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Monday
Aug082011

Man with Breast Cancer Denied Medicaid Coverage 

Photodisc/Thinkstock(CHARLESTON, S.C.) -- For Raymond Johnson it was bad enough being diagnosed with cancer when he was just 26 and without health insurance, but his shock was only aggravated when he was denied Medicaid, because rules say men are not covered for breast cancer.

Johnson, a construction worker from Charleston, S.C., is one of the roughly 2,000 men who develop breast cancer each year -- just 1 percent of all breast cancer cases.

But doctors say even though the numbers of cases may be small compared to the number of women who get the disease, what male breast cancer patients suffer is no less real.

When Johnson developed the lump, he said he ignored it, thinking it was just a cyst and wanting to avoid the cost of a doctor's visit. Besides not having health insurance, he said, his job for a small construction company does not allow him to make ends meet as it is.

But then over the July 4 weekend, he said, the lump caused an unbearable pain and he rushed to the emergency room. "They thought it had to do with my heart, but I showed them the lump and they sent me to get a biopsy," Johnson said. "That Tuesday, I was notified I had breast cancer."

Johnson said he was shocked, because he'd never had health issues before, but more than that he was concerned about how he would pay for treatment.

Though Johnson wouldn't normally qualify for Medicaid in the state of South Carolina because he is a single, non-disabled man with no children, he was advised to apply for a special supplementary program created specifically for those diagnosed with breast cancer whose income is 200 percent of the poverty line ($21,780 per year) -- even those with no dependent children. What Johnson didn't know is that the program, created by the Breast and Cervical Cancer Prevention and Treatment Act, is for women only.

He was sent to the Charleston Cancer Center to seek treatment and arrange for surgery to remove the baseball-sized tumor, according to his medical records at the center.

He and his family met with Susan Appelbaum, a breast cancer navigator and patient advocate for the Charleston Cancer Center, and he told her he had applied to the Department of Health and Human Services for Medicaid.

On July 11, he called Appelbaum to tell her he'd been denied coverage because he's a man.

Though health care reform might have changed Johnson's position, the controversial Affordable Health Care for America Act is facing challenges from dozens of states, and doesn't officially kick-in until after the 2012 election. For now, Johnson is on his own.

Copyright 2011 ABC News Radio

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