从绝望到希望
十年前，达林·理查森被诊断出患有肺气肿. Fighting an incurable lung disease was a familiar battle for him. 他的女儿, 克拉丽莎, 当时她14岁，和母亲住在新泽西, had severe chronic bronchitis and had struggled with it ever since she was born.
虽然被州界隔开, 这两个人有一个共同的纽带, 有相似且经常使人衰弱的症状. Constant wheezing and coughing were considered normal for the two. 每天的生活都是一场挣扎. 做家务让人筋疲力尽. 呼吸困难. 而是接下来七年的每一天, Richardson would get up and go to his job as a manager for IHOP, 照顾员工，在厨房做饭. 2007年一切都停止了.
Richardson’s health had deteriorated so badly that his doctor told him he would die without a double–lung transplant. 直到他能接受手术, 他需要带着氧气罐走来走去, IHOP厨房的主要火灾隐患. Unable to perform his daily duties, Richardson was soon out of a job. 2008年，当他的家在一场大火中丧生时，这种冲击不断袭来.
Around the same time, 他的女儿’s health also had spiraled out of control. 她的力气消失了. 她呼吸困难。. 她与肺病长达21年的斗争即将结束. 她于2008年8月16日去世.
20%的人
在大约一年的时间里, 理查森丢了工作, 他的健康保险, 他的家, 最珍贵的是, 他的女儿. The only thing he felt he had left to fight for was his life, and he couldn’t even afford it.
Without employment prospects, Richardson applied for both Medicare and D.C. 医疗补助计划. His caregiver Stephanie Wilson helped Richardson line up Medicare as his primary insurance and D.C. 医疗补助是他的第二保险公司.
Soon after Medicare approved his surgery, Richardson made an appointment with Inova Fairfax Hospital. Medicare only pays 80 percent of the double-lung transplant, hospital staff told him. 得到D.C. 医疗补助计划 to look at your case and make sure you’re approved for the rest, staff suggested. 他没有.
D.C. 医疗补助计划拒绝了他的请求, citing the fact that its plan states specifically that it does not cover lung transplants. “我以为我要死了. 没有人帮助我. They told me I had to move to Virginia or Maryland to get this operation done because D.C. 医疗补助计划不会支付那20%的费用。”理查森说.
移植手术本身估计要花费807美元,000, 但当一切尘埃落定, 他的手术将花费近100万美元. 100万美元的20%是无法逾越的. 钱从哪里来?
改善获得保健的机会
2008年D.C. 澳门赌场官网协会公益项目’s Health Care Access Project (HCAP) was created to help low-income District residents receive legal representation when they are being denied health care, 包括医疗和药物治疗, due to problems with obtaining pre–approval from insurance companies or unsatisfied medical debt.
“We understood how important this work would be for our clients, 让澳门赌场官网帮助他们获得必要的医疗服务,马克·赫尔佐格说, D .副主任.C. 澳门赌场官网协会公益项目. “We never imagined that our lawyers would literally be saving lives.”
根据国家健康事实.org是Henry J. Kaiser 家庭 Foundation, 40 percent of the low–income adult population in the District was on D.C. 而28%的人根本没有医疗保险.
Even those with insurance are often weighed down with medical debt because certain medications or treatments are not covered. Without pre–approval, many poor patients must forego treatment. In Richardson’s case, sacrificing treatment meant sacrificing his chance to live.
作为项目的一部分, HCAP offers lawyer training that explores a wide range of advocacy strategies for people with no health insurance, 公共健康福利, 或者私人保险, 或者有医疗债务的人, 或者被拒绝支付医疗保险的人. By participating in the training, attorneys agree to take two cases through HCAP.
个人争斗
Allison Highley, a federal contractor for the Centers for Medicare & 医疗补助计划 Services, was among the lawyers who participated in one of the training sessions. 对海利来说，获得医疗保健是一件非常私人的事情. 她的父亲于2011年8月去世，没有医疗保险.
“他工作了一辈子, 但是，在某种程度上, 他的健康状况很差, 他不把自己弄进医院就没法工作,”她说。. “大约一年前，他再也做不下去了.“她的父亲因为没有工作而失去了保险. 他年纪太小，不适合参加联邦医疗保险. His unemployment benefits prevented him from qualifying for income–based benefits. 仅他的处方就超过了1美元,每月1000万, 如果他付不起医药费，他的医生就不能给他看病.
“There are safety nets in place only if you’re old enough or only if you’ve spent all of your money and all of your family’s money, 你把所有的东西都卖了,海利说。. “很多次, I encounter people with federal jobs or jobs where health insurance is just a benefit they have. They’ve never known what it’s like to have to pay those expenses. It’s inconceivable to them that somebody wouldn’t have health insurance. I get a lot of, ‘Oh, people who don’t have health insurance are deadbeats,’ and that’s not true. 每个人都会遇到坏事……. 安全网并不总是合适的.”
To help those who fall through the net navigate the complicated health care process, 海利于2011年2月报名参加了HCAP培训. 几周后，理查森的案子送到了她的办公桌上.
一年的生命
Six months prior to meeting Highley, Richardson was told by his doctor he had 18 months to live. 现在还不到一年. “他很沮丧. 他很沮丧. 你能感觉到. 他几乎失去了希望，”海利说. They sat down and discussed the situation and what his eligibilities were.
“当我遇到她的时候，我就知道我有机会. She was going to do everything in her power to make it happen,” Richardson said.
“I did tell him, ‘You know, if there’s no coverage, then there’s no coverage,’” she recalled. “‘If there is something, then we’ll find it, and we’ll fight to get it for you.’”然后发生了一些事情. 在研读D.C. 医疗补助计划，她发现了一个非常具体的条款. 肺移植不包括在D.C. 医疗补助计划 unless there is additional coverage by another health care provider.
“如果你有双重资格[合格的医疗保险受益人], the 医疗补助计划 agency will pay the deductible and coinsurance amounts for all services available under Medicare, 没有例外,海利说。. 理查森符合要求.
During a status conference over the phone with counsel from the D.C. Department of Health Care Finance, Highley read the provision she had found. 几个小时后, 对方澳门赌场官网给她回了电话, 说他们已经重新评估了这个案子，她是对的. 几天后, the department issued a letter signed by the director of Health Care Finance saying that D.C. 医疗补助计划将支付理查森手术费用的20%.
她立即打电话给理查森. 理查森说:“我高兴得跳了起来，哭了起来. “她像她说的那样挺过来了. 这是一种祝福.”
海利补充说:“这只是其中一个时刻. 我们简直不敢相信. 这真的很神奇，”海利说. “这是最好的时刻，最好的时刻.”
9月27日, 2011, Richardson was officially placed on the waiting list for a double–lung transplant and is waiting for the call.
“这些情况真的是生死攸关. 对我们来说，这是一个很小的承诺,海利说。, 鼓励其他澳门赌场官网加入这一努力. “这个案子的实际工作时间只有14个多小时. 那是六个星期. 六周后，我们救了他的命.”
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卫生保健获取项目现在是D.C. 酒吧公益中心的倡导 & 正义的诊所. 有关参与倡导组织志愿服务的信息 & 正义的诊所, please contact managing attorney Adrian Gottshall by 电子邮件 或致电202-780-2744.
作者:泰国披乐
摘自《华盛顿澳门赌场官网》，2012年2月
达维.C. 酒吧工作人员作家Thai Phi Le at (电子邮件保护).
