A black hole in health insurance
byDec 25th 2009 3:00PM
At 63, Billie Hoke is two years and a ton of worry away from the health care goal line.
She will have to wait until 2011 to join the millions of Americans in the Medicare program for people 65 and older. Medicare provides relatively inexpensive -- and very secure -- coverage through the federal government.
Hoke has no security now. She lost her health insurance in August when her employer dropped its health benefits plan. Since then, she has gone without coverage, paying cash for prescriptions and medical services, skipping the more expensive care.
Ironically, Hoke is a licensed practical nurse in the Columbus, Ohio, area, working with people who have developmental disabilities.
She did get one recent price quote for private insurance: $2,200. That's twenty two hundred a month. For a nurse who is single, making about $40,000 a year, it was impossibly expensive.
The rate was high, she says, because she had breast cancer six years ago. Since then, "I've been cancer free,'' she says. ''But when they hear 'cancer,' they don't want to cover you.''
She also belongs to an age bracket hit hard by recent job and insurance changes: the 55 to 64 group, where the oldest of the baby boomers reside.
My own age group.
Many of my fellow boomers have lost jobs during the recession. But the chances of our landing a new position with good benefits appear as steep as winning a lottery. And we tend to have more health conditions than younger people.
"They are the most vulnerable of the uninsured,'' says Bill Custer, a health insurance expert at Georgia State University. This group has more health needs, he adds, and "if laid off, they have a harder time finding a similar job."
Even though self-employed, I'm one of the lucky ones. I have health insurance.
Recently, our age group was targeted for specific help in the health care reform debate. Senate Democrats floated a proposal to allow people 55 through 64 to buy into the Medicare program.
The Medicare ''buy-in'' was expected to offer subsidies eventually for the uninsured to get coverage, but not at the start. It would have cost an applicant hundreds of dollars a month. A buy-in, though, was a tantalizing idea for many reform proponents. It was also a much more tangible proposal than a public option, the government-run insurance plan pushed by many Democrats.
The idea, though, quickly died amid opposition from hospitals, doctors and centrist Democrats.
But the healthcare reform bill, which the Senate on Dec. 24 approved, along strict party lines, still could help people such as Hoke. That's because a proposal envisions creating a national insurance program immediately for ''high risk'' people with health conditions who can't get affordable insurance now.
Eventually, the uninsured could shop for coverage in a health insurance exchange, and people with low and middle-incomes would get subsidies to purchase coverage. Reform would bar insurers from discriminating against people with pre-existing conditions.
"The individual insurance market has never been very good,'' says Cheryl Matheis, an AARP senior vice president. "It has become increasingly discriminatory'' as insurers cherry-pick only the healthiest individuals, Matheis adds.
Reform will greatly help people 50 and older, she says, by eliminating these insurance company practices.
Meanwhile, Hoke is stuck in an insurance black hole. Because her company jettisoned its health benefits plan, she's not eligible for COBRA and its newly-subsidized lower price.
Hoke skipped a recent mammogram because of the cost. She takes only generic prescription drugs, saying her brand-name medications are too pricey. "I haven't gone back to the doctor, because I can't afford it,'' she says.
This sudden medical squeeze has heightened her interest in health reform for ''uninsurables'' like herself.
Right now, she hopes no serious illness occurs. "I can't think about it,'' Hoke says.