Health-care reform suffers pre-existing condition

Andrea W. Doray, Alchemy
Posted

You don’t get to be my age without a pre-existing condition.

Fortunately, in my case, I’m not battling a chronic disease. I simply have the misfortune of having seen a doctor before my COBRA coverage from the Peace Corps ran out.

Why a misfortune? Because, according to 2010 census figures, I am one of 196 million Americans with private health insurance — nearly 65 percent of our population. And such private insurance health plans are not cheap, often several hundred dollars a month, even with obscenely high deductibles, for, ahem, middle-aged individuals. But because bad things do happen, and even small accidents can cost big bucks, my monthly insurance premiums are a financial priority.

For example, the simple combination of a screaming tea kettle, a ringing phone and a lope up the stairs two at a time resulted in a spiral fracture of my fifth metatarsal. In other words, I broke my foot.

Eight weeks and two casts later, my only option was a surgically implanted plate and six screws to hold everything together. By the time all that was left is a neat little scar, the overall cost for a two-second misstep was more than $30,000, most of which was offset by the great employer-sponsored insurance I carried at the time.

Please don’t misunderstand me — I still have insurance now. But I mostly pay office visits and prescriptions out of pocket because of the coverage I’m able to purchase as an individual. My monthly premium is insurance in the truest sense of the word: financial protection against significant loss or harm.

In our state, CoverColorado is one health insurance option for individuals with pre-existing conditions or those who have exhausted their COBRA benefits, as I did. Some lapse-in-coverage restrictions also apply.

GettingUSCovered is another health care option for Coloradoans. This plan covers individuals who have been uninsured for at least six months and have medical problems, such as diabetes, that prevent them from getting other individual insurance.

Oh, but wait … this option is no longer available. Quietly, very quietly, citing financial concerns, the federal government has now directed GettingUSCovered, part of the Obama administration’s Pre-Existing Condition Insurance Plan, to no longer accept applications “until further notice.”

The Pre-Existing Condition Insurance Plan was designed as a stopgap solution until health-care reform measures take effect on Jan. 1, 2014, when full consumer protections will prevent insurance companies from turning people away because of poor health. (I’ll only believe that when I see it.)

The feds will also start subsidizing coverage for the millions of people without access to employer plans. (Ditto here on the skepticism scale.)

At the same time, however, other provisions are projected to take effect that will significantly increase the cost of coverage for millions of individuals, families and small businesses. Spiraling medical costs continue to drive up the cost of coverage, requiring an even greater share of government budgets and threatening the long-term ability of our nation to provide for the millions of Americans who don’t have — or can’t get — coverage. For now, I have insurance. But who really benefits from health care reform in America — with all its own pre-existing conditions — is yet to be seen.

Andrea Doray is a writer whose insurance premiums come off the top of her monthly budget … right after her haircut. Contact her at a.doray@andreadoray.com for info on the latest mishap on her stairs.