Hormones Matter TM

Falling Through the Cracks

March 26, 2012  |  Lisa Solod

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Lisa Solod

Editor’s Note: A version of this article was previously on www.Huffingtonpost.com and www.Middleagedfeminist.com

In the early nineties, I lived in Oxford, England, as the new mother of a six-month old. Nurses regularly came to our flat for well baby check-ups; all of my medications and doctors’ visits and all those for my child were free for the first year of her life. My prescriptions averaged around ten dollars each, no matter how expensive they were. I was only a temporary resident.

Ten years ago, I lived in France for two years and my prescriptions were uniformly 7 Euros each, even though the medication cost close to three hundred dollars in the United States. In both countries, I received health care as good or better as I have ever received in the US. In France, I broke my foot and the treatment was remarkable in how fast it got me back on my feet.

Past Insurance History Doesn’t Matter

Now, back in the United States, where I have had health insurance for the past 27 years in the state of Virginia, I haven’t been able to qualify for health insurance in the state of Georgia, where I recently moved. I am being denied due to the number of medications I take. As ignorant as I was, I didn’t consider I would have to apply and be medically underwritten for insurance all over again when I moved. Health insurance does not transfer. Did you know that? I didn’t. Even if the company writes under the same name it does not transfer. Blue Cross of Georgia has no obligation to cover me even though Blue Cross of Virginia has covered me for years. Other companies I have contacted have given me the same answer. I may get coverage from one company, but they will require a rider which will exclude the most expensive of my medications, an inhaler which I take for life-long asthma and costs nearly $300 a month. That same inhaler was less than 7 dollars in France and with my current co-pay costs me $90 a month out of pocket. The individual policy I currently have has a large deductible and still costs me close to $600 a month. I have a friend who has cancer and whose husband had a stroke, who pays almost $3000 a month. Yet health insurance companies run as for-profit enterprises and fat-cat CEOs are banking millions off the checks of people who are betting against themselves and millions more because they won’t insure anyone who might be a risk. None of the executives of large insurance companies makes less than $3 million a year and most of them make far, far more than that.

Although, supposedly children under 19 born with pre-existing conditions cannot be denied insurance, that doesn’t count for those over that age. If you look at the applications you will find that people with Down’s syndrome, a history of bi-polar syndrome, or history of a stroke or heart attack needn’t apply. If you have multiple sclerosis or other nerve diseases, like fibromyalgia, you cannot get coverage. If you have emphysema or COPD, denied. If you have ever had a drug or alcohol problem, don’t apply. If you take more than three medications, your chances are pretty slim. In fact, if you think you might be the kind of person who might need insurance, you are out of luck. If you are young and healthy insurance companies are quick to take your money. However, until the Affordable Care Act goes into effect, insurers may just as quickly drop your coverage or deny treatment should you actually need medical care. It’s no wonder medical bills are the number one cause of personal bankruptcy in the United States, and a huge majority of those who do file had some sort of insurance.

What IS it about the Affordable Care Act?

Yet the Affordable Care Act, which invokes the ire of Republicans, leaves much out and even its best provisions do not come close to approximating universal health care as can be found in much of Europe and Canada. Though it states, “For most plans starting on or after September 23, these rules stop insurance companies from imposing pre-existing condition exclusions on your children; prohibit insurers from rescinding or taking away your coverage based on an unintentional mistake on an application; ban insurers from setting lifetime limits on your coverage; and restrict their use of annual limits on coverage,” there is no provision that covers people, like me, who wish to get individual insurance in another state. While banks run wild with derivatives, we finance multiple wars on credit, spend billions on subsidies for huge corporations, and tax cuts for everyone, we still are unable to “afford” to do anything about insuring all of our citizens.

People, like me, who are self-employed, meaning their health care is not provided by an employer, and the many unemployed are still on their own to cobble together what they can afford or go without. Under the Affordable Care Act, anyone with a pre-existing condition (which basically means anyone with any kind of serious illness or anyone who takes more than three medications) can qualify for a good policy through the government, but only after he or she has gone without health insurance of any kind for six months. That means I would have to drop my Virginia policy and go uninsured – paying out of pocket for all my medications and praying that I don’t have an accident or come down with some horrible disease – before I can qualify. The clause that forces insurance companies to take those with pre-existing conditions won’t kick in until 2014. Until then I, along with many others, am out of luck.

I am not particularly unusual. I am a relatively healthy 55 year old woman. In fact, a doctor quite recently pronounced me in good shape. I eat properly and I exercise regularly. Nothing catastrophic has happened to me, yet. But, because of my pre-existing conditions I am now basicaly uninsurable in a new state, despite my past insurance history. For twenty years, I had insurance through my husband’s employment. When we separated and divorced, he was allowed to carry me for three years. Four years ago, I applied for my own insurance through his same company and was given a policy, a policy that had gone up by nearly fifty percent. Two of the conditions I have now, I had then. But I now take two other medications and that is two too many for an insurance company. I think it is a great irony that with one exception, the top executives of the afore-mentioned insurance companies are my age or older, and, I suspect, take medications or have conditions that might make them uninsurable. Yet, while insurance company CEOs’ pay goes up and up, their pool goes down and down. This may change now that insurance companies are supposed to use at least 80 percent of their monies to provide health care, but only time will tell. I was told by one broker that Blue Cross routinely denies coverage to sixty percent of people who apply.

All Insurance is NOT Equal

When I began applying for new coverage, I was inundated with sales reps and emails touting their “affordable” coverage. (Lots of them are scams, telemarketers offering inferior insurance with no major medical; I almost fell for one myself. Dateline recently did an expose of those insurance mills and many states are shutting them down, but still they prey on thousands of people each day.) Blue Cross sold me hard and after taking down my medical history assured me that I would get coverage. I called about my status and days later received an impersonal letter in the mail denying me. I still get emails pushing insurance, but I am smarter now. I finally found a broker who seems to know her business (after two brokers told me, in no uncertain terms, that I was completely uninsurable), who may have steered me to a reputable company which may cover me. This is after hours and hours of filling out essentially useless applications to companies who did not have the decency to inform me that they were mere salespeople and that the underwriters had all the power. And, according to my most recent broker, it doesn’t look good that I have been denied coverage. It’s a black mark that I have to disclose on all future applications.

This self-described, “greatest country in the world,” has a lot to answer for when its citizens can either not qualify for health insurance or can’t afford it if they can. The Affordable Care Act made some tiny inroads into a deeply broken system, and even those inroads the Republicans wish to repeal. Meanwhile, millions of uninsured people go to bed each night hoping nothing serious will happen to them, millions more have to choose between paying for their medicines or paying for food, and millions of others are filing for bankruptcy to pay for past and present medical bills.