Issue link: https://nnumagazine.uberflip.com/i/198630
above: Nathan Wilkes peruses a waiver application he's filling out in order to try and qualify Thomas for Medicaid. The Wilkes earn too much money to otherwise get on the program. opposite page: Sonji comforts Thomas and tries to determine whether his earache is just an earache, or whether he has a bleed. His parents must be finely attuned to any of his pains. 18 REGISTERED NURSE The same problem arose the next year. Now the company was facing a 55 percent premium hike, out-of-pocket maximums were jacked up to $8,000, drug prices were increased, and United Healthcare slapped a $1 million lifetime cap on claims. "When they instituted a million dollar cap, and I knew how much clotting factor costs, I thought, 'Oh boy, that's only going to last us a year,'" said Wilkes. One of the kinds of medications Thomas takes costs about $2,400 a dose, and just the other week he had an arm bleed and needed a dose every three hours for four consecutive days. Total? About $76,800. And prices are going up. Over the next few months, Wilkes educated himself about what insurance options were available for Thomas. The findings weren't pretty. He earned too much to qualify for Medicaid. Thomas could apply for some waivers, but would have to prove disability and even if approved, would sit on a waitlist W W W. C A L N U R S E S . O R G estimated at five to six years. Wilkes could try to switch jobs to a large company and hope the new insurer doesn't notice Thomas' claims for a while. Sonji could return to work and put the kids on whatever plan she gets, but then they'd have to pay to place all three kids in daycare—plus Thomas is chronically sick and needs special care. Wilkes could get a "paper divorce" from Sonji so that she and the kids could qualify for Medicaid, but he found that option totally inane. Wilkes found only a few alternatives remotely palatable. He could start a two-person consulting business under which he could qualify for small-group, guaranteeissue plans that in Colorado can't exceed 110 percent of the street rate. But his salary might not keep up with premiums. He could try to enroll Thomas in CoverColorado, the state's plan of last resort for patients who can't get coverage from private insurers. But he'd have to pay an extra premium there, and MARCH 2007