Living on a Thin Line

When Chris Nilhas learned he had cancer, his wife, Beckie, knew she might lose him. She didn't know she and their three young sons would also risk losing everything else.

As of last month, 16 months after the initial diagnosis, by Beckie's binder count, Chris had received 52 chemotherapy treatments; had four hospital stays and made 21 doctor visits; and undergone six chest X-rays, five CAT scans, four MRIs, three ultrasounds and one PET scan, plus weekly blood tests. The chemotherapy started with intravenous administration of 5-fluorouracil and pills of Xeloda; Chris also received IV doses of the antibiotic NeuTrexin. In April, three harmful strains of bacteria were detected in Chris' blood; he was hospitalized so that a strong antibiotic could be administered. But the treatments failed to stem the cancer's spread. The results of a test that reveals tumor markers in a blood sample went from an April 2000 level of 8,733 "tumors" to 52,012 on June 29 this year.

Since that bleak Tuesday when Chris was first given the cancer diagnosis, he has not worked. He first used up his sick days, but after that he received no income from Station Casino. After his supply of sick days was exhausted, the Family and Medical Leave Act kicked in. During that 12-week period, his employer was required by federal law to pick up the cost of medical insurance. Then there was a 30-day leave, when Chris paid his normal part of the insurance. After that, Chris was protected by the federal Americans with Disabilities Act, which enabled him to keep the same insurance coverage -- for a while. Once it became clear that Chris likely would not return to his job, even in a disabled capacity, the ADA protection disappeared.

On Aug. 7, 2000, just four months after his diagnosis, Dr. Morris sent a two-sentence letter to Station Casino: "Mr. Nilhas is under my care for colon cancer metastatic to the liver. He is totally and permanently disabled." Chris continued to pay his share of the monthly insurance fee and was covered by his HMO, HealthLink. On Oct. 12, Dr. Morris sent another letter to Station Casino. Two new sentences were added to the text of the earlier letter: "Chris cannot physically perform the duties of his job. He is currently receiving treatment and at times his immune status is severely depleted due to the treatment."

Denise Pauley, a neighbor of the Nilhas family, took the family's bills to work, where kindhearted co-workers chipped in to help.
Ryan Hudson
Denise Pauley, a neighbor of the Nilhas family, took the family's bills to work, where kindhearted co-workers chipped in to help.
Beckie and Chris Nilhas: "If it were just me and her, it wouldn't be so hard," Chris says.
Ryan Hudson
Beckie and Chris Nilhas: "If it were just me and her, it wouldn't be so hard," Chris says.

On Oct. 26, Chris' supervisor called Chris and told him his employment was being terminated. That meant the employer had to offer COBRA coverage, in which the former employee can continue the same medical insurance, provided he pays the both the employer's and employee's shares of the coverage. For the Nilhas family to continue the same health benefits would cost $410 a month. To carry Chris alone would cost $135. Chris and Beckie decided to carry just Chris and turn to Medicaid to cover the rest of the family.

Beckie mailed an application for COBRA coverage on Nov. 15 and received a notification on Nov. 22 saying that to extend coverage, prorated for part of November and all of December, $157.55 was owed. Beckie sent a check for that amount on Dec. 18, then waited for a bill to come in January. There was no bill. But then, a bill isn't supposed to be sent monthly, something that was mentioned in the initial notice but that Beckie didn't see or doesn't remember seeing. On Feb. 9, Beckie called USI, the insurance handler of the COBRA account, and was told that because she had missed a payment, Chris had been dropped from the plan.

That meant Beckie also had to turn to Medicaid to provide coverage for Chris. In order for the family to qualify for Medicaid, they were required to "spend down" what was left of the family assets. The family's retirement savings were cashed in. Because she needed to be home more often to take care of Chris and the kids, Beckie had stopped working at Toys R Us and had taken a part-time job waiting tables at Denny's to bring in some money. To stay on Medicaid, she had to quit that job. As long as the family's assets were low enough, they also qualified for $250 per month in food stamps.

By this time, because he was disabled, Chris qualified for Social Security payments. Chris receives $911 per month, and each child qualifies for $151 per month. That amounts to $1,364 per month. Because Beckie couldn't work without jeopardizing the family's Medicaid coverage, that $1,364 per month, along with $250 in food stamps, represents the total income of the Nilhas household. With a monthly mortgage payment of about $800 and a truck note of $409, little was left for miscellaneous fees, particularly utility bills, gasoline costs, clothes and day-to-day expenses.

Chris and Beckie hoped they could trade in the '99 pickup truck and Escort for one vehicle or do some kind of trade-in or swap. "We had two vehicles with two loans because we had two jobs, we had normal lives. When all of it went down, we wanted to turn one of the cars in," Beckie says. They went back to the dealer to talk about the idea of doing a "voluntary repossession," turning one or both vehicles back in because they couldn't afford them any longer.

"We walked into the dealership -- and this is how cold people are -- we told them our situation, told them what we wanted to do, and the guy said, 'Well, with your income and everything, we can't do anything for you, but you do have life insurance on both of these, so when your husband passes away, they're paid off.' I walked out of that door crying," Beckie says. "That was said to me in August of last year, so it was all very fresh. People just don't think before they talk."

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