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ACA provides vital protection for San Antonio woman with diabetes

May 1, 2017

By JULIE MINDA

"'Type 1 diabetes is such an unforgiving disease. You may not feel it now, but you will later,'" Ursula Garza Hernandez says her physician warned her several years ago.

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Ursula Garza Hernandez

At the time, she was uninsured and stretching her insulin by skipping doses or taking smaller shots than necessary to control blood sugar spikes.

She risked her life by limiting her insulin over a three-year period and now, at 38, Hernandez suffers from severe neuropathy and retinopathy — complications of her uncontrolled juvenile diabetes. Her physician told her the neuropathy and retinopathy were caused by her lack of insulin when she was cutting her doses.

Hernandez says the neuropathy causes "constant pain, all day and at times at night — that varies from a light burn to a stabbing feeling" in her extremities. But the divorced mother of a 12-year-old daughter says that as the primary provider for her child, "I have to have a huge smile, trying to hide the pain."

Hernandez says she was insured for most of her life, first under her mother's health insurance, and then under her employer's plan when she worked as a young adult. She was covered under her husband's workplace plan until he lost his job around 2012. That's when Hernandez found out her diabetes made any non-group coverage unaffordable. "And that began the nightmare of being an uninsured person with a preexisting condition," Hernandez says.

Hernandez is insulin-resistant, so she must take more insulin than most diabetics — about 12 vials a month. Each vial retails for about $600, she says. Friends who worked in doctors' offices would occasionally "smuggle" insulin to supplement her supply.

After a divorce, Hernandez moved with her daughter to San Antonio and took a job as an adjunct professor at Brown Mackie College. She began pursuing a doctorate in organizational leadership at the University of the Incarnate Word in San Antonio.

Even after the Affordable Care Act-enabled marketplace opened for enrollment in 2013, Hernandez remained uninsured because, she says, she assumed she would not qualify for subsidized insurance.

By 2015 her health had deteriorated to the point where the pain from a walk to class at Incarnate Word, left her in tears. She laid her head on her desk and wept silently. A concerned classmate asked what was wrong; Hernandez explained her situation. Fellow student Andrea Guajardo overheard. She is regional director of community health programs for CHRISTUS Santa Rosa Health System in San Antonio and co-chairs EnrollSA, a San Antonio campaign to enroll people in Affordable Care Act-enabled health insurance.

At Guajardo's urging, Hernandez called EnrollSA. She qualified for a subsidized plan on healthcare.gov and signed up during the call. She pays an $81 monthly premium after a $120 subsidy is applied. She has a drug benefit with minimal co-pays and a $2,000 annual deductible, she says. Her daughter is covered through the Children's Health Insurance Program.

Since enrolling, in addition to getting all the insulin she requires, she's started taking prescription medication to control high blood pressure and treat high cholesterol. She's undergone eye surgeries to improve vision damaged by retinopathy. She was able to afford all of the related out-of-pocket costs, she says.

In early April, in their second attempt this year to pass a bill to repeal and replace the ACA, Republican House leadership and President Donald Trump's administration renewed discussions centered around changes that would, among other drastic coverage rollbacks, remove the mandate that insurance companies cover people with preexisting conditions at rates that apply to the whole community.

Says Hernandez: "It's so disturbing that the president is trying to totally gut something that is not perfect, but that could be really good," with the right changes.

She adds, "This is not what the American dream is: You work hard and support yourself, but if you get sick, and can't afford your medicine, too bad, you die."

 

Copyright © 2017 by the Catholic Health Association of the United States
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