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The Indianapolis Star

Thresholds of Pain: Assessing the Human Costs of Health Care Reform

Health and Human Rights Clinic Staff and Students

As lawyers and law students, we have watched with great interest the recent arguments before the U.S. Supreme Court debating the constitutionality of the Patient Protection and Affordable Care Act. We have also followed the discussions about the law that are a staple of the presidential election campaign. While the legal and financial implications of health-care reform dominate the headlines, the law's human impact has received far less attention. The reason we noticed this gap in the discussion is because every day we see the frustrated, suffering people whose lives will be impacted forever if the court strikes down the law, or a president and Congress repeal it.

For example, as faculty and students in the Health and Human Rights Clinic at Indiana University Robert H. McKinney School of Law, we represent a client who is legally blind and whose wife is disabled. On paper, they do not present as one of the 53 million Americans who are without health insurance, since they qualify for the Medicare and Medicaid government programs. But Indiana officials have erected a daunting barrier between them and any possible Medicaid support for the prescriptions they need to fill. Our state's regulations require this couple to first "spend down" their income to well below subsistence level by incurring several hundred dollars each month in medical bills. When they cannot do that, which is often, they do not get Medicaid help and must go without the care their doctor has prescribed. The consequences of not taking the medication they cannot afford include severe pain, swelling and complications that have on occasion forced them to be hospitalized.

Another couple we represent lived a middle class lifestyle until the husband, the family's primary income provider, became seriously ill. He lost the health insurance his family maintained through his employer, but must wait a couple of years before becoming eligible for Medicare. Under Indiana's rules, Medicaid provides no help to them. Although every spare dollar this couple has is spent paying for prescriptions and doctor visits, they can't keep up. In less than six months, their health has spiraled downward and the family has tumbled from the middle class into poverty and unmanageable debt.

Other clients face similar challenges. A man who has worked all his life but now receives Social Security disability benefits has been denied access to Indiana's Medicaid program. Another struggles with severe mental health problems certified by his psychiatrist, but has also been denied Medicaid help due to a highly questionable ruling that he does not meet Indiana's disability standard. State officials admit that more than 20,000 Hoosiers like this man have been found to be both disabled and poor by the Social Security Administration, yet are not being assisted by the Indiana-managed Medicaid program. Likely, their applications have been wrongly denied, or they have never been informed they are eligible for the help they need.


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There are two common denominators for all these clients, and for many more we represent as part of our partnership with a local community health center. First, these people all endure daily physical and psychological pain because they are unable to access the treatment their physicians have prescribed. Second, their misery will end if the Patient Protection and Affordable Care Act takes full effect as scheduled in January, 2014.

Under the law passed by Congress and signed by the president in 2010, every American whose income is below 133 percent of the federal poverty guideline will receive Medicaid. Americans with incomes slightly above that level will receive help obtaining health coverage. The new law will allow each of our clients we describe here to be eligible for Medicaid or other health coverage, without the crippling spend-down obligation or the onerous disability barrier erected by state officials.

Our clients were not invited to argue before the U.S. Supreme Court, and they are not present at the election year stump speeches. But we hope their daily struggles will be taken into account by the judges and politicians who will decide whether their suffering should come to an end.

Written by Lauren Hendrickson, Jamie Wilkins, Garrett Lawton, Laura Longstreet, Mauricio Benavides and Kayla Hanlon. They are students in the Health and Human Rights Clinic at Indiana University Robert H. McKinney School of Law in Indianapolis. Their co-author Fran Quigley is a clinical professor and director of the clinic.

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