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Posted at 9:54 AM ET, 10/13/2009

My Health-Care Story: Over 50 and Out of Luck

By washingtonpost.com editors

By John Hewko
Washington

I am a Republican who did not vote for President Obama, but I support his health-care initiative because I have just experienced first-hand our system's dysfunctional wrath -- and it isn't pretty.
Recently, I left my job with the federal government -- I was a political appointee, so my tenure was limited -- and became an independent consultant. Although I have access to health insurance under the COBRA law, the premiums are extremely high and the coverage expires after 18 months. So I applied for individual (nongroup) coverage with CareFirst BlueCross BlueShield, the carrier that covered me while I was a federal employee.

I am a healthy 51-year-old. I am an avid cyclist and play in an over-50 hockey league. I don't smoke or drink. During my last physical, my doctor told me that my blood test, EKG and other screenings had been "perfect" and that I was one of his healthiest patients in my age group. Apparently, being healthy and physically fit is not good enough for CareFirst. To my surprise, the company denied my application.

I have borderline hypertension that is well controlled with a minimum dose of medication and mild stiffness in my left shoulder and right hip, for which I take an occasional Advil. This combination of "pre-existing conditions" -- conditions that millions of Americans my age experience -- was the basis for a complete denial of coverage. Not slightly higher premiums (which I would be happy to pay), not a short-term exclusion for the preexisting conditions, but a flat-out denial. However, CareFirst was kind enough, in its rejection letter, to send me an application for a guaranteed coverage policy for twice the premium, with astronomical deductibles and out-of-pocket maximums, and a $1,500 annual maximum coverage for prescriptions. In other words, even though I am healthy and can afford and am willing to pay high premiums, I can't get comprehensive individual medical and prescription coverage with this company at any price.

So I am forced to roll the dice with my health. What happens when my COBRA runs out (coverage might be available under the Health Insurance Portability and Accountability Act, but CareFirst's premiums for my family would be $3,000 a month and annual prescription coverage is limited to $1,500)? Will I again be denied when I apply for coverage after 18 months, particularly since my "pre-existing conditions" aren't going anywhere and many companies ask whether a previous application has ever been declined? Should I cancel my annual physical for fear that some new condition might pop up? Or, do I take a job, any job, so that I can get covered through an affordable employer group health plan?

And, even if I am able to get nongroup coverage, will my policy be rescinded later because I forgot to list a medical condition on the application, however minor or unrelated the omission was to the illness being treated?

William Kristol, in a recent commentary in The Post, stated that "there is no health-care crisis." He either has a cynical hidden agenda or he's ignorant of what millions of Americans who don't have access to employer-based plans face. The system is broken. I'm one of the lucky ones, because I have the means to pay for COBRA and to cover any catastrophic prescription costs and high deductibles under CareFirst's guaranteed coverage policy. But what about the laid-off factory worker or office clerk who cannot?

No silver bullet will solve all our health-care problems, but four measures would address one of most glaring weaknesses of our system: mandatory insurance for all; subsidies for those who can't afford the premiums; a prohibition against denying or rescinding coverage for "pre-existing conditions"; and meaningful tort reform. Yet Congress continues to make the ideological perfect the enemy of the desperately needed good. Democratic ideologues reject tort reform and insist on a public option that many suspect is a Trojan horse to a single-payer system, while their Republican counterparts deny that a crisis exists, decry any reasonable attempt at reform as a government takeover and fail to articulate an acceptable alternative.

Meanwhile, millions of honest, hardworking, self-employed or laid-off Americans continue to play Russian roulette with their health. Maintaining the status quo is unacceptable. A failure to adopt at least these four measures would be a national disgrace.

And to those Americans who are insured through their employers and are puzzled by all the buzz about a health-care system in crisis. Just remember: You are but a pink slip and a minor pre-existing condition away from insurance hell.

The writer, a lawyer, is a public policy scholar at the Woodrow Wilson International Center.

By washingtonpost.com editors  | October 13, 2009; 9:54 AM ET
Categories:  health care, public health  | Tags:  health care, insurance  
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Comments

That is very scary story with your insurance company with you being denied as healthy and unisurable. Yesterday I posted my video on Facebook because as of Oct. 31 I will lose my cobra and I have two existing threatening conditions. My video (youtube) posted on my Facebook page has reached throughout the country and I wish you could view it. You can friend me on FB or suggest another way I can get this video to you. We may have our differences of politics, however our problems are the same!!!!! Best Regards, Murray Braver, New York, New York

Posted by: mbravx | October 13, 2009 12:42 PM | Report abuse

Please see my story on YOUTUBE regarding the loss of cobra:

murraybravervideo re:cobra expiration

Thank and best of luck to all of us!!

Murray Braver

Posted by: mbravx | October 13, 2009 2:09 PM | Report abuse

Look, you made a dumb decision to quit a job where you had health insurance. Now you ask the rest of us to fork over the loot to give you a safety net! NOT!
Stop whining like a child who should have been weaned from his mother years ago. You got yourself into this by making a dumb decision. It's now time to pay the piper. Be accountable for your own decisions.

Posted by: MarcSunford | October 14, 2009 2:19 AM | Report abuse

It''s good we have the mean and greedy like marcsunford who have no soul or compassion to keep proving that conservatives do not give a damn about others!
What kind of country is America? Why are we the only industrializes nation on this Earth no to guarantee basic health care for all it's citizens? Does Mr. Sunford drive on PUBLIC roads, eat food he knows is safe, call the Fire Dept. or Police without concern about whether he can afford to pay for that service? I am sure all his children attended private schools as well--
The "I'M ALRIGHT JACK ( screw you) mentality of these conservatives sadly exposes them --When people show you who they are: BELIEVE THEM!

Posted by: suec716 | October 14, 2009 7:13 AM | Report abuse

Yep, most of us are "married" to a job so that we have health insurance. Mr. Kristol is right: for people with health insurance, the system does not need to be overhauled. The uninsured poor are a static issue that has not gotten a lot of traction. The author's experience of leaving an employer to become an independent worker is the storyline that may resonate with other Republicans.

The author sounds naive for leaving without a plan for what he would do about health insurance. If I were to leave my employer, I would expect to have to double my income to pay for solo health insurance and disability insurance.

Posted by: KS100H | October 14, 2009 10:40 AM | Report abuse

Yes, there should be tort reform; it should produce a major reduction in medical errors, in preventable infections while hospitalized, rapid and meaningful compensation for patients who suffer errors AND for ferreting out medical personnel who are error prone.

Medical errors that result in malpractice suits are a minute potion of medical errors. About 100,000 persons a year die from medical errors. Countless more survive but suffer from such errors. Every physical friend I know who has been hospitalized for a major illness has experienced multiple medical errors in the course of their care. Tort reform needs to provide for an effective weay to substantially reduce medical errors.

Then there are the hospital-based infections (now breaking out into the community) that kill about 100,000 a year and inflict horrendous suffering on survivors. These infections are costly in various ways, including for medical and hospital care. It has been shown that most of these infections can be prevented by screening, differential care, and rigorous hygenie. Tort reform needs to provide meaningful consequences for hospitals NOT implementing effective prevention procedures for hospital-based infections.

Posted by: jimb | October 14, 2009 12:57 PM | Report abuse

Note from the author: Several of the commentators have asked why I would leave a job that provided insurance coverage to become an independent consultant, thereby exposing myself to the risk of the individual (non-employer based) insurance market. I had a senior position in the Bush Administration and, as is customary and expected, left after the election to make way for the new Obama team. I would have been delighted to continue in my position(and to continue enjoying the benefits of comprehensive and affordable insurance coverage), but that would have required John McCain to have won the election, which, as we know, didn't happen. Sadly, under the current system, anyone leaving employer-based coverage, whether through lay offs, a decision to earn a living as a self-employed individual or, as in my case, a change in administrations, is forced to deal with the dysfunctional and expensive individual (non-group) insurance market.

Posted by: johnhewko2004 | October 14, 2009 6:27 PM | Report abuse

Thanks for sharing your testimony. I totally agree that we need a commonsense approach and that Congress needs to stay focused on practical solutions. I would encourage folks to check out another site that has some really powerful short video clips about people's horrible experiences with being denied health insurance/care. This should never happen in America. http://www.icareforhealthcare.org

Posted by: lilien1 | October 14, 2009 10:18 PM | Report abuse

I totally agree that the rules have to change for everyone to be able to get some kind of care in this country. But there are ways to beat the insurance companies in there game. Some states allow you to be a business of one. As a business you do not have a preexisting condition clause, which helps people out and you get better rates than if you looked for insurance as an individual. I was taught in college if a door shuts in your face look for an open window and get in. Its our health and we have to fight with every bit of our strength, to get the care we deserve as Americans.

Posted by: bigj3 | October 15, 2009 2:10 AM | Report abuse

The Author I'm sure is a conservative who, until this happened to him, would declare his undying affection for our current system with no need of repair. Now he knows better, but he still clings to his conservative ideals that capitalism is the solution and that a public option is evil. If he cannot see that insurance companies are the problem he deserves no help. He has done this to himself. More people need to be clued into what will happen if they lose their jobs or are sick and unable to work. Their rosy little view of our current system will soon be replaced by fear and loathing and a desire for change.

Posted by: Falmouth1 | October 15, 2009 5:56 AM | Report abuse

You chose to leave your job. You thought you could check out early and make big bucks working part time. Lots of people would like to go out early but can't. I would be more concerned about someone who lost their insurance through no fault of their own. This was about the worst time to make this kind of move so stop whining.

Posted by: tjmlrc | October 15, 2009 1:28 PM | Report abuse

Hey, this is a capitalist country. How can an insurance company make any money if they have to pay the bills for a bunch of sick people?

Posted by: posttoastie1 | October 15, 2009 2:31 PM | Report abuse

You knew that one of the downsides of working for any politician is the loss of job at the end. You chose to join the administration. With your credentials go get another job. I know a waitress who got laid off due to lack of business. She no longer has coverage and as such is more deserving of sympathy than you are.

Posted by: tjmlrc | October 16, 2009 8:37 AM | Report abuse

I sympathize with your health insurance quandary. But it is time for you to let go of your conservative Republican fantasy. You criticize the public option but support mandatory insurance. Mandatory insurance without the public option is just license for insurance companies to overcharge for insurance. Let go of your Republican fantasy and support the public option, but preferably single payer. With single payer NO ONE falls through the cracks.

Posted by: annegreen | October 16, 2009 12:16 PM | Report abuse

Note from the author to tjmirc's comment above: Yes, you are absolutely correct. The waitress you know is relatively more deserving of sympathy than I am: at least I have access to COBRA and can afford the high premiums. And I am sure that there are many examples of individuals who deserve even more sympathy than your friend. And that's the flaw in our system: millions of Americans who don't have access to comprehensive and affordable health insurance. The issue is not one of sympathy, but of a health system that is in need of significant reform.

Also, thank you for your thoughtful suggestion that I get another job. I do have full-time job as a self-employed independent consultant. But in the insurance world, if you are laid off or are self-employed (and earning money through self-employment is a legitimate job) and don't have access to a group plan and have a pre-existing condition (however minor), you will face difficulties in finding affordable and comprehensive health insurance even if you are able and willing to pay very high premiums.

Posted by: johnhewko2004 | October 16, 2009 1:56 PM | Report abuse

Welcome to the real world. My story is virtually identical to yours and I just got a notice from the Blues that my premium for single coverage will go up almost $100/mo, although they didn't pay a single claim this year.
I'm healthy but they managed to find a "pre-existing" condition that led to denial of my application for a sensible, tax-advantaged Health Savings Account plan at less than half of what I'm forced to pay. That wasn't a problem when I had BC/BS coverage from another State for years, but became a gotcha when I had to get a new policy in DC when my COBRA ran out.
My long-term doctor isn't in their network, so I'm basically self-insured, paying out-of-pocket, never reaching the high-deductible. The prescription drug plan is next to useless as their "bargain" mail-order arrangement is easy to beat without insurance at Costco or other pharmacies.
Basically, I'm paying top dollar for catastrophic insurance, but do I dare live without it?

Where you are wrong however is to "support [Obama's] health care initiative" because you are angry at the insurance company.
You sensibly outlined "four measures [that] would address one of most glaring weaknesses of our system," but they could be achieved without the massive government intervention of Obamacare.
And then you homed right in on the problem: CONGRESS. And you can add the Obama Administration to that.
They won't even consider your sensible ideas.
I know of NO Republican who "den[ies] that a crisis exists," would "decry any reasonable attempt at reform," or has failed to present any number of "acceptable alternatives."
Everybody agrees that the system is broken. We all want to fix it and we all want everyone to have access to good care.
The only thing that we are fighting about now is that the Democrats are saying that only THEIR way is what we are going to get, whether we like it or not. End of discussion. Shut up and sit down, as Obama has said.
How is that any better than what goddamned Blue Cross/Blue Shield does to you and me today?

Yes, I live in insurance hell too. And we're not alone. But we should not jump out of the frying pan into the fire.
Obamacare should be killed. Sensible people willing to work together can find sensible solutions to solve the real problems that we face.

Posted by: parkbench | October 18, 2009 5:38 PM | Report abuse

Thank You John Hewko! I hope no one thinks that the medical profession is exempt from insurance issues mentioned in your article. My husband is an MD and I am an RN. We are every bit at the mercy of health insurance companies as everyone else is. We too were "dumped" by Care First/ Blue Cross Blue Shield. We were also over 50. This coming out of Cobra insurance and attempting to get individual coverage for our family. Our denial had numerical codes on them. When I called about what the numerical codes meant I was told that my husband was inelegible because of "cancer" which was, in fact, the smallest of the small skin cancer on his forehead. For me I was told that my appt. for a minimal mental health problem (well controlled) automatically eliminated me and our family from coverage. Company policy I was told. I do beleive that was and is against the law.

After one calendar year of paying the highest of high rates, my husband had to take a job at a different hospital. Only then was our family eligible for coverage in a group setting.

I also have the greatest of sympathy for ALL who lack insurance coverage. But having a Blue Cross/Blue Shield Carefirst card in your wallet is no guarantee that you will have the coverage they so promise.

Posted by: Susancl49aolcom | October 18, 2009 7:01 PM | Report abuse

Mr. Hewko,
Here's what I want to know. Is it true, as you say in the opening of your piece, that you support President Obama's health-care initiative because you just experienced the system's dysfunctional wrath? Did it have to happen to you before it mattered to you? Did it have to personally affect you before you recognized that there was a grievous problem? I ask, because if it had to affect you "first-hand" before you chose to support health care reform, well, sir, THAT isn't pretty.

Posted by: washingtonpostknh | October 22, 2009 1:25 PM | Report abuse

I second that opinion, washingtonpostknh! Mr. Hewko was apparently a happy, complacent Republican who didn't support health-care reform when it was something in the neighborhood of 39,999,999 OTHER Americans who were without insurance. Now that he's seen the light, he's feels he's qualified to preach to those of us who didn't have to be personally affected to care!

Posted by: walker5 | October 22, 2009 1:41 PM | Report abuse

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