Victimized by the coverage gap

MINERSVILLE, Pa. - Dan Daskus' greatest pleasure was driving to the Susquehanna River in his Dodge truck and going bass fishing.

He took special pride in his pickup, with heated seats and leather interior. "That truck was my mark in life," said Daskus, 41. "I mean, it's not much, but for me that was everything. The only thing I loved more was my wife.

"Never missed a payment," he added.

That was until he got cancer in July 2007, couldn't work, lost his job, and went $27,000 in debt - partly from co-pays and medicines his insurance didn't cover.

On July 16 at 2 a.m., the repo man came to his home in Schuylkill County, loaded the truck on a flatbed, and drove it away in the dead of night.

"I cry when I think about that truck," he says. "It's humiliating to me that I can't pay my bills."

His is a common humiliation. The magnitude of the crisis is well known: 46 million uninsured, according to the U.S. Census Bureau; 80 million struggling to pay medical bills, according to the nonprofit Commonwealth Fund; premiums paid by workers doubling in 10 years, according to the journal Health Affairs; and at least 18,000 people a year dying because they lack health insurance, according to the Institute of Medicine.

This series, in the coming weeks, will bring those numbers to life.

Stories like these are hidden and rarely draw attention - a temp worker who can't get a cancer test until she gets insurance; a home health aide who can't afford a hernia operation; a young rock and roller who gives a fake name to avoid an emergency-room bill.

These aren't exceptional cases. And that's the point.

Daskus, 41, grew up in Minersville, three miles from Pottsville, in small-town central Pennsylvania. He has worked since he was 19. He was in trade school to become a cabinetmaker, but his father died, and he worked to help support his mother.

For 16 years, he worked for Schuylkill Products, a company that made concrete highway bridge beams. In 2006, he took a job with Tredegar Performance Films, closer to his home, operating a machine that made plastic wrap for paper towels.

He was earning about $2,000 a month, with a raise due when he hit his one-year anniversary. He was paying $256 a month out of his check for health insurance for him and his wife.

In the summer of 2007, he had fatigue, fever and flu symptoms that he couldn't shake. He assumed this was just the consequence of working staggered shifts - nights, days, then nights again - which can wear a man out fast.

His doctor, Lynda Graves, suspected Hodgkin's lymphoma, a highly treatable cancer, and put him on medical leave from his job. He went on short-term disability pay, 25 percent of his salary.

An oncologist found a mass in his chest, took a biopsy, and confirmed the diagnosis.

That day, on the way home from the doctor, Daskus and his wife, Debra, 51, stopped at the animal shelter and brought home two cats, Dingbat and Morris.

"I thought a cat would calm him," said Debra Daskus.

"We got them as a distraction," said Dan Daskus. "Something to think about besides dying and cancer."

Doctors, he said, decided to give him chemo to kill the cancer, then do radiation to shrink the tumor.

The chemotherapy started Nov. 9, 2007.

"The medical insurance I had was pretty good," Daskus said. The problem, he added, came with his prescription coverage. Drugs he needed to control nausea, pain and acid reflux associated with chemotherapy were covered only slightly, he said, and many times he paid $100 or more out of pocket at the pharmacy.

For three pills of Emend, to control nausea, he paid $400, he said.

"You usually find out what's not covered when the doc gives you the prescription and you get it filled," he said. "Nine out of 10 times, the cash price is astronomical."

Daskus feels his employer treated him fairly. But ultimately he couldn't work, so he was let go.

By January, Daskus' short-term disability check from his job ran out, so he had no income.

Debra Daskus can't work, she said, because she suffers from six herniated disks. And she said it was a full-time job driving her husband to all his doctors and being a round-the-clock caregiver when he was so sick from the chemo.

With no income, bills began to mount. On top of co-pays and prescriptions, Dan Daskus was still paying $256 a month to remain on the company insurance plan, plus household expenses.

He blew through $4,500 in savings and started maxing out credit cards.

Collection agents called.

In the spring, Daskus let his insurance coverage through work run out and applied for Medical Assistance - care for the poor, financed by the state and federal government.

"The day I went over to that welfare office," Daskus said, "I never dreamed in my entire life I would ever see myself having to apply for something like that."

He said he'd always looked down on people on public assistance, figured they were lazy or scamming the system.

At least he had insurance, but still no income.

Daskus applied for permanent disability from the Social Security Administration. He'd been paying into Social Security since he started working. If approved, disability pay would be $1,300 a month, he said, enough to squeak by.

He was denied.

This burned him up.

"I was denied because their doctors felt I should be able to return to work by July [a year after his diagnosis], without even giving me an examination," he said in late summer. "But of course it's already August and I still haven't returned to work. I've got all these side effects from chemo - neuropathy in my hands, compression fractures in my spine, osteoporosis."

According to the Social Security Web site, a person with Hodgkin's disease can qualify for disability if he still isn't cancer-free a year later.

Daskus's chemotherapy, however, appeared to work, and in June, he was told he was in remission - the cancer was no longer detectable.

Doctors still wanted him to go for radiation, to shrink that mass in his chest, but Daskus delayed going for months, he said, because he couldn't afford gas for his wife's car to get to treatment 20 miles away.

He's supposed to start radiation next week because the oncologist, he said, arranged for a van to take him there and back.

Daskus's debt is now about $27,000, he said as he spread bills all over his coffee table. A big chunk of his debt, he said, is from penalties and soaring interest rates.

Daskus is appealing his denial for disability - and said his lawyer told him he must wait a year for a hearing. If he is granted disability coverage, he'll face another catch-22 that hundreds of thousands of Americans confront every year:

If he does receive $1,300 a month in disability payments, he'll earn too much money to qualify any longer for Medical Assistance, and he'll lose medical coverage.

Daskus will need many more tests and treatments and must have insurance to pay for them. Yet with his preexisting cancer and its side effects, he said, he believes he will never be able to afford private insurance himself.

"I may as well wither up and die," he said. "In a year's time, if I can't work, and without any income, I'll lose the house and be in the street.

"And if I do get disability, I'll lose my health insurance. It shouldn't be that way."

Daskus had never paid much attention to politics or the nation's problems.

Cancer and poverty changed his outlook. He's registered to vote for the first time - as an independent.

He is furious with the way things are.

"I'm mad because my tax dollars go to bail out an investment bank because too many millionaires were losing money, but I can't get help from a system that I had paid into my entire working life," he said.

"It's time to change the system."

Dan Daskus had a job and health insurance, but it didn't cover the full costs for all his cancer-related drugs. And when he became too sick to work, he fell deeper into debt and landed on Medical Assistance. His case shows that even with health insurance, people might not be covered as fully as they think if a serious disease strikes.

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In Pennsylvania

Medical Assistance: To apply for many programs, go to www.dpw.state.pa.us and click on "Apply for Benefits."

CHIP (Children's Health Insurance Program):

1-800-986-KIDS (5437).

AdultBasic: Low-cost coverage for adults: 1-800-GO BASIC. There is a waiting list for the AdultBasic subsidy.

Low-Cost Private Insurance: Special Care plans are for low-income persons. In the Philadelphia area, call 1-866-282-2702.

Pennsylvania Health Law Project: Free legal services and advocacy. Help line: 1-800-274-3258. E-mail: staff@phlp.org

In New Jersey

Medical Assistance: 1-800-356-1561.

FamilyCare: 1-800-701-0710.

Hospital Charity Care: Contact the business office of your local hospital.

Prescription drugs: 1-888-793-6765 or go to www.rx4nj.org.

Catastrophic Illness in Children Relief Fund: For help with overwhelming bills for children under 18: 1-800-335-3863.

Community Health Law Project: For medical insurance questions: 1-888-838-3180 or 856-858-9500; chlpinfo@chlp.org.

Source: PA Health Law Project; Community Health Law Project

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