March 18, 1951-March 7, 2009
Friday, June 8, 2012
My Brother's Keeper-part II: Billy Koehler's Story
This is the forth story in a 5-part series called "Faces from the Frontline". Join "Health on the Horizon" on Facebook and Twitter.
Georgeanne Koehler still holds a scrapbook that she made for her brother, Billy, as a birthday present. She was planning on giving it to him at a family birthday celebration on March 18, 2009. Billy never made it to his 58th birthday. Instead, the scrapbook was displayed at his funeral.
Last week, “Health on the Horizon” presented the story of Billy Koehler, an electronics technician from Pittsburgh that died at the age of 57 because he was uninsured and could not afford to replace a battery in his AICD (defibrillator). The device was necessary to live with his diagnosed heart condition of Torsades de pointes. He passed away on March 7, 2009, when he was found slumped over the steering wheel of his car.
Billy’s heart condition began in April of 1990 when he experienced a heart attack while in triage at the emergency room. At the time, he had insurance, received a AICD and managed his condition with relative ease. Over the next 10-13 years he was able to receive the needed battery replacement procedure necessary to maintain an AICD. This procedure was done roughly every 5 years and usually cost the insurance company about $6000. However, when Billy was uninsured, he was told to be prepared to pay between $60,000-$100,000, a reality that the uninsured back the burden of cost.
A 2008 study published in the journal Health Affairs found this to be a common practice. In their study they found that 49% of the uninsured treated in a California hospital in 2005 paid a higher price for services than those with private insurance, medicaid and medicare. In Billy’s case, his sister, Georgeanne, tried to negotiate paying the price charged to insurance companies for the procedure, but was denied. Instead, the hospital sent him a Christmas bouquet.
Billy’s story is also telling of another reality in the challenges of the uninsured as they try to access healthcare. In Billy’s story, when he was admitted to the hospital he was told by a resident that he would not get the “same care as those with insurance”. According to the Institutes of Medicine, the uninsured do receive fewer services when they are hospitalized. Furthermore, the uninsured have a 25% greater chance of dying than those with health insurance. As a result, according to a Harvard University study, 45,000 people die prematurely each year in the US do to lack of access to healthcare.
Billy is more than just an example of the uninsured that have fallen through the cracks in the system. He is a human testament to the statistical realities that have been featured over the course of the past 10 months on this blog. When Billy’s employer suddenly closed shop in the Spring of 2003, he was not offered a COBRA plan because the employer had (unbeknownst to the employees) cancelled the health insurance plans for all the employees months prior. While unethical, this is not an illegal practice.
In the United States, a vast majority of people rely on employers for access to healthcare- a reality that is beginning to take its toll on both the employer and employee/patient. As we saw earlier this year in the story of Shontell, employer provided care has drastically declined in the past decade due to exponentially increasing costs. In 2014, the PPACA calls states to set up state based exchanges/marketplaces (for individuals and small businesses) where people like Billy will be able to go when they no longer are able to get health insurance through their employer.
Finally, following the loss of his job, Billy did try to apply for private insurance, but was denied due to his “pre-existing condition”, a situation common among 32% of the general public
and drastically increases with age. In January 2014, insurance companies can no longer deny coverage to people with a preexisting condition as part of basic patient protections that are written into the law.
As Georganne Koehler turns the pages of the scrapbook that was never gifted to her brother for his 58th birthday, she sometimes wonders if Billy was a martyr in the fight for healthcare. Georgeanne’s work as a healthcare advocate has taken her around the state of Pennsylvania and her message has hit the ears of thousands of people. Above all however, Georgeanne’s mission is to ensure that Billy’s death will not be in vain.
In 2010, The Pennsylvania Health Access Network, a consumer health advocacy group, named Georgeanne the “Pennsylvania Health Advocate of the year”. Each year, PHAN awards someone in the state with the award that is now named after Georgeanne. On April 29, 2012, I was honored to be given the “2012 Georgeanne Koehler Pennsylvania Health Activist of the Year” award for "Health on the Horizon".