Thursday, October 09, 2008

Can't Get Coverage

Some background: when I left the dayjob last year (o happy day!), I decided to stay on their small-group health coverage through COBRA. But COBRA has an 18-month limit, and I hit the end of that period on September 30th. So in mid-September I started looking for new coverage, knowing full well that as an individual, not a member of any kind of organization, I wouldn't be able to get the same level of excellent coverage.

Some further background: a couple years ago I was having trouble with my right shoulder. Turned out to be a little tendonitis and a wee bone spur. Couldn't raise my arm above my shoulder without a lot of, you know, screaming. So I went to my doctor, who sent me to a specialist, who sent me for an MRI. The MRI revealed that I didn't need surgery, and that the problem would most likely find a way to resolve itself. (Sloooowly.) The specialist gave me some specialized exercises, I did them, and the problem did in fact resolve itself. (Sloooooooooooooowly.) It's quite gone now, and I can raise my arm above my shoulder, all the way to the ceiling, easily. Yay, me.

I first applied for a health-care plan tailored to young people. They saw the MRI, laughed in my face, and turned me down. So I started over again, and ended up applying for a plan linked to an HSA, thus allowing me to actually own a substantial portion of my own health-care money rather than simply send it to the Aetnas of the world and maybe never see it again. The application was just about the meanest, nastiest application I've ever completed, and it took a good ninety minutes to complete it and get it submitted.

There was, obviously, a great deal more detail requested. And when I filled out the section about that MRI, since I don't have the actual medical records, only the claim forms, I tried very hard to remember what specifically happened then, and when the application essentially defaulted to a choice of "Rheumatoid Arthritis," I figured that was probably pretty close to what had happened, and selected that.

Ninety minutes to complete the form. Ninety seconds to get turned down again.

Bear in mind, there's a section in the application where you can write an explanation of whatever you wish, so I described exactly what happened with the MRI, how it successfully ruled out a costly operation, and how I am now entirely trouble-free. But of course the computer making the decisions doesn't bother with that, it was "Rheumatoid Arthritis" and that was it, end of story.

I had to visit the specialist's office, get copies of the medical records, and send them in with a letter requesting a review. That was ten days ago, and still no word on a decision. In the meantime, I haven't had health-care coverage all month, and am rightfully worried about what would happen if something should happen to me. Because you know--if something should happen while they're still reviewing my file, it's an ironclad guarantee that they'll find some other reason to turn me down.

All this while I am, in fact, completely healthy. Nothing wrong with me. Look at that shoulder, what a terrific shoulder.

This has, of course, given me some perspective on the health-care debate going on between the candidates. There are two proposals, and boiled down (thanks to an analysis by some guys at Bank of America), they are:

McCAIN: Eliminate deductibility of employer-sponsored insurance and replace with refundable credit of $2500 for individuals and $5000 for families.
OBAMA: Universal health care with affordable health coverage and benefits similar to those available to Members of Congress ... Creation of National Health Insurance Exchange for people without access to employer insurance or public programs...


Okay. So McCain would provide me with a $2,500 tax credit to spend on health care however I wish. (The plan I applied for would cost around $4,000, including money put into the HSA.) But here's what caught my attention: if I were still employed at the law firm, the incentive for that law firm to provide health insurance, namely the tax deduction, would disappear. That means it's pretty much a sure thing that the firm would discontinue the program, and everyone would have to obtain coverage as individuals rather than members of a group.

Having gone through exactly that process, I can tell you: plenty of people would be declined, particularly people with any kind of preexisting condition, and everyone would end up spending more, more, more on their coverage, no matter how big the tax allowance provided for by Mr. McCain.

The real winners? The insurance companies. If they get to charge everyone individual rates for the same (or worse) coverage those folks were getting as employees at group rates, the insurers will rake in the cash.

Ask me if I'm surprised.

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