Ironically, it was a health crisis that caused me to lose my health insurance - but not in the way you might suspect.
Last summer I came down with a bad case of poison ivy, all over my body. The pain, the endless itching, the face that swelled like a football...it was bad. So bad that I neglected to fill out the health insurance reenrollment letter from the Madison school district. It was sitting on my desk all that time, through those sleepless nights of ice compresses and calamine.
The Aug. 4 deadline passed, tripping a hair-trigger clause in the Madison school district's health insurance program for substitute teachers like me. On Aug. 6, a letter arrived from Human Resources, saying I would no longer receive the benefit. I was welcome to stay on the plan, but only if I paid the full premium, an amount nearly eight times more than I'd been paying, or an additional $4,560 a year.
For some people, a hit like that might mean one fewer vacation a year. For me, it's a disaster.
My first impulse was to join the ranks of some 47 million uninsured Americans, at least until next year, when I might re-qualify for the district's lottery-like health benefit. Up to 100 substitute teachers are eligible each year, based on who's worked the most days.
I could go without insurance for a year, but what if I got sick - really sick? I could lose everything to the health care monster.
When the district didn't consider my circumstances extenuating enough to let me back in, I assumed there was no room left in the pool. However, Ken Volante of Madison Teachers Inc. told me that quite a few of the allotted slots for subs went unclaimed this year. What, I wondered, has happened to the "H" side of human resources?
Such dilemmas are not uncommon in today's health care world, says Bobby Peterson, director of ABC for Health, a Madison-based public-interest law firm. "It's the insidious side of cost-containment," he says. "Once you are out of the pool, you have to search through dirty puddles to find coverage."
If you go without and a health condition arises, your creditors could sue and take everything you have or force you to declare bankruptcy. Either way you could land in what Peterson calls "electronic debtor prison," unable to get an apartment, bank account, or even a job due to your suddenly rock-bottom credit score.
Peterson, whose firm has assisted more than 13,000 Wisconsin families during the past 10 years, isn't just trying to scare me. He sees it happen all the time.
Toward the end of August, I did the unthinkable. I enrolled in the district's Group Health Cooperative (GHC) health plan at the full $437 monthly price, while I shopped around for other options. I clung to the high-priced coverage from GHC the way someone dangling over the edge of a cliff hangs on to a craggy rock.
Granted, the first pay period of the year for subs is a short one. But after deductions, my take-home pay for September was zero.
I knew the cost of health care had been skyrocketing since I'd last purchased my own health insurance in the 1990s. But I guess you don't really appreciate how fast a runaway train is going until you try to get on.
I found plans with lower premiums than the district's GHC plan, but with benefits and services hugely lacking. The out-of-pocket expenses can be as catastrophic as the illness. Now it's all about deductibles, coinsurance, copays and "comfort level."
My efforts to secure alternative coverage at a more affordable price have been as dispiriting as they've been instructive.
"I can make recommendations, but ultimately you have to decide what you are comfortable with," said Chris Mitchell, an agent with Anthem Blue Cross Blue Shield's corporate sales office in Cincinnati. "If something happens to you, the plan you have now is the better fit. If nothing happens to you, this would be a better fit." (He had suggested plans with $3,500 or $5,000 deductibles and 30% coinsurance.)
"It sounds like gambling," I told Mitchell. People in my position can continue spending more than they can afford or roll the dice: Am I going to get sick? Am I not going to get sick? How am I supposed to know? And what does it have to do with access to affordable health care?
"It's not gambling. It's insurance," Mitchell said. "You have to make a decision ahead of time and hope it will be the right one."
Robert Kraig, executive director for Citizen Action of Wisconsin, a Milwaukee-based nonprofit with a strong interest in health care, agrees the individual insurance market presents an array of unpalatable choices.
"It's like the Wild, Wild West," he says. "It offers the least protection for consumers."
This is not by accident but by design.
"Insurers use armies of accountants and actuaries to sift through who is a good risk," says Kraig. "They only want to insure healthy people and so will deny coverage or charge discriminatory rates to people they think are a bigger risk." Kraig adds that my age bracket, 55 to 64, is particularly disadvantaged in this regard.
Filling out the application for individual insurance is a challenge in itself, requiring applicants to go back 10 years in doctor's visits and medical issues. AB-100, a bill passed by the state Legislature last year, limited the "look back" period to one year, but this does not apply to the individual market, agents told me.
And it's not a task that applicants can take lightly. You may be accused of fraud and denied coverage if you don't disclose something the insurance company decides is related to a disease you develop down the road, even something a doctor jotted down on your chart without telling you.
"A couple of months ago," says Kraig, "it came out that Anthem Blue Cross had a computer that automatically triggered a fraud investigation for anyone diagnosed with breast cancer. It was quite a scandal."
Nationwide, some 14 million non-elderly people buy their own health insurance, according to a 2010 Kaiser Family Foundation survey. It's a relatively small segment of the total market, but a growing one. A 2008 Citizen Action report on health care costs in Wisconsin noted that the market share for privately purchased policies in the state increased from 14% to 20% between 2000 and 2007.
The report attributed this rise largely to employers dropping group coverage in the face of rising costs. And that was before unemployment surged, cutting off thousands of other state residents from the group benefits attached to their jobs.
According to a report from the Wisconsin Office of the Commissioner of Insurance, in 2009 there were 102,451 independent health insurance policies statewide, a 19% increase over 2007. With dependents, the 2009 total covers 162,871 people.
The health care reform bill passed by Congress and signed into law by President Obama is intended to provide consumers with much-needed protections. But, as Bobby Peterson puts it, "There is no sheriff riding into town to enforce them." Already there has been pushback from the insurance industry, most significantly in the form of rising premiums this fall.
"The government said reform wouldn't increase insurance rates," Anthem's Mitchell told me. "But it increased the benefits, so of course it will increase the cost." He called me on a Monday, offering rates he promised would jump by about 18% if I didn't apply by Tuesday. That coming Thursday, Sept. 23, annual and lifetime limits would be lifted on insurance coverage, and preventative health care services would be provided free of charge.
"The biggest complaint before health reform was that the rates were too high," Mitchell said. "Well, now they are going to be even higher."
The Obama administration calculated that changes taking effect this fall would raise premiums no more than 1% to 2% on average, according to a recent Wall Street Journal story about rising health insurance premiums. The article noted that Celtic Insurance in Wisconsin and North Carolina was seeking an 18% hike in premiums, and suggested other companies were likely to follow suit.
Nancy-Ann DeParle, a top White House health official, told the Journal that insurers had planned to raise the rates regardless of health reform and that "consumers will see through this."
The longer I look, the more expensive and confusing the system becomes. In recent weeks, I have been bombarded with phone calls and emails from health care brokers and agents from all over the country, a result of searching for health insurance information online. The calls have come frequently and at all hours. In the beginning, desperate to find my ever-elusive "comfort zone," I answered the calls.
The first was from Bobby Cromer, a broker in California who contacted me after I'd browsed with health insurance.
Business for eHealthInsurance has grown fairly steadily since the company went public in 2006, according to spokesman Brian Mast.
"We are not a leads-generating site," Mast said when I asked about the calls and emails that followed my visit to the site. But he said he'd heard such complaints before and promised to look into it. I haven't heard anything more.
Anthem's Chris Mitchell, and quite a few others, found me after I'd keyed in the wrong URL for BadgerCare Plus (.com instead of .org). You don't want to go to Badgercareplus.com if there's any chance you are eligible for Wisconsin's health care plan for low-income adults. You will be directed to links offering quotes from a host of major insurance companies and sketchy information about BadgerCare Plus, not all of it accurate. One shadow site said applicants must be uninsured for 12 months to be eligible. In fact, there are a number of exceptions to that rule.
Helen, a soft-spoken rep with American Association for Medical Benefits (AAMB) in Fort Worth, Texas, gets my nomination for the most misleading sales artist. She leaves continual voice messages about a "full medical plan" that will cover "all your health care needs" with no yearly deductibles, no height, weight, age or preexisting restrictions, all for a locked-in, cancel-proof $159.95 a month on the Platinum Plus plan.
AAMB states on its application, however, that it is not a licensed insurer or underwriter and that "no portion of any provider's fees will be reimbursed or otherwise paid by AAMB." It claims to be a "discount" program for use only with "certain health care providers." Someone should tell that to Helen.
Bill McIlroy, a broker at Truth Benefits in Twinsburg, Ohio, alerted me to the fact that any plans I'd been looking at could change significantly in the underwriting process. If I had used any prescription medicine in the last 12 months, had any medical issues in the last five years, I could be in for some unhappy surprises, he said. McIlroy offered to save me a lot of time and aggravation by running my medical issues past the various insurers to see how high the rates or exclusions would fly. He called this pre-screening.
Health care reform has abolished rescission, a formerly common practice of canceling a policy when the insured got sick. But adults with preexisting conditions can still be excluded until 2014, when health insurance will be mandatory for all. And already insurers have found loopholes in regard to free preventative care.
For instance, if a previous preventative test has indicated certain issues (e.g., benign polyps in a routine colonoscopy), you'll be charged the full amount for your next test. That's not the insurance company's doing, Anthem's Mitchell told me. "If the doctor codes your next test as 'diagnostic,' it's no longer preventative care."
As it happens, I don't have much in the way of preexisting illness. But that's my point of view. Insurers see it differently.
Back in the 1990s, WPS excluded me from coverage for any form of breast disease (read: cancer) because of a benign fibrocystic condition that affects more than 60% of premenopausal women. I didn't even know I had it until WPS scoured my medical records. I took the policy and found something better as soon as I could - a job with group health insurance.
In August I applied to WPS again through a link on eHealthInsurance. It was such a deal, $218.78 a month. WPS accepted me right away, but with a five-year exclusion for Lyme disease, tests, tick bites and any "complications...thereof." (I've had Lyme disease for more than four years. Since consulting a Lyme-literate doctor about a year ago, my symptoms have all but disappeared.)
I called WPS to ask why the exclusion was for five years (wouldn't I be on Medicare before that?). I also wanted to make a few corrections to my application. Steve, the WPS agent I reached in Madison, said he couldn't help me with anything pertaining to the application or Lyme waiver because eHealthInsurance was the "agent of record." That was news to me. I had no idea I was giving control to a third party - a rather large, anonymous one at that.
Even without the Lyme rider, I couldn't buy that policy, which had a $5,500 deductible. It's one of those health savings account plans, geared for people who can afford to put $5,500 aside tax-free (up to $11,000 for families) and thereby, in effect, become their own insurers.
As Bobby Cromer, the broker from California, explained it to me, "I usually sell health savings account plans to young, healthy families who aren't going to go to the doctor anyway."
So what do I do? I'm not eligible for the BadgerCare Plus Core Plan (which has a long waiting list) or the less comprehensive BadgerCare Plus Basic plan. My income is almost low enough, but even if the sub work decreased, it's a moot point. If you have access to health insurance through an employer, no matter how high the premium or deductible, you are not eligible for the state plan for childless adults.
I did find a Dean Health private plan that looked attractive compared to what I could get for the same money from other companies. Still, it could cost more than $5,800 a year in premiums and out-of-pocket expenses, with no coverage for prescription medicine. It took almost a month in underwriting, but I've been approved. It's $319.41 a month with a $1,000 deductible, and no preexisting exclusions.
So there you have it. I can buy health insurance. I won't have to shoot myself in the arm, as an unemployed, uninsured woman in Niles, Mich., did last summer in an unsuccessful attempt to get treatment for a dislocated shoulder. But I would have to go into big credit-card debt or "steal" from my retirement savings as a result.
It puts me in mind of a famous Jack Benny joke. (I know I'm dating myself, but the underwriters have done that already.) The joke has Benny, a self-labeled skinflint, confronting a highway robber.
"Your money or your life," the highwayman says, and then repeats the demand because Benny doesn't respond.
"I heard you the first time," Benny finally says, and adds with inimitable timing, "I'm thinking about it."
Yep, that's what I'm doing. Thinking about it.
