I graduated college at the age of 23. I was living in Chicago Illinois and working as a stage actress. My pay was low and my job did not provide health insurance, although it was a professional union theater. I also had any number of part-time jobs but none of them provided me with health insurance. Yet I was paying all my bills on time and taking care of myself.
My mother took me off of my father’s COBRA plan once I graduated from college. She thought I could purchase an individual plan with no major problem. She was wrong. I applied for Blue Cross Blue Shield for a standard individual plan. The costs were extremely high even back in 1996. I was also being charged about double since I was a woman, I thought this was a bit absurd but it was explained to me that since women might need maternity I was paying in for myself and for all women. A slightly twisted concept I thought since women can only get pregnant with the help of a man yet only women had to pay extra for other women.
I filled out the paperwork and waited, and waited and waited. Finally after about six-weeks the insurer informed me that I had too many medical problems and they wouldn’t cover me. I was 23 years old with no chronic conditions. My asthma wasn’t even diagnosed until years later. When I demanded to know specifically why I wasn’t covered they said it was because I hadn’t had enough healthy pap smears in a row, and because of a cervical biopsy I had at the age of 22, I was deemed high risk. Even though the biopsy showed no signs of disease and I didn’t even have an STD. My exam was free and clear. The biopsy was given to me because my pap smear was slightly off due to being on the tail end of my period when the test was taken.
I had only had two pap smears up until that point, which is perfectly normal for a college-aged woman. Blue Cross said that I need five healthy pap smears in a row before they would consider insuring me. A woman typically get a pap smear a year, so what they were really telling me is that I had to wait five years.
I tried to apply for coverage with other insurers, I even went to an insurance broker who sat me down and told me what the real problem was, as no other insurer would cover me at any amount. My paperwork would get “lost”, phone calls were left on voice mails never answered, I would spend over an hour on hold, mail would be returned to me. The broker told me that I was basically being blacklisted by Blue Cross Blue Shield, and yes he used those very words. Blacklisted. Somehow the fact that Blue Cross Blue Shield was denying me was showing up in my medical records and no other insurer would touch me due to the size of Blue Cross. If an insurer that large wouldn’t cover me, it just made me look extremely high risk.
So we devised a plan. I was able to get emergency only coverage for six months, that could be renewed but only for two years total. So I couldn’t use it to go to the doctor, but if I got hit by a bus I could go to the hospital. The coverage was lousy but better than nothing. I also decided to get those five healthy pap smears and send them to Blue Shield, but my plan was to do it in half the time. So every six months I went to Planned Parenthood and explained my problem. The nurse practitioners sympathized with me and obliged me, even though they thought it was ridiculous. So after getting and paying for five healthy pap smears in about 2 1/2 years I applied again, only to be denied again. The insurer cited health concerns again, but they wouldn’t give me a specific reason.
Meanwhile during this time I got sick, nothing major but I ended up at Cook County hospital twice. Cook County was a no frills, bare bones public facility that could turn down no one. The first time I went to Cook County I waited eight hours to see a doctor, and then got a free prescription, only waiting an hour to get the prescription. The second time I went it was only a five-hour ordeal. While waiting to see the doctor I sat in a waiting room of wooden benches along with the poorest of the poor and homeless people. It was a rattling experience to say the least. When I applied for the health insurance program through the state of Illinois I was informed that since I did not extend my COBRA coverage that I was ineligible. The cost of extending my father’s COBRA coverage was astronomical once I left college, but according to Illinois state in order to be eligible for their plan I had to extend my COBRA for as long as possible. Of course I had no way of knowing any of this when my mother opted to stop covering me at the age of 23.
Finally my luck changed a bit and I ended up with a full-time job, at all places the American Medical Association. When I was filling out my employment paperwork I noticed their health care plan was through Blue Cross Blue Shield. I panicked, I thought surely they would deny me coverage. The woman in HR told me that no one was denied coverage and that they had never even heard of it happening. And they had employees with major chronic health problems, or children with chronic health problems and no one was ever denied. My application went through and I was suddenly covered. I went back and asked my friend the insurance broker what exactly had happened.
He explained it like this. An insurer will most likely lose money on an individual plan. They have to do the paperwork and claims for one person, a person who is paying their premiums themselves and is probably going to squabble over every charge. The same person is probably going to use the insurance more often that they are paying a few hundred dollars a month for it. Whereas a person in a group plan won’t fight over every bill and is more likely to use their coverage less often. Group plans were just much more efficient and cost-effective both for the insurers and the employers. That is why the cost of individual plans are so high and why insurers usually don’t want to deal with individual plans.
So given my experience, I can’t really get enthusiastic about a “market based” solution to health care. In my case the market completely let me down. I couldn’t get health insurance at any cost. So my libertarian friends can rant and send me links to websites denouncing reform, and my Republican friends can call Obamacare socialism and tell me to read this book or that email, but my personal experience is going to trump all of it. I was a perfectly healthy 23-year-old female with no cancer in my background, no chronic medical conditions and no history of lapsed coverage for more than a few months, yet I was denied coverage. If I was denied coverage than just about anyone could be denied coverage.
And now that I live in New York state with its much tougher patient protections I don’t want to buy health insurance from a state with less. New York state is one of the few that a patient cannot be denied coverage for medical reasons. People actually move here after they are denied coverage due to cancer or major heart problems in other states. I don’t think Obamacare is perfect as it still puts too much power in the hands of health insurance companies and we still have no single payer public option. But at least now a person who has survived cancer or is born with some type of genetic problem is able to get health insurance. And a perfectly healthy 23-year-old would be able to buy a plan on their own. My personal experience has shaped how I view the health insurance fiasco in this country more than any political rant or speech ever could. I am lucky in that I didn’t get anything serious in those years I went without coverage. And if I had, I would have ended up in the emergency room with bills that were never paid and probably ended up on Medicaid which would cost everyone that much more. Our system is broken and it was broken 15 years ago and is only getting worse. Hopefully the plan by the Obama administration that was just held up in our Supreme court today is the first of many reforms to help fix our system.
If you don’t believe my story, then sit down and talk to some of your friends, especially anyone with chronic medical conditions, small business owners or the self-employed. You are likely to hear similar stories of denied coverage, frustrations over claims, skyrocketing premiums and financial ruin. I have heard stories much worse than my own with some blaming health insurance companies for the premature death of family members. After all putting a profit motive into denying coverage can have deadly consequences. Hopefully we will figure this mess out soon enough, I know I never want to end up without any options again.