What the ACA Means to Average Americans

Last week I posted something to Facebook about how upsetting it was that the GOP is taking actions to dismantle the ACA. That post ended up in the trending topics on Facebook, and I had to turn it to friends only as a number of strangers and trolls decided to chime in. I was headed out of the house for the Women’s March and couldn’t address the ugliness entering my feed, so I put it on lock down.

I thought I would take the time here on my blog to post in more detail, though, and address some of the rhetoric I’m hearing out there. I can offer some additional insight into the issues since I’ve worked in the healthcare field (to be specific, I worked in the Administration and Finance department dealing with contracts, physician payments, and Board meetings). Others in the healthcare may have a different take, I suppose, but here is mine.

First, a note: There has been a lot of spin about what the Affordable Care Act (a.k.a. Obamacare) is and why people want it. Republicans have lobbied hard against the ACA for years. Many people have forgotten that the original iteration of the ACA was torn apart by Republicans and what we were left with is just a shadow of what President Obama intended–literally, the bare minimum he could get through Congress. There are a lot of things wrong with the ACA, of course, and that is in large part because of the refusal of Republican lawmakers to work with Democrats during that time (and since). Some states were able to develop their own ACA-related programs to address the holes in the law, and some were not. So in many areas around the country, insurance companies have hiked rates because there is little or no consequence to them.

Ewokmama.com: Why we Need the ACA

Logistics of implementation aside, I want to make it clear that my support of the ACA is not about wanting free healthcare for my family. In fact, we don’t have insurance through the ACA programs. We have an employer-sponsored plan because we are lucky enough to be in good health and able to work. The unemployment rate is pretty low at the moment and my husband and I have pretty secure jobs (as secure as any job is these days).

With that said, the tenants of the ACA impact ALL healthcare plans. See this article for more on that.

When I use my family as an example of why we need the ACA, it’s because my family is pretty typical. Our circumstances are subject to change at any time, just as most Americans who don’t have a hoard of cash as a safety net. We are living paycheck to paycheck and have credit card debt and have experienced lay offs in the past. We have a house and cars, but those things could easily be taken from us if we hit hard times–just like so many other Americans.

There are many, many Americans who do not have employer-sponsored plans. Some are unable to work, perhaps due to illness or because they are caregivers. Some are self-employed or work with small companies that do not offer healthcare. Some have lost their jobs–most people I know have experienced a lay off at some point in their lives! The ACA is meant to help all of these people and prevent them from going into catastrophic debt from which they can never recover.

You can easily google “how much does cancer cost” and find out just how financially catastrophic that diagnosis can be.

And then there are those pre-existing conditions clauses. These do directly impact my family. My older son, a cancer survivor, is considered to have a pre-existing condition. That will never go away. He cannot hide it because he will need monitoring for the rest of his life to catch any other issues that cancer treatment causes. I have mild asthma and a history of mental health issues. My younger son has Reactive Airway Disease, which is often a precursor to asthma; he is only two–who knows what else will come up for him.

Prior to the ACA, even employer-sponsored healthcare plans could exclude us from coverage for periods of time. Prior to the ACA, and before I had employer-sponsored healthcare, I was denied private healthcare insurance due to a history of mild asthma and depression. I could not afford to pay for the medications to treat these health issues out of my pocket, so they went untreated.

When people cannot afford to take care of their health, that impacts their ability to work and be fully functioning members of society. Their health problems do not magically go away during that time!

Now let’s talk about hospitals. Did you know that if someone shows up in an Emergency Room, the hospital cannot deny them care even if they can’t pay? Some uninsured patients that show up in ERs are able to qualify for Medicaid (which, I might add, also doesn’t reimburse the hospital 100% for cost of care), but some are not. So many hospitals are taking on the cost of caring for uninsured or “under-insured” patients. If there is a large number of these people who need health services and cannot afford to pay for them, the hospital accrues large amounts of debt. The hospital has to then raise their rates for the rest of us to make up for the gap in operating costs.

And what happens if we refuse to pay those higher hospital bills? Well, in many cases those hospitals get shut down. This was a major issue for the Catholic hospital where I worked in rural northern California. It nearly shut down. Hundreds of people were laid off to keep it operating!

These issues snowball. Rural hospitals and facilities in debt have trouble hiring quality medical staff. The quality of care goes down. More mistakes are made and more lawsuits happen. People die, and costs continue to skyrocket.

This was happening in rural areas all over the country before the ACA. And these rural hospitals are still struggling due to key provisions missing from the ACA.

But if the ACA is repealed, it doesn’t fix any of these problems. We just go back to large numbers of people being uninsured or under-insured!

We need to fix the ACA. We need healthcare reform to hold insurance companies accountable–not a big gaping hole.

Please, call your representatives and demand they either KEEP THE ACA or develop SOME sort of bandaid in the mean time!

Why I Marched on Oakland

On January 21st, I marched in Oakland as part of the Women’s March on Washington. I know there are some out there who don’t understand what marching accomplishes. I don’t always know the answer to that, but sometimes you feel strongly about things going on in the world and you can’t sit there anymore and do nothing. Sometimes, marching just feels right.

It was a diverse group that marched in Oakland. It wasn’t only women; there were people of every color, size, shape, ability, gender, sexual orientation, and flavor. The reasons why participants marched were many and varied.

Jack and me at the march in Oakland. Photo © Rhea Avalos.

Jack and me at the march in Oakland. Photo © Rhea Avalos.

Here are the many reasons that I marched (with my son Jack) yesterday:

  • To show that I will not be a silent victim of Trump’s fascist agenda and toxicity.
  • Because every person who marches builds up a critical mass that results in 2.5 million people, which shows that we are not a small minority of people who are concerned with the dangers of a Trump administration.
  • To show support to every person who will be targeted and harmed by Trump’s agenda and toxic atmosphere for simply trying to live their life:
    • people of color
    • LGBTQIA people
    • women
    • immigrants
    • those in need of affordable healthcare and protections against pre-existing conditions clauses
    • children who deserve to go to school without worrying about gun violence
  • To feel solidarity with my fellow citizens who also want to build a better America–an America that is constantly improving and not trying to return to the past.
  • To be part of a movement so big that it cannot be ignored.
  • To show my children what freedom means.

I will keep marching because it means something to me and reminds me what it means to be an American.

Progress in Getting a Better IEP

After many years of back-and-forth with Jack’s school, we have finally gotten an IEP that I think we are all happy with!

For the first time since we started meeting with the educational team at the school back in 2013, they didn’t fight us on where Jack is academically. Everyone agreed that he is demonstrating the long-term effects of his cancer treatment. Everyone agreed that what we’ve been doing so far has not helped. Finally, the school accepted that the holes in Jack’s learning would not just magically fill up again now that chemo is done. They have conceded that Jack has a huge gap between intellectual ability and academic achievement in math due to processing problems (i.e. dyscalculia), memory, and attention issues.

fear of math

Does not compute… Photo © Jimmie, Creative Commons usage.

I can’t tell you what a relief it was to walk out of that IEP meeting last week and have plans in place – not just HOPE but plans.

Jack has four new goals written into his IEP, including learning to tell time*, learning to count money, practice basic math facts so that he can get 80% accuracy, and fraction learning in the resource room prior to learning it in the classroom. Accommodations will include shorter assignments, untimed classwork, and the teacher will make sure he understands instructions/repeats them back before left to do the assignments.

Jack previously had time one day per week in the Resource Room (which amounted to 75 minutes per month) along with two other students and no individual help. Now he’ll spend time three days per week in the Resource Room and one of those will be solo with the resource teacher!

It feels like the future is looking brighter! Even if these things don’t work, we’ll know more about whether Jack can learn certain things if taught in a different way or just…not at all.


* Jack has no concept of time – not hour of the day, not day of the week, etc. He can’t tell how long something takes or how much time has passed – whether it is nearing bedtime, whether it’s late or early in the day, or what day tomorrow is. He floats along and has to have everyone around him tell him what to do next. This makes time management impossible! Part of the problem is that he can’t hold onto information about sequences longer than maybe two steps (so even if he does know that today is Monday and tomorrow is Tuesday, he has no clue where those days fall in the sequence of the seven days of the week). Another part of the problem is that he has trouble with assigned meaning of things – i.e. a quarter is worth 25 cents because someone long ago decided that was the case; the value isn’t inherent to circular pieces of metal of that size. He can’t wrap his brain around that. It’s like it’s another language that he can’t comprehend – the language of sequences and numerical meaning.

Keeping Your Toddler Busy When Traveling

Last week I hopped on a plane with my very active 13-month-old baby/toddler. Desmond and I took a 4.5 hour flight from San Francisco to Atlanta, just the two of us (well, and everyone else on the plane). We flew back home yesterday.

I will come out and say this for all to read – I was terrified to take this trip on my own. But that’s how most adventures in parenting start, right?

Airport baby wearing

Babywearing at the airport

To prepare, I scoured the internet for ideas for keeping small children occupied on airplanes. I found a lot of suggestions that work for kids over the age of 2 years – those kids that are less likely to eat the crayons or throw the blocks at other passengers. Dez is still not 100% accurate with putting food in his mouth – there is no way he would have luck drawing on a magnedoodle!

Having very little luck with my search on the internet, I proceeded to tear through my house looking for items that I wouldn’t normally let Dez play with but that also aren’t dangerous while supervised. I came up with quite a few things to put in my “forbidden items grab bag.” I then hit up my Facebook parenting groups to gather more ideas before heading to Target. (I came out spending way too much, but it was less than $100, which is kind of amazing for a trip to Target!)

In the end, I collected quite the mishmash of items to entertain my toddler on the plane. And thus I bring you tips for flying with a toddler (without losing your mind).

Ewokmama tips for flying with toddler

Ideas for Fun and/or “Forbidden” Items to Bring on the Plane:

  • a fun keychain with spare keys and a large paperclip attached
  • various expired membership cards
  • a bracelet
  • post-it notes
  • small, portable toys that are new to your toddler – we had Little People figurines, My Little Pony minis, a Little People clown car
  • a pill organizer filled with snacks
  • stickers
  • interactive books (i.e. a “slide & seek” book and Pat the Bunny)
  • a pack of playing cards from the $1 bin

My cell phone is the ultimate forbidden item, of course…so I also looked around the app store to find things that might appeal to a toddler. [Note: If your kiddo is closer to 2 years and above, Toca Boca makes some awesome apps.] The best app I found is called “Animal and Tool Picture Flashcards for Babies” by Open Solutions. It’s free and contains a mixture of animal photos and clip art pictures; when you tap on a picture, the app states the name of the animal and then plays a clip of the sound that animal makes.

That app was the best money I never spent! Dez LOVED it. Even aside from the animal pictures and sounds, he really enjoyed dancing to the background music. It came in handy in the hotel room later, as well.

A word of warning, though. Now that I’ve let Dez play with my cell phone, he is more demanding about it than ever. Still, it was worth it for peace of mind on the plane!

If I were to pick one item from the above list to suggest above all others (aside from the animal flashcards app), it would be the pill organizer filled with snacks. Dez thought it was great to point to the container he wanted me to pop open – over and over. The snacks were key! A well-fed kid is a happy kid!

Aside from items to schlep along with you onto a plane, here are a few more tips for flying with toddlers:

  • Opt for the window seat. Not only will your kid like the view, but you can use stranger anxiety to keep him from trying to make a run for it.
  • If you are flying with your child on your lap, upgrade to get extra legroom. You can let your kid stand up a bit or maybe even play on the floor (depending on how MUCH leg room there is). And in case of tantrums, flailing limbs are less likely to hit the seat in front of you.
  • Babywear through security.
  • Ask for an empty cup and/or water bottle for your kid to play with.
  • Make sure to nurse or give your child something to drink during take off and landing to help with eardrum pressure.

Hopefully these things will help you get through your trip without any meltdowns from your toddler OR YOU. If not and your kid has a tantrum, hang in there! And maybe buy your neighbor – and yourself – a drink to cope.

Moms and dads, what did I forget? What are your tricks for traveling with toddlers?

Cancer is a Thief

Another school year has begun. Jack’s fourth grade teacher seems likes she knows her stuff. Right from the start she walked the kids through how to organize their day so that there are fewer opportunities to “forget” homework; they carry a binder with a planner inside and dividers for each subject. Every day the class reviews what is to be done that evening and writes it in their planners. Ms. A is helping them establish executive function skills, an area in which Jack has a lot of trouble thanks to cancer treatment.

In addition, she is starting off the year with light homework that is mostly review material. Which is great…

Except that Jack is struggling a bit with even this small amount of homework. He is fighting increased anxiety and having bouts of depression. By the second week of school, he was difficult to rouse in the mornings. He drags his feet getting ready to leave and is incredibly slow and distractible when doing any task. He complains of stomach aches or nausea a lot. He speaks of the pressures of being in fourth grade and he despairs about growing up.

My son has turned into Peter Pan.

Last week I met with Ms. A and the school’s new resource teacher to review Jack’s IEP. Afterward I felt exhausted and defeated. I’d tried to explain the issues we’re dealing with but they didn’t seem to grasp it. I guess that’s not a surprise – I feel like I am gaining new understanding all the time about why Jack’s experience with cancer has had such a profound impact on him academically and emotionally. The territory we’re in – that of a childhood cancer survivor – is relatively new in the grand scheme of things. Schools and even our oncology team are still learning what the long term effects of cancer treatment are.

As a parent of a survivor, I get a unique and up-close perspective (lucky me!). I’m only now really coming to understand that cancer is a time thief. This effect feels more pronounced with a child – a treatment that spans three and a half years impacts many more developmental phases in a child as compared to an adult.

Jack Kindergarten

Jack, age 5, first day of Kindergarten

In school and outside of it, Jack spent much of the last three and a half years in a haze. Compared to other kids his age, he didn’t play much of the time – he didn’t have the energy. He went from being a happy-go-lucky five-year-old to an intense and conflicted nine-year-old…he didn’t have much opportunity to be a kid in between those two points in time. He didn’t admit it at the time, but he admits it now: he was afraid of dying.

Academically, we are observing that Jack is missing some key building blocks for math. This past Thursday, we spent at least an hour together going over a fairly simple problem – 3,000 divided by 10. It was as if he had never divided before. And while he can answer 5×3 relatively easily, 5×30 is a whole different ball game. He hasn’t been able to connect increasingly complex math concepts with the basics.

Some of the building blocks are missing due to frequent absences from school for treatment or side effects from treatment. He missed half of kindergarten and started first grade a couple of months late because he had no ability to fight off illness. Once he was given the okay to go back to school, he rarely attended a full week until sometime in the later part of third grade. Generally if he was too sick to attend school he was also too sick (or just plain foggy-brained) to do any schoolwork at home. We did our best, but he was going at a snail’s pace while his fellow students sped along at school. When he did make it to school, he felt lost and like an outsider.

Other building blocks are missing due to the effect of chemotherapy on the brain. One of the key chemotherapy drugs Jack was given went into his spinal fluid and is known to cause learning problems in things like math and executive function. We were warned about this, but it’s not something we had the time to worry too much about because we were so busy going to and from various appointments and dealing with administering medications or battling side effects. We had limited emotional capacity for worrying about that, in any case. It was always in the back of my mind, but I had no choice but to push it aside and carry on.

Now Jack is faced with trying to catch up in an environment that barely acknowledges that he has fallen behind. He has to work much harder to stay on track – both to fill in the blanks and to learn the next thing.

Meanwhile, he has boundless energy, almost like he’s been saving it up all these years. He wants to PLAY and EXPLORE and TALK. But fourth grade is stricter, harder, has one less recess, and more kids per class. Fourth grade demands more maturity out of the kids and it just happens to coincide with a time when Jack is trying to shrug off the very thing that demanded maturity of him too soon and attempting to, essentially, recapture his youth.

Jack DC Ball Pit

Jack, age 9, in a giant ball pit in DC

Jack feels a sense of unfairness and has articulated it in his own way from time to time. “I’m dealing with cancer; why do I have to do homework?” is one line I’ve heard on several occasions. And there is the repeated refrain, “I don’t want to grow up! It’s too much pressure!”

It has taken me some time but I understand now. Three and a half years of treatment left Jack with only vague memories of what a carefree existence was like. He has his life, thankfully, but he also has PTSD and lives with so much fear. He can’t get time back – cancer has stolen his innocence and so much of his childhood.

Many nine-year-olds struggle with school and homework – in that, Jack is not alone. But Jack is the only one in his class (and, as far as I know, the only one in his school) who is dealing with those things while trying to make up for years of lost time and heal his soul. The school faculty have no idea how to help him.

Neither do I, really, but I won’t stop trying.