Kelsey Binas celebrates her first birthday today. There will be a little party. And a cake. And gifts.
The gift she needs, though, Kelsey won't be getting.
In the medical field, it's called a peg -- a feeding tube that goes directly to the stomach. It's not a difficult operation, maybe an hour's work. The doctor performing the surgery gets $500 to $1,000. The anesthesiologist costs another $400. The hospital might run $700, lab work $100. The total is around $2,000.
Insurance would cover most of the cost -- except that Kelsey and her 2-year-old brother and her mom and her dad are among the 600,000 people in Maryland and 30 million nationwide who have no health insurance.
What the Binas family has instead is an ever-growing mound of bills and a 1-year-old who requires constant medical attention.
"Sometimes, I feel like I don't know what I can do anymore," says Kelsey's mother, Chris Binas.
The Binases are the people you hear about who fall between the health-care cracks. Kelsey's father, Leo, is a supervisor in a firm that does not offer health insurance. Leo's take-home pay, after taxes, is $460 a week. Basic, non-group health insurance runs several hundred dollars a month -- more than the family thought it could afford.
"When I was going to have Kelsey, we paid $1,500 and that was supposed to cover everything -- the prenatal care, the doctor, the hospital, the whole thing," Chris Binas said. "We never anticipated that anything would go wrong. I guess you never do."
There were, of course, complications. There were massive complications. Little Kelsey was born with cerebral palsy. She is mentally retarded. Her head is abnormally small and might require surgery to correct the problem. She has seizures. She may be blind.
Her first year has been a parade of doctors and nurses and therapists.
And bills. Always bills.
But Kelsey is not simply a patient. She's somebody's child. And as she sits in her mom's arms in a modest Middle River apartment, Kelsey offers a smile.
"At first, the doctors said she wasn't going to make it," Chris says. "Then, when she was in a coma, they said she might be a vegetable."
She pauses, catches her breath and turns to Kelsey.
"You keep fooling 'em, don't you, Kels?" she says. "You keep fooling 'em."
Chris Binas talks with a mother's pride about her baby. And, with a mother's pain, too. Kelsey now has a feeding tube that runs down her nose. It aggravates her sinuses and also her harried mother. The stomach peg is a much superior option, but one that's not available.
"It's not a life-threatening situation, so the hospitals won't take her without insurance," Binas says.
They can't afford the operation, and they already owe plenty. There's more to come. Kelsey will need special walkers, maybe a wheelchair. She may need glasses. She's on a formula now that runs about $40 a week. The medicine is another $50 a month. When she saw a developmentalist, the visit cost $520.
And there are neurologists, ophthalmologists, gastroenterologists, nurses, physical therapists to whom they owe thousands. They owe another $5,000 to the hospital where Kelsey was born.
"We try to pay what we can," Chris says. "We pay $20 a month here, $20 a month there. My husband works all the overtime he can, but like he says, it never seems to be enough. It feels funny having to go to doctors, knowing you owe them money. It's hard."
At first, they thought they were going to get help from Social Security. For three months, they received checks. Then, it was determined that Leo made too much money to qualify and the checks stopped.
There is now some hope of health insurance at Leo's firm. But there's a question whether it would cover Kelsey's condition, and it may cost $500 a month.
Chris can't get a job to help. Somebody has to care for Kelsey, who typically has medical appointments four days a week. And so, there's no money for anything except the rent and food and some of the medical bills.
"The stress," Chris says, "is very hard to deal with sometimes."
Forty miles south of here, the arguments will begin soon on universal health care. The Clinton plan will be unveiled. Congress and all the lobbyists will have their say. And in an apartment in Middle River, the Binas family hopes somebody does something.