Just this spring, a woman called our helpline desperately trying to keep her son on his health insurance. The son’s situation is an all too familiar Catch-22, and one that will be addressed under the new health care reform act.
The son had some problems as a young man, but has turned his life around and is now working at a job and living independently. With his job and health insurance, he is able to get medications that keep him healthy. But through no fault of his own, he may lose his insurance. Worse yet, because his health status includes this pre-existing condition, it will be difficult to impossible for him to get health insurance in the individual market.
Without health insurance, her son can’t afford the $700 per month medications. Without the medications, her son will not be healthy enough to work.
This young man is not alone. According to a report issued this week by Families USA, more than 593,000 Connecticut residents have been diagnosed with at least one condition that would likely disqualify them from individual coverage. In addition, over 300,000 state residents do not get health insurance from an employer, but purchase it on the private individual insurance market. Not only is private insurance more expensive, averaging 17 percent higher than the rest of the country, it is routinely denied to people with pre-existing conditions.
The report found that the conditions people are denied coverage for include any diagnosis of cancer, asthma, diabetes, arthritis, heart disease, or obesity. While the problem affects all ages, it is most acute for people between 55 and 65 years, not quite eligible for Medicare. Forty percent of the near-elderly have at least one pre-existing condition that could disqualify them for individual coverage.
Pre-existing conditions are not limited to any race, age or income group. Over half of Connecticut residents at risk are living in families with annual incomes of more than $88,000 for a family of four. Whites, African Americans and Hispanics are about equally likely to have a pre-existing condition.
The good news is that under the new national health care reform act, as of this coming September, insurers can no longer deny coverage to the 44,200 children in Connecticut with pre-existing conditions. But that still leaves more than half a million adults in our state at risk until 2014 when the national law prohibits denials to anyone, including adults.
Since 1975, Connecticut has had a program to cover people with pre-existing conditions, run by the Health Reinsurance Association. But enrollment is low and costs are high, reaching well over $2,000 per month for some people. Thankfully, the new national health reform bill gives Connecticut $50 million to supplement that coverage.
Unfortunately, the caller’s son would not qualify for the federal funds until he has been uninsured for six months, another catch-22. The current system is indeed broken because it provides reasonably priced, high quality insurance only to people who don’t need it and allows insurance companies to deny it to people truly in need.
Anyone who thinks we did not need health care reform, or that the national bill went too far, need only talk to a mother I know.
Ellen Andrews is Executive Director of the CT Health Policy Project, a non-profit research and advocacy organization working to expand coverage to affordable, quality health care for all Connecticut residents. The Project provides policymakers with information about options for coverage and provides assistance to consumers struggling to access health care in Connecticut.