This is Timmy.
He’s Six, and he lives with his parents and little sister
in a town between Washington, DC and Baltimore.
"He insisted on a trash themed 5th birthday party.
We decorated the whole house with recycling
He's into Angry Birds and monsters. He's drawing, he's writing. He's reading really well.
Timmy was born 7 weeks before his due date.
He was only 3 pounds 9 ounces.
He spent the first five months of his life in the NeoNatal Intensive Care Unit (or NICU).
Timmy has a rare genetic condition which requires him, among other things, to breath through
a tube in his throat and get most of his food through a tube in his abdomen.
Every room in Timmy’s home doubles as a medical supply stations for his daily medical needs.
But when you’re around him, it’s impossible to avoid Timmy’s amazing energy -- a 6 year
old bursting with vivid imagination, fixated on trucks, legos, and building binoculars
out of toilet paper rolls.
Timmy’s mom Michelle is showing us the medical bills from that NICU period.
Timmy’s been put under anesthesia 42 times, and between all the surgeries, medicine and
intensive care, the bills added up quickly Michelle:
“773,000 dollars by the time he was 2.5 months old.
We figure by 3, or 3.5 months we hit a million.”
Like many insurance plans, Timmy’s policy had a clause which caps how much the insurance
company will pay over his lifetime, cutting him off once he hits a certain dollar amount.
This is called a lifetime maximum.
Timmy’s lifetime maximum was one million dollars which he hit within just a few months
of being in the NICU.
According to his policy, after he hit a million dollars of care, he would be on his own.
But something happened just six days before Timmy was born that would dramatically affect
him and his parent’s lives.
"The patient protection and affordable care act goes into affect today"
"The new healthcare reform bill kicks in today."
"Health insurers can no longer impose lifetime limits
or discriminate against kids with preexisting conditions.
"The issue of lifetime limits: that is not going to be the law any more after tomorrow. "
The Affordable Care Act, or Obamacare, is best known for requiring insurers to cover
people with preexisting conditions and letting kids stay on their parents’ insurance til
age 26.
But one of the lesser-known parts of the law is that it banned insurers from putting a
cap on how much care they will pay for over a year or over a lifetime.
This came right in time for Timmy’s family.
“He would have lost his insurance at a million dollars which would have been
about half way thru the NICU stay.
I think we have $4000 dollars in savings right then which would have covered less than a
day of care in the NICU and I don’t know what would have happened.
See, we’ve only experienced life post Obamacare.
Before Obamacare, 60% of all bankruptcies in the US filings were tied to medical bills.
And it was the sickest patients with complicated blood infections and heart conditions who
were losing their insurance due to lifetime limits.
These are the patients who needed insurance the most.
When the family moved to Maryland they intentionally looked for a new insurance company
so that they could start from zero in case lifetime limits came back.
But even on this new plan they are getting close to a million dollars.
“As of this morning, it’s at 985,147.19.
That’s for the current insurance plan we are on now which started when he was 8 months old”
You're not eight yet. How old are you?
Six
I said 8 months. Do you know how old 8 months is? It's when you were a little baby. You couldn't even walk.
As of now Timmy and his parents are safe from a lifetime limit to his benefits.
But 20 miles away, congressional republicans and President Donald Trump are working on
dismantling the law that got rid of lifetime limits and saved Timmy’s health coverage
Republican replacement plans are split between staying with unlimited coverage and reimposing
the lifetime limit.
A late February draft of a Republican bill would keep the ban on lifetime limits — which
would be good news for Timmy.
But legislators say this is far from the final version, and likely to change significantly
But overall, the lifetime maximum issue is not a huge part of the debate, which mostly
focuses on things like “pre existing conditions.
And allowing folks to stay on their parent's insurance until the age of 26
But for Timmy’s parents who have a good employer provided health insurance plan, the
lifetime limit issue is the only thing that matters in this debate.
That's the only thing we think about. I mean more so than the preexisting thing.
Actually when you said the other day when we were talking you were like
"Oh the lifetime maximums dont get covered enough"
I was like "really?"
Bedtime in the Morrison home looks similar to bedtime in many homes with story books
and stuffed animals.
But things are more complicated.
Once a week, Timmy’s parents replace his throat tube.
This is one of many steps that is Timmy’s family goes through to keep him healthy.
But Timmy and his family have a routine to manage all of his care.
It consists of lot of medical supplies, equipment, help from nurses and doctor’s visits.
This routine has been enabled by the fact that the Morrisons don’t have to worry about
Timmy’s insurance going away once they hit a million dollars.
But this dependable routine in under threat as the healthcare debate may result in lifetime
limits coming back.
If that happens, Timmy could lose his insurance and this predictable if complicated routine
will be turned upside down.
You know we're not trying to say that it's not our responsibility to be paying for his care.
I mean that's our responsibility.
It's just that the reason you have insurance is that's so far above what's possible.
So I guess I don't want to come across as saying that I want someone to swoop in
and pay for everything. That's not what I'm saying.
But we want it to be manageable. Something that we have some hope of paying.