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| Barbara: Berks County, PA |
I like games just as much as anyone else. However, in the past 9 months of my journey across the state of Pennsylvania, there is one game I have come to realize I no longer want to play. That’s the game of healthcare poker. Let’s face it, to insurance companies, it’s a game. If you get dealt a bad hand or play your cards wrong, you lose. I won mine with beginner’s luck, I missed the lapse of coverage by 48 hours. However, so many people loose in the worst kinds of ways, as we know with the story of Billy Koehler.
Let’s take Barbara Stakes as an example. Barbara is a 64 year old Buck’s County resident. At the age of 42, Barbara discovered she has a seizure disorder called Venous Angioma. However, to the insurance industry her disorder has another name. It’s called a “Pre-existing Condition”.
So what has this meant to Barbara? Since her condition appeared in the late 1980‘s when she worked as an administrative assistant for a biotech research company, she was covered under a large group employer plan and she had full coverage. However, when the company closed it’s doors in September of 2002, she lost her health insurance. Fortunately, she still had a hand in this “game”. Her 60 year old husband who worked for Amtrak was able to take her on his policy.
As with all games though, sometimes you loose. In 2007, Barbara’s husband turned 65 and he was therefore automatically enrolled into Capital Medicare. She was now uninsured at the age of 59 and had to play a new hand in this sick and twisted game of healthcare poker. Let’s explore her possible moves: (1) an unaffordable COBRA plan for $650 a month, (2) gamble with being uninsured and pay $400 a month for prescriptions or (3) call the private insurance companies and try and get a comprehensive policy.
Barbara went with #3. When she called two large national health insurance companies, a customer service agent leveled with her and said, “go ahead and apply, but you’ll probably get rejected”. Barbara played the hand anyway, but lost. One immediately rejected her and in the letter it stated it was due to a “health history that exceeds the allowable limits”. However, the other accepted her for $835 mo. with a $5000 deductible (Barbara’s pension was $1230 month). Go ahead and do the math. Yes, that’s more than her yearly income! Let’s face it, that was a denial for a “pre-existing condition” too.
In the end, Barbara had no choice but to choose option #2 and gambled for 3 1/2 years without insurance until the PPACA was passed in 2010. At that time, PA Faircare began, the high risk pool to assist the uninsured until the state based exchanges open up in 2014. For now, Barbara is able to manage the $283.20 a month premium with at $1000 deductible.
This October, Barbara will be eligible for Medicare. However, according to a recent (April 2012) Government Accountability Report to Congress, on average, 32% of the US population has a pre-existing condition, with this number drastically higher among older populations. After 2014, the “house” will no longer always win. Under the PPACA, insurance companies will no longer be able to deny customers due to pre-existing conditions and for those that can not get insurance through an employer, there will be state based exchanges where individuals can go to purchase insurance at a reasonable rate. All policies are subject to basic patient protections, must provide essential benefits and based on one’s income, individuals may qualify for a premium tax credit.
Right now we sit at the crossroads of uncertainty while we wait for the Supreme Court to decide the fate of the PPACA. To those who oppose the PPACA, I ask you this question: should we continue to play this game of healthcare poker? As for me, I’ll pass.
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| Source: Department of Health and Human Services |
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