Camille Landry is a writer, activist, and advocate for social justice who lives in Oklahoma City. This is the first in a series, “Neglected Oklahoma”, focused on Oklahomans who find themselves in a position where the basic necessities of life are hard to come by. The people whose stories we tell are real people and their stories are true. Names have been changed to protect their privacy.
If you live in Oklahoma and do not have medical insurance, your life is at risk. Lack of health insurance coverage and the inability to access both primary and higher-level medical care result in Oklahomans having a life expectancy that’s ten years shorter than the national average — on par with countries like Bangladesh and Iraq.
Oklahoma’s Medicaid insurance program, SoonerCare, provides coverage for low-income people who don’t have insurance, but adults have to be very ill in order to get coverage. The preventive medical care that helps people avoid serious illness and the diagnostic and screening services that identify problems early so that they can be treated before they become fatal, are out of the reach for 690,000 uninsured Oklahomans.
Karen O’Connor (not her real name) has been living without medical insurance for years. A serious illness while she was a student cost far more than her student health policy covered. She was left with a huge amount of debt and a pre-existing condition that would deny her the ability to purchase medical insurance.
Karen discovered a lump in her breast. She paid for an exam at Planned Parenthood. “You have cancer,” the practitioner told her. “You need a diagnostic mammogram and biopsy as soon as possible.” Karen simply did not have the thousands of dollars to pay for the required workup. (Note: Diagnostic mammograms are different from the screening exams that are provided free of charge for uninsured women.)
O’Connor applied for services through a program called Oklahoma Cares. It is a federally funded program administered by the State Department of Health that provides treatment for women with breast or cervical cancers. In order to receive services patients must first provide a mammogram, biopsy, an ultrasound and lab work that confirm and “stage” the disease. Karen could not get treatment for her cancer because she could not afford the required diagnostic workup.
Tia Yancey, Screening Coordinator for the Oklahoma Cancer Prevention and Control Program explained: “We do not have funding for diagnostic workups. Women have to pay for this out of pocket.” What happens to women who can’t come up with the money? “If they cannot pay for a diagnostic mammogram, they are not eligible for Oklahoma Cares services,” Yancey replied. “But Oklahoma women are resourceful. They find ways to do what they have to do. There are great healthcare providers who will work out payment plans or even give discounts to women without insurance. They just have to work it out.”
Finally Karen’s sister gave her the money for the diagnostic workup. Karen’s Oklahoma Cares application was approved. She underwent surgery followed by radiation treatment and chemotherapy at OU Hospital. Karen feels that the care she received was excellent but the limitations imposed by SoonerCare soon became apparent.
The chemo and radiation therapy caused awful nausea. Karen’s doctors prescribed 30 anti-nausea pills per month but SoonerCare recipients are eligible for only 8 pills per month. The cash price for a month’s is $246. Karen coped by borrowing and trading medications with members of her cancer support group. “Women nursing their mastectomy scars, trying not to throw up, trading nausea medicine and hugs with each other. Drug sharing is illegal but survival forces you to do things you never imagined you would do,” Karen said.
“Still, I’m lucky to have a well-funded disease,” she explained. “There’s money available for breast and cervical cancer treatment. I have a friend who contracted sarcoma. She had no medical insurance. She’s dead now. She wasn’t able to obtain the care she needed before the disease took her life.
“I worked things out. But what about the mom who has to choose between paying for a diagnostic mammogram in order to treat her cancer, or paying rent?”
Oklahoma Governor Mary Fallin has rejected the federal Medicaid expansion and health insurance exchanges that are part of the Affordable Care Act (“Obamacare”). These programs would provide health insurance to the state’s poorest residents and those who are not eligible for insurance due to pre-existing conditions like Karen’s. Oklahoma ranks sixth in the nation for residents without medical insurance. Uninsured rates range from 16 percent uninsured in some suburban areas to over 35 percent uninsured in rural areas of the state. If Oklahoma participates in the Affordable Care Act, the diagnostic workups required to receive life-saving medical treatment would be covered. People would not have to struggle to gain access to treatment.
How is Karen now? “I’m bald, I’m underweight but I’m alive. My docs say that I got treated just in time. If I hadn’t had a sister who could help, I’d be dead today.”
As for the women who aren’t as lucky? “I struggle to survive so that I can fight for the women who are not as fortunate as I am.”
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