STEVE INSKEEP, HOST:
For more than 40 years, the state of Michigan had a unique system of high-quality lifetime care for people with the most serious injuries from car crashes. Now new auto insurance changes are dismantling that system.
Michigan Radio's Tracy Samilton reports this is causing real problems for thousands of accident survivors.
TRACY SAMILTON, BYLINE: Here's what happens to most severely injured car accident patients in the U.S. At the hospital, survivors with spinal cord and traumatic brain injuries get their initial surgeries and treatment.
But Susan Connors, who heads the Brain Injury Association of America, says it's often downhill from there.
SUSAN CONNORS: They're going to send you - you know, my favorite phrase is discharge to the couch, but it could be any kind of facility that will take you where you will not get rehabilitation. You will not get cognitive stimulation. You'll get three meals a day and a change of sheets. And that happens all over the country.
SAMILTON: For the last four decades, Michigan was different. Its unique no-fault insurance law assessed a surcharge - about $15 to $20 a month - to cover high-quality lifetime care for such survivors. It paid for one-on-one nursing care in your home if you needed it, ongoing rehabilitation, transportation to therapies and doctor's visits. But three years ago, Democratic and Republican leaders joined together to scrap that law. They replaced it with a hastily drafted one they said would make car insurance in Michigan affordable but which also slash payments nearly in half for the agencies caring for crash survivors. Now many of those agencies are going broke.
CONNORS: What they have done is essentially gone to the bottom of the barrel.
SAMILTON: Providers say, for many of their patients, this can be a tragic turn.
UNIDENTIFIED OPERATOR: Of your emergency?
SHARA CURRY: Hi, my name is Shara Curry. And I'm calling to report that Kelley Miller - she's a vent-dependent quadriplegic. She is without care.
SAMILTON: Kelley Miller is going to the hospital today. She's not sick. Her home care agency just can't afford to take care of her anymore.
CURRY: She cannot take one breath on her own. And there's no...
UNIDENTIFIED OPERATOR: OK, so she needs an ambulance. Is that your question?
CURRY: She needs an ambulance.
SAMILTON: Miller's accident in 2011 left her paralyzed from the shoulders down, but she could live at home with a nurse and aide 24/7. She lived with her husband. She was part of the community, babysitting her grandkids and going on outings.
KELLEY MILLER: My granddaughter's birthday party is today at Skateland. And it's something I looked forward to. (Crying) But I won't be there.
SAMILTON: Nurse Shara Curry has been with Miller for 10 years. She watches the EMTs hoist her onto a stretcher. She's crying. She says Miller's ventilator stops working on a regular basis. So if the hospital forces her to go to a nursing home...
CURRY: We save her life at least twice a month. In a nursing home, she can't move. She can't press a call light. How would she let them know that she was in trouble?
SAMILTON: Miller's husband Bud is also distraught as the ambulance takes his wife away.
BUD MILLER: It's just killing us, how the laws can this do what they want to destroy people.
SAMILTON: So far, more than 1,500 auto accident survivors have lost their care, according to an independent study. Several have died.
TOM JUDD: This is just the beginning.
SAMILTON: Tom Judd heads the Michigan Brain Injury Provider Council.
JUDD: You know, over the next few months, we're going to see more and more companies who are just - can't hold on any longer, and more and more patients are going to be displaced.
SAMILTON: Starkly put, he says more people will suffer, and more will likely die. Republican leaders in the state legislature have largely ignored media requests for interviews about the law's impact, and they've declined to schedule hearings on bills that were introduced to address what's been happening. For their part, insurance companies often say they're not taking care away from anyone. They're just following the law. Or they blame the care agencies for the situation, claiming they're price-gouging.
Susan Connors says this was largely avoidable.
CONNORS: And honestly, it didn't have to happen. Any one of those policymakers could have taken a look at any of the other states around the nation and understood how fantastic a system you had in Michigan and how awful it is elsewhere.
SAMILTON: As for making car insurance in Michigan more affordable, advocates for survivors say the law failed there, too. At the time the new law was passed, Michigan had the most expensive car insurance in the U.S. It's now number two. And in the past year, insurance premiums in the state have gone up again.
For NPR News, I'm Tracy Samilton.
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