "I don't expect charity. I've always paid my own way."

A natural next step would be for Joann to buy a single policy from an insurer. Joann's predicament happened before healthcare reform opened up new ways for uninsured individuals to get health insurance.

I do not know if Joann tried to buy a single policy from an insurance company. Perhaps not. The COBRA law required her husband's employer to offer Joann the same policy she had with her husband. But Joann and her husband had to pay the premium in full to continue her health insurance. They could not afford it. Joann may have given up trying to get a single policy when she saw how expensive the COBRA premium was.

By standing with the portraits, I wanted to put the healthcare stories in the public eye. I wanted to raise awareness and stir up change. I wanted Joann and the uninsured millions like her to get the healthcare they needed. Uninsured Joann lost 85% of the vision in one eye. She could not afford to pay for surgery in time to save her eyesight.


Theresa BrownGold's painting "Joann" for her art project, Art As Social Inquiry.
A study. Oil on canvas, 24 ins. x 20 ins.

(from a 2011 interview)

Grandmother, Widow, Homemaker, age 65, Uninsured for 18 years until eligible for Medicare in 2011

In 1993, Joann thought she had the health insurance coverage she'd always had. As her husband's spouse, she qualified for coverage as a dependent on his employer plan. Joann's husband worked as a refrigeration engineer.

Joann went to the hospital for tests and discovered her her health insurance coverage had been canceled.

Joann's husband was injured at work. His employer's workman's compensation insurance started paying his medical bills after his injury.

Joann's husband was now getting his medical coverage from his employer's workman's comp policy. If we connect the dots...Joann finds out she has no insurance when she shows up at the hospital...her husband's employer dropped her husband from his group employer plan since he is covered by workman's comp...the husband no longer has private insurance...therefore, Joann no longer has insurance as a dependent on her husbands policy before he moved to workman's comp. (In 2021, I'm piecing together what happened to Joann's insurance. At the time of the interview in 2011, I still didn't know enough to know what questions to ask. Whatever the exact cause, one thing was certain. Joann's husband went on workman's compensation, and Joann found herself uninsured.)

The employer did not tell Joann's husband that his wife would lose her health insurance through the company's group health plan after he received workman's comp. Joann found out the hard way when she showed up for tests and her insurance card was no longer valid.

The employer offered Joann insurance through COBRA. The COBRA law required her husband's employer to offer Joann a chance to continue her health benefits for a limited time. But the employer is not required to pay for them. Joann would have had to pay the premium in full, $580/month ($1,084.77 in 2021 dollars).

In 1999 and still uninsured, Joann could no longer endure the pain. She went to the emergency room for gall bladder surgery. Without health insurance Joann was responsible for the entire bill. She paid the hospital $25/month -- more than she could afford at the time.

(I do not know if Joann received any charity care, free or discounted care for those who qualify at nonprofit hospitals. Was the hospital a nonprofit? I do not know. Even some nonprofits, however, were loath to tell patients they qualified for discounted or free care.

Joann's husband died in 2000. Joann remained uninsured until 2011 when she turned 65 and became eligible for Medicare, a federal health insurance program.

In March 2005, Joann went to Wal-Mart for glasses. The optician saw something behind her left eye. He referred her to an ophthalmologist. Joann had cataracts in both eyes, the left being much worse than the right. Joann paid cash for the consultation But she had neither insurance nor enough cash to pay for further treatment.

By September 2005, Joann could not see out of her left eye. Her doctor found a detached retina requiring immediate surgery. Joann was instructed to come back when she had health insurance to pay for the surgery. Joann's adult daughter tried frantically and unsuccessfully to put her mother on her own policy.

Joann told a large city eye hospital known for pioneering technology that she could scrap together the money for the doctor, but could she pay the $2,500 hospital bill on a payment plan? ($3,923.61 in 2021 dollars) Joann's best friend would also co-sign. The hospital said it "was burned too many times." Joann would need to pay in full before the doctors would do the procedure.

Joann's best friend tried to get her on Pennsylvania's now defunct adultBasic, a Pennsylvania state health insurance program for low-income Pennsylvanians who do not qualify for Medicaid. The program accepted Joann but put her on waiting list. There were over 42,000 people insured through the adultBasic program and another almost 500,000 on the waiting list.

Joann earned $158 too much to qualify for Medicaid. But being on the adultBasic waiting list meant she could buy the adultBasic insurance at full price while waiting to get into the program.

Joann borrowed the money to pay the $316/month adultBasic premium ($498.17 in 2021 dollars) She got her surgery in August 2006 almost a year after her detached retina diagnosis. Joann dropped the adultBasic insurance after the surgery. She could not afford to pay the premiums.

Joann lost 80-85% of the sight in her left eye. Doctors told her, "If you would have come earlier, we could have saved the whole eye."

Joann gave up reading. "The bad eye burns and I don't want to stress out the good eye." She fears she could go blind; has no depth perception; feels a burden to daughter; is easily thrown off-balance; can't pour a liquid in a container; is afraid of falling, and therefore is reluctant to go out with family and friends. Joann felt she was treated as "half-dead" when she desperately needed healthcare and could not get it without health insurance.

Joann said she always opted to pay extra through husband's work for the better insurance. She said, "I don't expect charity. I've always paid my own way."


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