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Struggling to Find Affordable Health Insurance

September 23, 2009 at 12:00 AM EDT
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An excerpt from a PBS special on one family's struggle to obtain affordable health care.
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JIM LEHRER: Finally tonight, one family’s struggle to find affordable health insurance. It’s part of a 90-minute PBS special on health care reform. The reporter is Maria Hinojosa of “NOW on PBS.”

MARIA HINOJOSA: Eight-year-old Sophie O’Reilly just started the second grade here in Tulsa, Oklahoma. This morning, she’s accompanied by her best friend, Breezy, who’s offering a little moral support, because today Sophie will be giving her first big class presentation.

SOPHIE O’REILLY: What is asthma? Asthma is swollen airwaves, and it can make it harder to breathe.

MARIA HINOJOSA: But this isn’t just any school presentation. It’s a window into Sophie’s world. From the time she was four, she’s lived with chronic pulmonary disease.

SOPHIE O’REILLY: I have asthma, and sometimes it makes it harder for me to run as fast as other kids. Sometimes I wheeze, and sometimes I just get tired.

MARIA HINOJOSA: In 2006, Sophie underwent major surgery to take out an entire lobe of her tiny lung.

SOPHIE O’REILLY: This is me after my lung surgery when I was 5 years old.

MARIA HINOJOSA: It’s a tough concept for her classmates to grasp.

STUDENT: How was your heart collapsing?

SOPHIE O’REILLY: It wasn’t my heart that was collapsing. It was my right middle lobe in my lung.

MARIA HINOJOSA: And they aren’t the only ones with questions. Even Sophie’s own doctors still don’t know why her lungs are weaker than everyone else’s.

Without a clear diagnosis, she suffered with symptoms for years. And her parents, Natalie and Stephen, have watched their little girl confront this very big disease.

Keeping Sophie healthy has become a way of life for the O’Reilly family. To prevent a serious incident, inhalers, pills, and oxygen monitors are all part of the daily routine from early in the morning until late at night.

To find out how health care is working for middle-class families today, we came here to the middle of America. In fact, you can’t get much more central than Tulsa. It’s a mere 80 miles from the midpoint between New York and Los Angeles.

Like many Americans, before their problems began, the O’Reillys never thought much about health insurance.

NATALIE O’REILLY: I say to people pretty frequently — because they’re like, “Oh, you know, my plan works great for me.” And my answer to that is, “Insurance works really well until you need it, until you really, truly need it.”

MARIA HINOJOSA: Natalie O’Reilly is a social worker with a masters degree. Husband Stephen plays guitar for a successful rock band and owns a small recording studio. Along with Sophie’s younger brother, Felix, the family lives here in a house just three minutes from the hospital, because access to medical care is their number-one priority.

STEPHEN O’REILLY: We’ve had to, you know, sort of keep a cap on our lives and how we planned our lives based on this one factor, health care.

MARIA HINOJOSA: But it wasn’t always this way.

NATALIE O’REILLY: We had this healthy, beautiful little girl.

STEPHEN O’REILLY: Nothing more than like a little cold or, you know, I think she had a stomach — she had a stomach thing once. That was it.

MARIA HINOJOSA: Natalie and Stephen had been paying for the same health insurance plan for five years, but then Natalie finished grad school and got a job that offered a health plan, so she canceled her old policy.

NATALIE O’REILLY: Looking back, I wish we had been a lot more cautious.

MARIA HINOJOSA: The insurance plan through Natalie’s work turned out to be too expensive, they say, so they decided to shop for a more affordable one on the independent market.

What was the mistake that you think you made from the time that you left your old insurance and decided to get new insurance?

NATALIE O’REILLY: We allowed for a gap between the policies. Our biggest mistake was setting that end date before we had something lined up, solidly lined up.

MARIA HINOJOSA: In the gap between policies, Sophie, who had recently had several bouts of pneumonia, got labeled with a pre-existing condition.

JIM LEHRER: You can find out what happens to Sophie and her family, watch the PBS special report on health care reform, which is a collaboration of three PBS programs, “NOW,” “Tavis Smiley,” and the “Nightly Business Report.” The program airs tomorrow night. Please check your local listings for the exact time.