HARTFORD, Wisconsin — Tiffany Koehler was raised in foster care, is biracial, a veteran and a cancer survivor.
She also is a former candidate for the Wisconsin state legislature. She ran as a Republican and once was anti-Obamacare. Today she says she supports it — mostly.
Her biggest objection remains the mandate that individuals must obtain health insurance coverage. “We all want to thrive,” said Koehler, “and make America great again, as (President Donald Trump) says, but we can’t do that if we’re struggling to pay bills.”
“People have to be able to get to their doctors. People have to be able to get their medicine,” said Koehler, “and out of any country in the world we should be doing it.”
Two years ago, after losing her job, she did something she always had wanted to do; she ran for a seat in the Wisconsin State Assembly. She lost, and in the aftermath of that disappointment, got some awful news — she had cancer. Koehler had been diagnosed with non-Hodgkin lymphoma.
“I was Stage 4. My prognosis was poor. I wasn’t supposed to survive,” she said.
When she lost her job she got health insurance through the Affordable Care Act marketplace. But she soon found that the $400 monthly bill was too high for someone who was unemployed.
So she dropped Obamacare and opted for Medicaid, under Wisconsin’s BadgerCare Plus program. It’s the only state in the US to adopt federal guidelines for Medicaid expansion but not accept federal money.
Koehler, recently was diagnosed with a thyroid condition possibly related to her cancer and still has three years of monitoring before she can be declared cancer free. In all her care and treatment so far has cost more than $1 million.
She has a message for Congress and President Trump as they press ahead with repealing President Obama’s signature legislation. “They can be celebratory in Washington” but, she said, “it’s going to have real-life implications and they have to realize that.”
Dick Woodruff, who lobbies Congress on behalf of the American Cancer Society’s Cancer Action Network, said under the current Republican proposal a forty-something cancer survivor making around $50,000 a year could expect to pay at least $1,000 monthly for treatment — far above the $400 Koehler was paying in the Obamacare market.
They probably would qualify for a partial tax refund at the end of the year, but the out-of-pocket expense would likely be substantially more under the plan Congress is considering.
“The lowest income individuals who currently receive premium subsidies,” said Woodruff, “are going to be losers because they’re going to get fewer subsidies.”
Many with cancer rely on Medicaid
He also said Medicaid recipients — the poorest and most vulnerable — will likely also suffer over time.
The Medicaid expansion under the Affordable Care Act covered some 11 million Americans — but estimates by the Center on Budget and Policy Priorities calculate the current Republican plan would cut $560 billion from the federal Medicaid program over the next decade.
Woodruff said today there are about 1.5 million Americans with cancer relying on Medicaid, many of them children.
Under the current Republican proposal “it’s quite possible that as states begin to lose money … and begin to change the enrollment requirements or eligibility requirements, particularly for single adults, some of those people could be dropped.”
Koehler was born to a mother with mental illness, cycled through 19 foster homes by the time she was an adult and served 14 years in the Wisconsin National Guard. For her, surviving cancer and losing a political race were bumps in the road.
She wants to write a book about her experiences to inspire others. “Maybe down the road,” she said, “when there’s an open seat I will run and win.”