Smile Politely

A first person look at the Illinois workers health insurance mess

A lot of other people have much at stake in the state government’s recent decisions on health insurance for their employees. One of the most outspoken has been Cynthia Voelkl, University of Illinois employee and author of the local blog The Sandwich Life. Cynthia currently has Health Alliance health insurance HMO plan and has dealt with Carle physicians as much as anyone in Champaign-Urbana. She testified at a hearing in favor of Health Alliance and has been interviewed several times by the local media on the issue.

SP: Can you give an ever-so-brief description of your family’s current health situation? What kind of a relationship have you developed with your current physicians?
CV: We are a family of four and have had Carle doctors and insurance through Health Alliance since 1994, when we moved back to town after living in Chicago for a number of years. At that time I was working at Record Service and kudos to them for offering insurance to their full-time employees despite being a business in the struggling music retail industry. Of course the catch was that the cost of it ― given that they were a small business ― was great enough that many of the full-time employees couldn’t even afford it. In 2001, my husband and I were both working there and at that point, with a two-year-old, we were paying the family rate. It was becoming unmanageable to handle the insurance cost, though, so we made a plan. We would both look for jobs with cheaper insurance and whoever got the one that made sense for the family would take it and the other one would stay home with the kids and work part time ― because we had another child on the way. I specifically explored employment at the University because of the insurance benefits. I was at the point where I wasn’t thinking ‘explore your dream’ … I was thinking ‘gotta care for these little ones.’ Despite the fact that we really focused on health insurance costs because of our children, it is actually my husband that was saved by our coverage.

2004 was not a particularly good year for us and in the spring of that year, Record Service, where my husband was still working, closed and weeks later my husband was diagnosed with prostate cancer. The boys were only two and four and it was hard to process the reality of this happening to us. As much as you rationally know you’ll have these challenges in life, it’s still a shock when it happens. I remember my two-year-old wearing his favorite firefighter hat to the Cancer Center and trying to keep him occupied while we waited for his father. Seems unreal now. So my husband had a radical prostatectomy, radiation, and then two years of hormone therapy. He initially worked with a urologist for the detection and diagnosis and then after that with two oncologists, a medical oncologist and a radiation oncologist. Two years after he completed that round of treatment the cancer returned. Since that time it has metastasized into his bones and he will now continue treatment for the rest of his life. He’s doing well and living a perfectly normal life thanks to his treatment.

Around 2007, my father began to really decline into the haze of Alzheimer’s so we worked with various Carle doctors for his treatment. In 2008, my sister, who lived in South Carolina, was diagnosed with bile duct cancer. My father died shortly after. We eventually moved my sister into our home. We worked with one of my husband’s oncologists and then with Carle hospice. She died early in 2009. After that, my mother began to decline rapidly and was in and out of the hospital and nursing homes for the next year, dying in 2010. Again, we worked with Carle doctors throughout all of this.

So yes, we do have bonds with our Carle doctors. There’s no question that when you know someone for years and they see you at your most vulnerable … that you feel a bond. And overall, despite frustrations here and there, have felt we have had very good care.

I don’t believe those bonds entitle me to keep Health Alliance if the state can change to comparable coverage at a lower cost, however. I would HATE to change doctors … with some doctors it would not be terrible ― but those with whom we have worked with closely and know well ― it would indeed be hard. But hell … we’ve been through harder than that … and despite this debacle I do count us fortunate to have health insurance. There are many who would be thrilled to have even inadequate coverage. I am fully aware of that.

SP: Do you believe Blue Cross was handed a sweetheart deal because of connections with state workers at DHS? Political donations?
CV: Honestly … I just can’t fathom the whole thing. I know the procurement process has been reviewed and declared fair. It seems to me that they compared apples and oranges thinking they were both apples. But hell, these should be intelligent people. I just have no idea … It doesn’t make sense to me. Something seems funny…

SP: What are your thoughts on Carle’s ownership of Health Alliance in all of this? Are you concerned there is a conflict of interest there? Do you think Carle is playing hardball in working with Blue Cross/Blue Shield so its patients will advocate in favor of Health Alliance?
CV: Yeah, most likely. Carle wants to make money ― that’s their job. Just as I’m looking at this from my personal point of view, they’re looking at it from their personal point of view. I don’t begrudge them that. Certainly Carle and BCBS aren’t good friends and haven’t been in the past. My sister had BCBS from Clemson University, where she taught, and when she moved here it cost her a lot of money to die because Carle wasn’t a BCBS preferred provider.

I really don’t have complaints with BCBS or Health Alliance in this debacle. They are both businesses trying to make money ― hopefully allowing people to get excellent care ― but basically to make money. That is their angle. The State of Illinois on the other hand ― their angle should be to provide adequate, comparable, and currently available coverage for all state employees. That has not happened.

I’m also not adverse to switching to a PPO. I actually like the flexibility. One concern with having a patient with a long term disease is wondering how far your HMO will go with treatment… When standard treatment fails, do they just tell you the switch is turned off? A PPO would provide more flexibility if you want to go outside your HMO/Tier One coverage.

If the State had said, ‘Hey, we’re switching you to a PPO; for HMO benefits use Tier One,’ and Tier One had an adequate network for this county in place at the time of the switch … well, I would have hated to switch doctors, but switch I would have. It’s that, and that is key however…

SP: Do you think there is a difference between these state contracts and what a smaller employer would do when they change their health plans?
CV: Yes, I think there is a huge difference. If a smaller employer changed health plans the plan would change for all employees covered. This change basically offered workers in some counties continued HMO coverage and not in other counties. Telling us that the market will adjust and there will be adequate HMO coverage through Tier One is saying that it’s not there currently.  

SP: How do you feel about current health care coverage in the U.S. in general? In Illinois?
CV: Health care coverage in the U.S. breaks my heart. My husband and I scramble and worry about bills, but we are managing. We are so lucky. I’ve been at the point where I didn’t have insurance … sometimes through youthful arrogance (me? get seriously ill?) and sometimes because you can only juggle money so much. There is no question that we need universal health care. It is what would be right … absolutely right. How anyone other than those in the insurance field can think that the current system is better than a program similar to Medicaid is beyond me.

SP: Any other general thoughts about any of this
CV: I was really heartened to see the bipartisan support in the State legislature. I really felt that legislators like Naomi Jakobsson, Mike Frerichs, and Chapin Rose really went to bat for us. I testified at a hearing in Springfield and was honored to do so. We brought our boys with us because we wanted them to see how important it is to make your voice heard. I feel that was kind of a gift we got out of this whole thing. I’m normally not one to speak in public or write letters to the paper so all I could think through all of this is how pleased my parents would have been. Silver linings I guess…

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