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A blog post I read today that lays out in simple language how easy it is to fall through the cracks in our broken insurance system. Nothing I didn't already know, but the "absolutely can't afford COBRA" angle is one I hadn't really thought through. And how many states have a last-resort plan like Texas? My guess is "not most"...
http://www.reallivepreacher.com/node/1441:
http://www.reallivepreacher.com/node/1441:
Health Insurance in the U.S. - A Broken System
November 30, 2007 - 9:45am
Maybe you noticed I was gone for a few days. I had some pretty important stuff going on, and I just didn’t have any energy to write. I’m going to tell you what happened to us. I could have written this without so much detail, but I think the details might be important for someone who is in the same situation.
Four days ago Jeanene and I were looking at the real possibility of our entire family being medically uninsured. No insurance of any kind for us or our children.
Jeanene quit her job, as I’ve mentioned. After 20 years of chaplaincy, 20 years of being on-call for emergencies, she was through. I could see it in her eyes. Some essential part of Jeanene was gone. Used up. And our children, particularly our middle daughter, really need a parent at home right now.
She had to stop. An opportunity for me to do some blogging work with The Christian Century and The High Calling gave us a chance to let her retire from being a chaplain. We're taking a significant pay cut, so it's risky. And there is no guarantee the blog networks I work with will continue. This was an important decision for us and we agonized over it. But sometimes in life you take a leap of faith. The faith we have is not a faith that God will rescue us physically and make sure that everything is okay. The Creator of the Universe has obviously made peace with the idea of mostly letting things unfold here according to our choices and the natural movement of the planet.
The faith we have comes with believing that it was the right thing for her to leave. The right thing for her health and our family. We felt peace about it. So we held hands and jumped.
---
About 6 years ago, when Jeanene was laid off for a period of two years, we called Blue Cross Blue Shield and had health insurance for our entire family in a matter of days. We thought we’d be able to do that again.
We were wrong.
Our middle daughter has had some emotional traumas in the last couple of years. She’s told me that I could write about our journey through all of that, but it hasn’t felt right yet so I haven’t. With a lot of help and with two serious medications, she’s doing well. She’s been doing very well since the Spring.
Unfortunately, those two drugs and something she went through in January make her untouchable. There isn’t an insurance company in America that will take her. Even if we release the insurance company from all mental health benefit obligations. Even if, like Blue Cross Blue Shield, they don’t cover any mental healthy benefits anyway. Even so, no one will take her. She’s tainted because of something that happened to her. It’s strictly an emotional thing. She has no physical problems.
As it turns out, no one will take me either. Why? Because I’ve been taking Wellbutrin for 2 years. It works beautifully. It’s given me back my life. If you read my pieces on depression you know how much I HATED to admit that I needed help with a drug. But I obviously did.
But that’s it for me. I was turned down by Blue Cross Blue Shield even though they don’t pay for any mental heath issues anyway. I was even turned down by the insurance provider for Texas Baptist ministers who serve small churches without benefits. I thought they would listen and give us a chance. Nope.
I’m a bad risk now. That’s the thing. Good heart. No cancer. No high blood pressure. Low cholesterol. I’ve never even had surgery. I don’t smoke. I’ve only missed two Sundays in 17 years as a pastor for illness. I’m a healthy guy, and I’m used to being treated like a healthy guy.
But I take Wellbutrin, so there must be something wrong with me, right?
Actually, it’s not quite as personal as someone looking you in the eye and saying, “Your a bad risk.” The health insurance industry is too big for that. They have computer-generated statistics that tell them people who take drugs for mental health reasons are bad risks - period. I am a clear exception to that rule, but that’s the rule.
Congress passed a law called COBRA in 1986 that requires employers to allow you to keep your insurance if you leave their company. They don't have to help you pay for it anymore, but they have to carry you - at your own expense - for at least 18 months. We went online and discovered that it was going to cost us $1600 a month to keep our insurance. And of course, that's only for 18 months. 18 Months from now we would be in the same position.
We can’t afford that, so it’s really no option for us. Please! That’s more than our house payment. Technically the hospital has fulfilled the obligation of the law, but I don’t know too many families who can afford $1600 a month for health insurance.
Texas has a state-subsidized health insurance pool for people who can’t get health insurance. Shelby and I could go into the state pool, leaving Jeanene and the other two girls to get their insurance in a more traditional way. But now COBRA really comes back to bite you. The State insurance pool won’t take you if you have any other options. Even if your only option isn’t really an option because you don’t have $1600 a month.
We were falling into a crack in the system. We can’t afford what the insurance company grudgingly offers ex-employees at an insane price. And we don’t quality for the State insurance pool because they did offer us something.
By Tuesday we had admitted defeat.
---
I’m going to tell you right now that this story has a happy ending. But it could have gone the other way. Very easily could have gone the other way.
We found a man in town who is a kind of independent health insurance broker. He knows the system, and he can figure out ways for you to get insurance. It’s not always great insurance, but he can find something. He’s really good at what he does. I wouldn’t assume that many people can find someone like him.
What if we hadn’t found out about him? Or what if we lived in some other city and couldn't find someone like this? I keep thinking about that. What if?
But we did find him. He came to our house on Wednesday and got right to work. He pulled Shelby out of our family, as far as insurance is concerned. Jeanene’s company has to cover her for 18 months because of the COBRA law. If it is just her, the cost of COBRA drops to $300 a month. In 18 months that benefit will run out and she can go into the Texas pool for the uninsured. Even this specialist admits that no one will ever cover Shelby for anything as long as she is on the medication that is making her well and keeping her from harming herself. Ironic, huh?
He knew of an insurance company - a good one - that will take someone like me, someone who takes Wellbutrin or some other drug for depression. They won’t cover me for mental health benefits - that’s over for me - but they will at least cover me for regular medical coverage. And it’s affordable.
You put the whole thing together and it comes out to about $900 a month. That figure includes my medication, which I will have to pay for myself from now on. That’s double what we were paying through Jeanene’s work, but we can swing that. It’s going to be hard but we can do it. So the story has a happy ending. Or at least a tolerable one.
So why am I telling you all of this? Because this is what people are going through in our country. Jeanene and I work hard. We’ve never been unemployed. In fact, for the last decade, we’ve had three jobs between us. We don’t smoke and we don’t take risks. We’ve never had a single major medical incident. You’d think a company would want to insure us.
No. And we came just that close to being uninsured.
For many people this is never an issue because they work for companies with insurance plans. If our church were large enough to have a plan, we could have moved from Jeanene’s plan to my church’s plan. With group insurance they have to take you if you currently have coverage.
That’s great for families with that option. But what about families that only have one person working for a company with insurance? If that person loses their job or can no longer work for any reason, you have to get individual coverage. And with individual coverage, they can turn you down for any reason they want.
You want to know something else? If you apply for insurance and get turned down two or three times, that goes on your record. Every time you get denied, other companies become even more unwilling to consider you. With two or three rejections in your history (for any reason), you can become uninsurable pretty quickly.
What I’m saying to you is, hard-working people who are physically healthy sometimes can’t get health insurance. It almost happened to us. If we hadn’t found this man and our insurance had lapsed for more than 60 days, then we would really have been in trouble. Because being uninsured is yet another big mark against you in the system.
People - it’s time we admit that the system isn’t working. We are going to have to have some kind of a national health care program. It won’t be perfect, but it will be better than what we have now. We need it, and we need it quickly.
November 30, 2007 - 9:45am
Maybe you noticed I was gone for a few days. I had some pretty important stuff going on, and I just didn’t have any energy to write. I’m going to tell you what happened to us. I could have written this without so much detail, but I think the details might be important for someone who is in the same situation.
Four days ago Jeanene and I were looking at the real possibility of our entire family being medically uninsured. No insurance of any kind for us or our children.
Jeanene quit her job, as I’ve mentioned. After 20 years of chaplaincy, 20 years of being on-call for emergencies, she was through. I could see it in her eyes. Some essential part of Jeanene was gone. Used up. And our children, particularly our middle daughter, really need a parent at home right now.
She had to stop. An opportunity for me to do some blogging work with The Christian Century and The High Calling gave us a chance to let her retire from being a chaplain. We're taking a significant pay cut, so it's risky. And there is no guarantee the blog networks I work with will continue. This was an important decision for us and we agonized over it. But sometimes in life you take a leap of faith. The faith we have is not a faith that God will rescue us physically and make sure that everything is okay. The Creator of the Universe has obviously made peace with the idea of mostly letting things unfold here according to our choices and the natural movement of the planet.
The faith we have comes with believing that it was the right thing for her to leave. The right thing for her health and our family. We felt peace about it. So we held hands and jumped.
---
About 6 years ago, when Jeanene was laid off for a period of two years, we called Blue Cross Blue Shield and had health insurance for our entire family in a matter of days. We thought we’d be able to do that again.
We were wrong.
Our middle daughter has had some emotional traumas in the last couple of years. She’s told me that I could write about our journey through all of that, but it hasn’t felt right yet so I haven’t. With a lot of help and with two serious medications, she’s doing well. She’s been doing very well since the Spring.
Unfortunately, those two drugs and something she went through in January make her untouchable. There isn’t an insurance company in America that will take her. Even if we release the insurance company from all mental health benefit obligations. Even if, like Blue Cross Blue Shield, they don’t cover any mental healthy benefits anyway. Even so, no one will take her. She’s tainted because of something that happened to her. It’s strictly an emotional thing. She has no physical problems.
As it turns out, no one will take me either. Why? Because I’ve been taking Wellbutrin for 2 years. It works beautifully. It’s given me back my life. If you read my pieces on depression you know how much I HATED to admit that I needed help with a drug. But I obviously did.
But that’s it for me. I was turned down by Blue Cross Blue Shield even though they don’t pay for any mental heath issues anyway. I was even turned down by the insurance provider for Texas Baptist ministers who serve small churches without benefits. I thought they would listen and give us a chance. Nope.
I’m a bad risk now. That’s the thing. Good heart. No cancer. No high blood pressure. Low cholesterol. I’ve never even had surgery. I don’t smoke. I’ve only missed two Sundays in 17 years as a pastor for illness. I’m a healthy guy, and I’m used to being treated like a healthy guy.
But I take Wellbutrin, so there must be something wrong with me, right?
Actually, it’s not quite as personal as someone looking you in the eye and saying, “Your a bad risk.” The health insurance industry is too big for that. They have computer-generated statistics that tell them people who take drugs for mental health reasons are bad risks - period. I am a clear exception to that rule, but that’s the rule.
Congress passed a law called COBRA in 1986 that requires employers to allow you to keep your insurance if you leave their company. They don't have to help you pay for it anymore, but they have to carry you - at your own expense - for at least 18 months. We went online and discovered that it was going to cost us $1600 a month to keep our insurance. And of course, that's only for 18 months. 18 Months from now we would be in the same position.
We can’t afford that, so it’s really no option for us. Please! That’s more than our house payment. Technically the hospital has fulfilled the obligation of the law, but I don’t know too many families who can afford $1600 a month for health insurance.
Texas has a state-subsidized health insurance pool for people who can’t get health insurance. Shelby and I could go into the state pool, leaving Jeanene and the other two girls to get their insurance in a more traditional way. But now COBRA really comes back to bite you. The State insurance pool won’t take you if you have any other options. Even if your only option isn’t really an option because you don’t have $1600 a month.
We were falling into a crack in the system. We can’t afford what the insurance company grudgingly offers ex-employees at an insane price. And we don’t quality for the State insurance pool because they did offer us something.
By Tuesday we had admitted defeat.
---
I’m going to tell you right now that this story has a happy ending. But it could have gone the other way. Very easily could have gone the other way.
We found a man in town who is a kind of independent health insurance broker. He knows the system, and he can figure out ways for you to get insurance. It’s not always great insurance, but he can find something. He’s really good at what he does. I wouldn’t assume that many people can find someone like him.
What if we hadn’t found out about him? Or what if we lived in some other city and couldn't find someone like this? I keep thinking about that. What if?
But we did find him. He came to our house on Wednesday and got right to work. He pulled Shelby out of our family, as far as insurance is concerned. Jeanene’s company has to cover her for 18 months because of the COBRA law. If it is just her, the cost of COBRA drops to $300 a month. In 18 months that benefit will run out and she can go into the Texas pool for the uninsured. Even this specialist admits that no one will ever cover Shelby for anything as long as she is on the medication that is making her well and keeping her from harming herself. Ironic, huh?
He knew of an insurance company - a good one - that will take someone like me, someone who takes Wellbutrin or some other drug for depression. They won’t cover me for mental health benefits - that’s over for me - but they will at least cover me for regular medical coverage. And it’s affordable.
You put the whole thing together and it comes out to about $900 a month. That figure includes my medication, which I will have to pay for myself from now on. That’s double what we were paying through Jeanene’s work, but we can swing that. It’s going to be hard but we can do it. So the story has a happy ending. Or at least a tolerable one.
So why am I telling you all of this? Because this is what people are going through in our country. Jeanene and I work hard. We’ve never been unemployed. In fact, for the last decade, we’ve had three jobs between us. We don’t smoke and we don’t take risks. We’ve never had a single major medical incident. You’d think a company would want to insure us.
No. And we came just that close to being uninsured.
For many people this is never an issue because they work for companies with insurance plans. If our church were large enough to have a plan, we could have moved from Jeanene’s plan to my church’s plan. With group insurance they have to take you if you currently have coverage.
That’s great for families with that option. But what about families that only have one person working for a company with insurance? If that person loses their job or can no longer work for any reason, you have to get individual coverage. And with individual coverage, they can turn you down for any reason they want.
You want to know something else? If you apply for insurance and get turned down two or three times, that goes on your record. Every time you get denied, other companies become even more unwilling to consider you. With two or three rejections in your history (for any reason), you can become uninsurable pretty quickly.
What I’m saying to you is, hard-working people who are physically healthy sometimes can’t get health insurance. It almost happened to us. If we hadn’t found this man and our insurance had lapsed for more than 60 days, then we would really have been in trouble. Because being uninsured is yet another big mark against you in the system.
People - it’s time we admit that the system isn’t working. We are going to have to have some kind of a national health care program. It won’t be perfect, but it will be better than what we have now. We need it, and we need it quickly.
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