Issac J. Bailey | Russian Roulette health care

Officials in Washington, D.C., Columbia and elsewhere are scrambling to figure out just how to embrace the Affordable Care Act now that President Barack Obama has been re-elected..

They’ll be discussing philosophy and ideology, costs and quality, state and federal responsibilities.

They also need to keep in mind stories such as Shannon Sherman’s.

Sherman and her husband Jeff spent the past couple of decades doing what we all are encouraged to do, paying down debt, living within their means and being responsible citizens.

After Shannon was laid off from AVX years ago, she used money that others would have blown to pay off their mortgage.

She and Jeff have – and do – work hard.

They spent almost a quarter of a century paying monthly health insurance premiums through Shannon’s employers.

But Shannon was laid off from the Kimbrell Company in March 2011. The COBRA coverage the company paid for expired two months later.

She’s been able to get temporary work, including a stint with International Paper in Georgetown, but none that included benefits. Her husband’s small employer can’t afford to provide coverage, either.

They had been making it without until one day several weeks ago when a brain aneurysm blew them off course, instantly thrusting them into the debt they had so meticulously avoided.

The bills, so far, amount to at least $80,000, and that includes a 60 percent discount from one of the hospitals that treated her.

Jeff initially rushed her to the South Strand medical center. She was then flown to the Medical University of South Carolina in Charleston.

That ride cost $28,000.

She was hospitalized for about a week, miraculously surviving an incident many don’t. Then she was rushed back to Charleston not too long afterwards because of a mini-stroke.

They have bills, but they still don’t have insurance.

Here’s one of the frustrating truths about our system:

Had Sherman been diagnosed with breast or cervical cancer, she likely would have been eligible for Medicaid.

It’s the result of intense lobbying by those in the fight against breast cancer.

It’s a noble cause but underscores a reality about the American health care system that makes little sense – funding and health care priorities are often based too much on those who have the loudest, most influential voices instead of what’s best for the system as a whole.

That’s something Tony Keck, director of the S.C. Department of Health and Human Services, seems to understand.

“Congress said here’s an illness that we should give coverage to at higher income limits,” Keck said. “It shows the problem of awarding coverage to people based on their income instead of real health needs. We’d like to have flexibility to use the dollars in situations like these to serve people that we really want to serve.”

That’s one of Keck’s criticisms of the Medicaid expansion planned through the Affordable Care Act, an expansion he and Gov. Nikki Haley oppose, even while many other health care professionals in the state, such as the S.C. Hospital Association, believe the expansion should move forward. The cost of expansion will be fully paid for by the federal government in the initial years and no less than 90 percent in the intervening ones. Still, Keck says it is too expensive.

The good thing is that the political games played with health reform are mostly behind us. The Affordable Care Act will be implemented now that President Obama has been reelected. The only questions that remain are how states who have opposed the law, such as South Carolina, respond.

Keck and others have been working on a plan he said would bring down costs and improve quality – the same goals of the Affordable Care Act – that might allow South Carolina to opt out of certain provisions of the law.

There’s little reason to rehash the political back-and-forth now, or guess how negotiations over the fiscal cliff will reshape health care funding.

The Affordable Care Act is here to stay. State officials have to find a way to improve access to the state’s health care system – about a fifth of residents don’t have health insurance – or the federal government will.

That’s the good news for people such as Sherman who work hard and are blindsided by the sin of unexpectedly getting sick, the kind of sin that has become the No. 1 cause of personal bankruptcy in the country.

The Affordable Care Act, which won’t be fully implemented until 2014, include provisions designed to help families such as the Shermans, including a temporary program that makes individual insurance cheaper – right now, despite a pre-existing condition such as a brain aneurysm – than it otherwise would be and insurance exchanges that will do the same in coming years.

Even with those changes, the Shermans have to contend with tens of thousands of dollars of health bills because for too long in this country we’ve allowed a person’s level of personal wealth to determine their ability to access the system.

“We can’t go back into debt over this. I don’t think we should have to,” Sherman said. “I’m a little nervous, but I’m not too worried. There is no way we will ever just be able to pay it off unless we hit the lottery. But we are not likely to hit the lottery.”