The United States' highest court is about to decide if a universal health care system will be introduced in the country. For families like the Ritters, the ruling will determine how they live the rest of their lives.
Anyone who knows the Ritter family's story might be surprised by how idyllic their house looks. They live in a new neighborhood on the outskirts of a town called Manheim in south-eastern Pennsylvania, occupying a two-story house with a light-brown wooden facade typical for this area. A gray station wagon stands in the driveway; roses and chamomiles decorate the entrance. The family's pet dog, a poodle named Bailey, plays outside. The air smells like freshly mown grass and freshly baked cookies.
Stacie and Benjamin Ritter live here with their four children: Abby, Ethan and twins Madeline and Hannah. The twins are identical but have completely different personalities. "I am the hippie," says outgoing, talkative Madeline. She is dressed in a linen skirt and wooden jewelry. In her spare time she paints pictures and makes earrings. Hannah, meanwhile, is shy and reserved. She wears black eyeliner and writes short stories about vampires and werewolves. "Hannah is a bit of a goth," says Madeline of her sister.
Hannah and Madeline are two typical American teenagers - but they have already lived through a lot more than most other 14-year-olds. When they were four they both developed a rare form of leukemia. They spent eight months in hospital fighting for their lives before a suitable stem cell donor was found in Germany. But they are still not healthy. "The treatment doesn't end when you leave the hospital," explains Stacie.
The cancer therapy stunted the girls' growth. They are smaller than their female classmates and only a few centimeters taller than their sister Abby, who is five years younger. Their survival still depends on expensive medication.
Hannah und Madeline survived cancer, but the therapy is barely affordable
The burden of pre-existing conditions
The twins were lucky to survive cancer, but in the current US health care system they are classified as high-risk patients. The term "pre-existing condition" hangs over them like a dark shadow. For a long time, American health insurance companies did not accept patients who had suffered from serious illness prior to applying for health insurance, or they offered them unaffordable premiums.
President Barack Obama's health care reform plan prohibits this kind of discrimination in the case of children, and it is set to include adults from 2014 onwards. But if the US Supreme Court rejects the reform, the Ritter twins' history of cancer could become their downfall. This could happen if their father lost his job and with it the family's health insurance - but even without this misfortune they would inherit the burden on becoming adults.
"We're talking about thousands of dollars in premiums," says Stacie. She sits at the dining table, speaking slowly as she recalls her daughters' illness and their health insurance struggle. Her words reveal a deep disappointment with her country's health care system. The leukemia treatment resulted in $30,000 in debts for the family. Half a year after the twins were diagnosed with the illness the family had to declare insolvency.
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US Supreme Court to decide on health care reform