As I have mentioned in the past, my son has asthma. Right now, it is under control. We have the orange daily maintenance inhaler, the blue emergency inhaler and a penguin shaped nebulizer with albuterol liquid for the times when his breathing is getting rough but we have time and space to respond cheaply and effectively. He has not had a serious breathing crisis in almost two years.
We have his asthma under control. But there was a time when we were still learning what his triggers were and an asthma attack would come sneaking up on us. And that led us to the emergency room.
The first time I took him to the ER, he had been having an asthma attack for hours and we did not know. He was in pain, he was nearly manic and he could not calm down. We knew something was wrong and given that I had a nap that afternoon, I took him to the ER so my wife could get some sleep.
When we got to the ER, his blood oxygen saturation was in the upper 80s. The triage nurse recognized the problem and had us in a treatment room within three minutes of our arrival. The ER staff got a dose of steroids and then pure oxygen mixed with albuterol went through a dinosaur shaped mask for the next forty five minutes. Four hours later, he was asleep on my lap curled up in the way that an exhausted two year old can contort themselves, and breathing normally.
This was a crisis. It took three ER visits and two urgent care encounters until we were able to find the right combination of medications and behavioral changes that has allowed us to effectively control his asthma. Now his asthma is something we talk to his pediatrician about for five minutes at the annual EPSDT wellness visit to make sure that we have a new prescription for the three drugs for the next year. But when he was two and three years old, asthma was a crisis and an emergency.
I bring all of this up as Maine’s Medicaid Section 1115 Medicaid waiver application wants to apply cost sharing to emergency room utilization based on the primary diagnosis on the claim. Diagnoses based co-pays are post-facto justifications for denial using information that the patient did not have at the time of the decision to seek care in a particular location. If they knew the diagnosis they would not need to be diagnosed.
Maine wants to categorize emergency room visits for asthma as non-emergency. This would mean that co-pays would apply as either a shifting mechanism to get people to address care needs at their PCP or an urgent care center or as a punitive measure. I know that when my son was having severe attacks, his PCP shipped us straight to the ER.
Breathing is somewhat important. Not being able to breathe well is an emergency. The ideal situation of course is to have well controlled asthma via the combination of appropriate medical/pharmaceutical interventions and behavioral changes (including moving away from a working steel mill). But sometimes that fails and breathing becomes an emergency.
RobertDSC-iPhone 6
They are pure evil.
O. Felix Culpa
How scary for you as parents. I’m glad you’ve got the kiddo’s asthma under control. I had childhood asthma too, along with several runs to the emergency room. Breathing is super important and struggling to breath is exhausting. The protocols for managing asthma have gotten much better since I was a kid, but emergencies can still happen. Stupid f*ckers don’t understand just how serious an asthma attack can be, sometimes even leading to death. Or perhaps they don’t care, which makes them evil f*ckers.
rm
My god, I hate these people.
Lyrebird
@RobertDSC-iPhone 6: Just like Sessions, trying to take us back a century. My nearly-centenarian relative remembers each summer wondering if her brother was gonna die from his asthma. He didn’t, but when things got real bad the only med they had available was something that made his heart race in a way that was very frightening to the already-struggling kid.
Major Major Major Major
Mm, yes, ER doctors, in their rush to not let everybody die, certainly have never checked the wrong box on a form, and if they were to I’m sure it’d be a simple measure to get it corrected after the fact if there’s an insurance dispute…
Karen
I know the fear of child not breathing and them struggling to breathe; my step daughter had Cystic Fibrosis, I dreaded every time there was an insurance company change through father’s employer since it meant we could end up in waiting room of a primary doctor who had never seen a CF patient in their life.
Tokyokie
Excuse me, but status asthmatius isn’t considered a medical emergency? Untreated, it will often result in respiratory failure, which, if untreated, is usually fatal. And if the prescription meds could relieve it, then the patient wouldn’t be in status asthmaticus. The patient urgently requires the interventions that only an ER physician can administer, which pretty much sounds like an emergency to me.
MomSense
Thank you, David! I too had a kid with asthma that took some time for us to get under control. He has been asymptomatic for a number of years now (knock on wood!!) and I hope the same for you and your son.
I’m forwarding this on to some people here who are working on our Medicaid expansion question. Anything you offer on this subject is greatly appreciated.
For those juicers who are also in non-expansion states, our November ballot question may be a model for your states. We could also use help!
Mary G
They got so upset when Kanye West said GWB hates black people after Katrina, but it’s nothing but the truth. Republicans find poor people surplus to requirements and just want them read because they cost money.
Mary G
@Mary G: wants them dead, I meant to say.
Shrillhouse
As an adult, who has been asthmatic since a young age, I can confirm that an asthma attack is VERY MUCH an emergency.
As a Canadian, I’m just thankful to live where I live…
MomSense
@Mary G:
Sadly, we knew exactly what you meant. ?
EMedPA
So apparently no-one in the Maine GOP has any family members with asthma, or has the disease themselves. Every last one of us who works in emergency medicine has admitted someone to an ICU because of asthma.
To quote Charlie Pierce, these really are the f*cking mole people.
Laura
@Lyrebird: my late mother and uncle both were bedridden for over a year with severe asthma as children. Both brothers and I also had severe asthma as children and I suffer exercise-induced asthma that puts the kibosh on running.
It can kill. It’s scary as hell. So yeah, no need for emergency room visits despite so many republican doctors in the Senate and Congress. Whatever the fuck is wrong with these people and their corrupted by obscene wealth owners?
rikyrah
Not according to Republicans.
Starfish
Doesn’t everyone have similar experience with asthma when they are learning the triggers? We ended up in the ER when urgent care wouldn’t treat my child who was under 3 at the time because his blood oxygen levels were in the 80s. We had tried to see a doctor. We had tried urgent care. No one would touch the child. He ended up with this hours long asthma attack because everyone’s business practices were more important than giving the kid a nebulizer treatment.
Now we take our nebulizer whenever we travel and avoid such emergencies.
This thing in Maine is going to run into everyone’s business practices, and there are going to be kids who are not going to be treated by doctors or by urgent care because they are out of town, because their kids are too young, etc.
low-tech cyclist
Good Lord, these people really are pure, distilled evil.
My kid’s one of the healthiest kids ever, so I’m lucky in that I’ve never been in a similar situation with him. But I have no trouble imagining just how terrifying it would be. And being told that the ER won’t pay for asthma because it’s, what, not a fucking emergency? The whole point is, when it sure seems like an emergency, how the fuck do we know what is or isn’t one until we go?
What’s next? They always tell you to go to the ER if you’re experiencing chest pains, even though 98% of the time, it’s not gonna be a heart attack. Are they gonna start refusing to pay if it’s not one? Makes more sense than their deciding that a kid having difficulty breathing isn’t an emergency.
Just. Fucking. Evil.
aimai
I had the same experience with my youngest–now 18 and over her asthma as far as I can see–wound up in the ER twice, quite appropriately since it looked like pneumonia. She ended up hospitalized twice. Scary as hell with a three year old. You don’t want to discourage people from getting treatment for their children. It would make more sense (says the social worker!) to have adequate social work assistance for parents who are not understanding how to handle their sick children as well as better nurse outreach for kids who are having consistent problems. We should look at the ER situation as one in which we can flag a family that is going to need more intensive help later to stay out of the ER. Everyone should get three or four “free” ER visits per child.
cleek
seems like i spent half my childhood going to emergency rooms, unable to breathe, and getting injections of adrenaline. made my eyes bug out and my arms would twitch for an hour – but i could breathe!
finally, theophylline got it under control. and i eventually grew out of it. mostly.
Villago Delenda Est
@rikyrah: If you can’t afford to breathe, you should die. This is GOP dogma.
I’ll bet Governor LePaste has something to do with this.
David Westenkircher
For status asthmaticus, the ICD-10 code used should be J45.902? How is that handled? It is not to be found in the MaineCare document to which you linked.
Mnemosyne
I’m still haunted by a story I read here in LA probably 15 years ago now about a woman on Medicaid whose child had severe asthma that was difficult to treat. She took him to the ER so many times that the case worker decided that it was a case of Munchausen’s By Proxy and put the child in a foster home, because there was no way that a kid could have asthma that severe.
You’ve probably guessed the sad outcome: the child had an asthma attack at the foster home and died, because the foster parents didn’t know how to deal with asthma that severe. The case worker got fired and the city got sued, but that mother’s child died because a supposed professional didn’t think asthma could be that severe and life-threatening.
RAM
I had fairly severe childhood asthma growing up in the early 1950s, a time when the only ‘treatment’ was cough medicine, which, frankly didn’t do anything at all. I spent a lot of time at the hospital in oxygen tents (remember those?). Then the early nebulizers came out, giant positive pressure machines that looked like SCUBA gear mounted on a big oxygen tank. That really helped but they were unaffordable for regular folks. It didn’t help that we lived on a farm, and that I was allergic to about everything there. This time of year, in particular, during the oat and wheat harvest, was murder for me, as was getting anywhere near the chicken house or the haymow up in the barn.
Things got better when we moved into town, but not much better since I’m allergic to grasses of all sorts. And here in northern Illinois all that corn and oats and wheat are nothing but genetically modified grasses that regularly tried to kill me. The neighbor kid down the street had childhood asthma, too, but him mom fought it by ordering steroids from Mexico, something my doctor cautioned against, and for good reason. It stunted his growth and seemed to have some severe effects on his behavior. He was a mean little bastard growing up who today is dealing with Parkinson’s and dementia.
I remember when Tedral came out, and it was a revelation. It could stop an asthma attack in its tracks, but it severely raised my heart rate, and it was discontinued, although apparently you can still get the stuff in Canada. I was panic-stricken about what I’d do if I got another attack. By then I was a young adult with a wife and kid and in the early throes of ankylosing spondylitis (AS) and went through a variety of meds including the new inhalers. Some worked, some didn’t. Fortunately, the company I worked for had good insurance, although the pay was lousy.
What I learned over those years is that prompt self-medication is absolutely vital–something I taught my son as he dealt with childhood asthma, but which (unlike mine) was largely gone by the time he was in junior high. You’ve got to get ahead of the damned stuff before it gets a foothold, because then it’s MUCH more difficult to get under control.
Today, I still have a bit of asthma, but it’s mostly morphed into COPD and I have maintenance inhalers scattered around the house just in case. What amazes me is that back in the ’50s, my folks paid all my medical bills with minimal insurance, and that included house calls by our family doctor. Granted, it pretty much depleted their life savings, especially since my dad also had severe AS and spent lots of time in the hospital and at the Mayo Clinics as they experimented on him. But they didn’t go into debt for it. Today, that’s just not at all possible.
I wish there was some way to give those legislators an asthma attack. Just one. They might not be quite so off-hand about it–a serious attack’s about as close to being waterboarded as you can get. The foregoing is one reason I’ve always been in favor of universal health insurance.
Scamp Dog
I had asthma attacks as a child. I’d spend a couple of hours sitting up, late at night, struggling to inhale, my mom trying to nap on the couch next to me. Eventually, I’d ask her to take me to the ER, where I’d get an injection (adrenaline? This was back in the ’60s), and finally be able to breathe.
There are plenty of reasons to be angry at conservatives, but this one is much more visceral to me than the others.
ETA: …and RAM just expressed the situation better than I did. Well said.
Adria McDowell
@Mnemosyne: I think this is kind of the same mentality as folks who think vaccinations are unnecessary- no one dies from, I dunno, polio anymore! (Yeah, due to vaccines, nitwits!) I’m glad that asthmatics have much better treatment now, but for some people who don’t have to deal with it, it masks just how dangerous it can be.
If I was that mom, I’d go on a rampage. Literally.
Republicans are the minions of Satan.
Adria McDowell
@RAM:
Me, too. I’m also allergic to all sorts of stuff (including mold, so I get to take medication all year ’round. Yay.) I think my allergist is surprised I don’t have asthma. I wonder how many instances of asthma are caused by allergies?
opiejeanne
@Lyrebird: My great grandmother died of asthma in 1917, in September. She was 69 years old, from a family that tended to live into their 90s. I have no idea what the treatment was like back then, but I’ve had ashthma attacks that were pretty frightening.
My son’s HS math teacher died in the late 80s from a very bad attack because he didn’t have a rescue inhaler with him and didn’t get help quickly. I don’t remember all of the details but he waited to call for help until he got home and realized his inhaler was empty.
Ohio Mom
I have asthma too. There sure are a lot of us.
I’m wondering if the thought behind this new approach in Maine isn’t based on frustration with people who don’t take their maintenance meds regularly, let their unwashed dog sleep with the patient, etc., and as a result of their non-compliance, overuse the ER, and ultimately make a bad health condition worse.
If so (rhetorical question coming up), maybe they should have developed a few carrots before resorting to this huge stick?
MomSense
@Ohio Mom:
We should have expanded Medicaid. Instead, LePage and the GOP actually made further restrictions to the existing Medicaid program. Lots of people here fall into the bigger gap so they don’t have the option of primary care, can’t afford the prescriptions,etc. At the same time they placed conditions on food assistance and did other horrible things that disproportionately affect poor people.
opiejeanne
@MomSense: My son was asthmatic as a child. Starting at age 2, around midnight every time, we’d rush him to Kaiser, Fontana and Triage would send him to Pediatrics, who would give him a shot of something like adrenalin, but the excitement of the late night rush to the hospital, the cool night air, and the dread of a shot usually had him starting to clear up by the time we got there. When he was little he only had these attacks when he was recovering from a cold, but later there were some environmental triggers that eased when we moved from the north side of Riverside, CA to another area just south of downtown when he was 6, and by then the treatments were starting to improve. I don’t remember when we got his first inhaler but I carried it everywhere with me, his daycare had one, and his school had one in the office.
While we lived in that first house I had asthma attacks too, and I’d never had them before other than the infrequent exercise asthma. Mine cleared up after we moved, too. It was when the Santa Anas would blow, and they tended to blow from the north where there was a cement plant so I’m guessing that it was the dust from the plant. The second house had much better weather-stripping and I was pleasantly surprised to not find the black dust on the windowsill. We had a cat. Of course the doctor told us to get rid of the cat but it was HIS cat, they adored each other, and he wasn’t allergic to the cat.
He still had bouts of asthma through HS and when he first started college, but the attacks stopped soon after and he hasn’t had one for 27 years.
HRA
I am not writing this for anything other than my own experience of having a child with juvenile asthma. I knew what it was during her first attack for a close friends and neighbor’ s child had it. I had helped her find a doctor who specialized in it.
I took my child to our GP who insisted she had to have her tonsils removed. I disagreed. That led me to go to the asthma specialist where the practice included 2 other pediatricians and where I signed in the other 3 children.
Jackie was 2 years old. Tests were done down her back and her upper arms. They had a lab where they tested the results while we waited and gave me 8 sheets with what she was allergic to and instructions on what to not have in the home. Spring cleaning once a week, bedding washed also, curtains washed, etc.
It was not an easy job at all. Still I followed it by throwing out rugs, furniture, plants, my makeup and the bad foods. Jackie got a shot starting with every week, every two weeks, and on till the day came with no shots. No shots was 6 years later and the last appointment for asthma.. Jackie went on the college, graduated, got married with 2 grown children and never another asthma problem.
.
efgoldman
mrs efg, now 63, used to require ER visits for asthma attacks. She, too had multiple inhalers and a home nebulizer, which she used regularly. Then about 25 years ago one of her docs prescribed Accolate (a pill). No ER visits for asthma since. Once in a great while she uses an inhaler. Nebulizer sessions once every few years.
It’s available as a generic, so most insurance should cover it.
brendancalling
I also have asthma, and use the same inhalers as your kid (probably higher dosage for me). Before the ACA, I couldn’t afford my orange inhaler out-of-pocket. Now I can.
Asthma is terrifying.
RAM
@Adria McDowell: My asthma was certainly triggered by stuff I was allergic to. My son’s, too. But he was allergic to stuff indoors, me outdoors. So he spent as much of his childhood as possible camping with the Scouts (got his Eagle, too!) and now he’s a happy carpenter with an English degree.
Ohio Mom
@MomSense: of course they should have expanded the social safety net! And I don’t doubt for a minute that there is a fair amount of sadism behind this.
Amai’s comment has the sorts of things I was thinking of when I said “carrots,” which are all supports for families who need them. Needless — -and sadly — to say, it doesn’t sound like the state of Maine will institute anything like them.
The sometime-blogger Jon Schwartz once wrote about discovering a very dark mole on the back of his leg and going to the doctor precisely because it didn’t cost him anything (he had great insurance, IIRC, he was working for Michael Moore at the time).
It turned out the spot was very early melanoma, the type of skin cancer that spreads to other organs and kills you.
If he had had to pay to see the doctor? Maybe he would have put off having his mole looked at.
Mnemosyne
@Adria McDowell:
As I understand it, asthma and allergies tend to go hand-in-hand. The allergy/asthma specialist I saw was surprised that I have virtually no allergies (I have a mild one to mold), but I do have asthma.
A complicating factor is that allergy and asthma triggers can be the same thing, but for different reasons. And my asthma is a migraine trigger, which is loads of fun, as you can imagine. ?
Mnemosyne
Why am I in moderation? I don’t see any forbidden words.
Cheryl from Maryland
Evil people. I skimmed the report and didn’t see allergies. Just wait. My mother developed serious allergic reactions (anaphylactic shock) after a bee sting. We were unclear as to what would set her off — one time she had to have a trach as her throat closed due to a medication. No joy for getting a prescription for an Epi Pen (if you live in Roanoke, VA, avoid the doctors.
Try another city). Finally, my brother and I convinced her to take Benadryl every day and to carry it with her to take more if she felt her throat close up. With only OTC medications, it was a miracle she avoided the ER.
StringOnAStick
David, I heard a local NPR story yesterday (Colorado) about how the new bill submission system for Medicaid in our state still has some FUBAR issues and some practices are refusing to take anymore new Medicaid patients because of slow payments and claims rejections related to problems with the vendor’s new software system. The married-to-a-programmer side of me said “well, duh; new systems have glitches, always” but my cynical side said that this experience will be trotted out nationally as a reason to distrust Medicaid, especially on the provider side. Extra side eye for the ortho practice in CO Springs (wing nut central, in a specialty that trends that way anyway) that is using their practice’s outdoor electronic banner sign to bitch about the problem, plus their refusal of any new Medicaid patients.
Roger Moore
@Villago Delenda Est:
Exactly. Think of how much money we’d save if we just let sickly poor people die rather than live as drains on society. I’m waiting to see how soon they decide that sickle cell disease and Tay-Sachs don’t deserve to be covered.
SWMBO
I was hospitalized at 3 days old with pneumonia caused by asthma. EVERYONE in the house smoked. I was in and out of oxygen tents in the hospital for years. No. No one gave up cigarettes. No one smoked outside either. This was a multigenerational house with aunt, uncles, granny, etc. my asthma got somewhat better after puberty. Then menopause brought it back. So something that you think is under control may reoccur after a certain age. I take Breo once a day and carry a ventolin rescue inhaler. Every one of these assholes should have to deal with this personally twice at least. The first time to teach them fear and the second time so they know it’s never going away.
BCHS Class of 1980
@Roger Moore: And certain Trump supporters would be joyful to do it, considering the groups most susceptible to those diseases.