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Lisa Solod Headshot

What You May Not Know About Health Insurance and the Affordable Care Act: Now and Later

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When in the early nineties I lived in Oxford , England, as the new mother of a six-month old, nurses regularly came to our flat for well baby check-ups. All of my medications and doctors' visits and all those for my child were free for the first year of her life. My prescriptions averaged around ten dollars each, no matter how expensive they were. And I was only a temporary resident.

When I lived in France for two years about ten years ago, my prescriptions were uniformly 7 Euros each, which at that time was about the same in dollars; even the medication that costs close to three hundred dollars here in the United States. In both countries I received health care as good or better as I have ever received here. In France, I broke my foot and the treatment there was remarkable in how fast it got me, literally, back on my feet.

Now, back here in the United States where I have had health insurance for the past 27 years in the state of Virginia I haven't been able, so far, to qualify for health insurance in the state of Georgia, to which I have recently moved. I am being denied due to the number of medications I take, a factor which I really didn't consider when deciding to move, ignorant, as I was, that I would have to apply and be medically underwritten for insurance all over again.

Because health insurance does not transfer. Did you know that? I didn't. Even if the company writes under the same name. Blue Cross of Georgia has no obligation to cover me even though Blue Cross of Virginia has covered me for years. Other companies I have contacted have given me the same answer. I may yet get coverage (the jury is still out) from one company although they will require a rider which will exclude the most expensive of my medications, an inhaler which I take for life-long asthma and which costs nearly $300 a month. That same inhaler, I might add, which was less than 7 dollars in France, and which, even with my current co-pay costs me $90 a month out of pocket. The individual policy I currently have, has a large deductible, too, and still costs me close to $600 a month. I have a friend who has cancer and whose husband had a stroke and they pay almost $3000 a month. Yet health insurance companies run as for-profit enterprises and fat-cat CEOs are banking millions off the checks of people who are betting against themselves, and millions more because they won't insure anyone who might be a risk. None of the executives of large insurance companies makes less than $3 million a year and most of the big guys make far, far more than that.

I suppose I am lucky, though, that I have none of the conditions which would have excluded me from even applying for insurance. Although, supposedly children under 19 born with pre-existing conditions cannot be denied insurance, that doesn't count for those over that age. If you look at the applications you will find that people with Down's syndrome, those who have a history of bi-polar syndrome, anyone who has had a stroke or heart attack needn't apply. If you have multiple sclerosis or other nerve diseases you cannot get coverage. If you suffer from fibromyalgia you cannot get insurance. If you have emphysema or COPD you cannot get coverage. If you have ever had a drug or alcohol problem, don't apply. And of course if you take more than three medications, your chances are pretty slim. In fact, if you think you might be the kind of person who might need insurance, you are out of luck. Best be young and healthy and insurance companies are happy to take your money and -- until the Affordable Care Act goes into effect -- dropping or denying you should you actually need medical care. Yet medical bills are the number one cause of personal bankruptcy in the United States, and a huge majority of those who do file had some sort of insurance.

Yet the Affordable Care Act which invokes the ire of Republicans leaves much out and even its best provisions do not even come close to approximating universal health care as can be found in much of Europe and Canada. Though it states that "For most plans starting on or after September 23, these rules stop insurance companies from imposing pre-existing condition exclusions on your children; prohibit insurers from rescinding or taking away your coverage based on an unintentional mistake on an application; ban insurers from setting lifetime limits on your coverage; and restrict their use of annual limits on coverage," there is no provision that covers people like me who wish to get individual insurance in another state. While banks ran wild with derivatives, we financed two wars on credit and still we spend billions on those wars and billions more on subsidies for huge corporations and tax cuts for everyone, including the very wealthy, we still are unable to "afford" to do anything about insuring all of our citizens.

People, like me, self-employed, whose health care is not provided by an employer, and the many unemployed are still on their own to cobble together what they can afford, or go without. Under the Affordable Care Act, anyone with a pre-existing condition (which basically means anyone with any kind of serious illness or anyone who takes more than three medications) can qualify for a good policy through the government but only after he or she has gone without health insurance of any kind of six months. That means I would have to drop my Virginia policy and go uninsured -- paying out of pocket for all my medications and praying that I don't have an accident or come down with some horrible disease -- before I can qualify. The clause that forces insurance companies to take those with pre-existing conditions won't kick in until 2014. Until then I, along with many others, am out of luck.

I am not particularly unusual. I am a relatively healthy 55 year old woman. In fact, a doctor quite recently pronounced me in good shape. I eat properly and I exercise regularly. Nothing catastrophic has happened to me. Yet. (I need to knock wood on this, as my grandmother would say: "God willing.") But because of my medications I am now just about uninsurable in a new state, despite my past insurance history. For twenty years, I had insurance through my husband's employment; when we separated and divorced he was allowed to carry me for three years. Four years ago I applied for my own insurance through his same company and was given a policy (which, incidentally has gone up by nearly fifty percent). Two of the conditions I have now I had then. But I now take two other medications and that is two too many for an insurance company. I think it is a great irony that the top executives of the afore-mentioned insurance companies are, with one exception my age or older and, I suspect, take medications or have conditions that might make them uninsurable, too. In another universe. The universe of the ordinary man. Yet while Blue Cross CEOs' pay goes up and up, their pool goes down and down. (This may change, in the future, now that insurance companies are supposed to use at least 80 percent of their monies to provide health care, but only time will tell.) I was told by one broker that Blue Cross routinely denies coverage to sixty percent of people who apply.

When I began applying for new coverage I was inundated with sales reps and emails touting their "affordable" coverage. Blue Cross sold me hard and assured me, on the phone, even after taking down my medical history, that I would get coverage. I was denied in an impersonal letter which came in the mail days after I had called about my status and told that they would not cover me. I still get emails pushing insurance but now I am smarter. I finally found a broker who seems to know her business (after two brokers told me, in no uncertain terms, that I was completely uninsurable) who may have steered me to a reputable company which, as I said, may cover me. This is after hours and hours of filling out essentially useless applications to companies who did not have the decency to inform me that they were mere salespeople and that the underwriters had all the power. And, according to my most recent broker, it doesn't look good that I have been denied coverage. It's a black mark that I have to disclose on all future applications.

This self-described "greatest country in the world" has a lot to answer for when its citizens can either not qualify for health insurance or can't afford it if they can. The Affordable Care Act made some tiny inroads into a deeply broken system, and even those inroads the Republicans wish to repeal. Meanwhile, millions of uninsured people go to bed each night hoping nothing serious will happen to them, and millions more have to choose between paying for their medicines or paying for food. And millions of others are filing for bankruptcy to pay for past and present medical bills.