Health care: Five faces of the uninsured | Arthritis Information

 

http://www.usatoday.com/money/industries/health/2009-09-22-faces-uninsured_N.htmLynn, thanks for posting... Interesting stuff. So now it's back up to 46 million? Also, a couple of these people kill me...

[QUOTE=José]...but where are her priorities?... And Really, millions of single people making -85k/yr that can't afford insurance? Wow...[/QUOTE]

Wow indeed. I am always bemused when people speak of "the health care crisis" as if it is a sudden and unexpected phenomenon.

Having been uninsured a time or two I do understand how frightening that situation can be, however self-responsible adults who have been in the work force for years should have formulated a contingency plan and have the means to implement it.

As has been said before, no one needed a crystal ball to predict this "crisis".
My health insurance company pays out far more than it takes in from me. My medication alone cost more than ,000 a month! (Course they don't pay that I'm sure!) My insurance premium is 5 a month. Now that's ,000 a year for just my medication! That doesn't include my various medical appointments, x-rays and lab work. This is just for my RA alone. ,420 a year is what my employer has invested in my health insurance. I can see all too well why insurance companies have this "pre-existing condition" clause in there.

Lovie has pointed out the difference in having a "group" plan (insurance through one's employer) as opposed to nongroup health insurance -- a person buying a plan on the "individual" health insurance market.

In a group plan, because of the number of people in the "insurance pool," employers have a position of leverage with negotiating with insurance companies for better coverage and lower health care costs (i.e., drugs).  Also, because employer health insurance costs are exempt from federal income tax, employers must comply with federal rules and not discriminate on the basis of medical history, age or gender.  I think many of us have gotten our insurance this way, through our employer, so are not familiar with the discriminatory practices someone faces shopping for insurance in the individual health insurance market.

Finding affordable health insurance in the individual insurance market, is not only a problem for someone with a pre existing condition, but also for older people (folks in their fifties) and women.  In the individual health insurance market, woman have to pay more for maternity coverage.  A woman on another arthritis site wrote she would have to pay an additional 0 for maternity coverage, on top of her already high premium, cuz she had a pre existing condition, RA.  With the recession, folks in their fifties, may have lost their jobs, and find it impossible to find affordable health insurance.  And the self-employed and workers of small businesses, that often can't afford to pay for health insurance, are faced with trying to find affordable health insurance in the more expensive individual health insurance market.

My sympathies do not lie with private, for-profit health insurance companies, but with working people that are locked out of purchasing affordable health insurance. 


 
[QUOTE=Joie] ... I think many of us have gotten our insurance this way, through our employer, so are not familiar with the discriminatory practices someone faces shopping for insurance in the individual health insurance market.[/QUOTE]
In more than 40 years of being employed I have seldom had insurance as a benefit of employment and have always been able to find insurance to meet my needs. Thus I too fall into the unfamiliar-with-discrimination-zone with insurance, although I have regularly shopped for coverage.

A few years ago I was in need of a new policy with better benefits secondary to my age. I was able to find reasonably priced insurance with 60 days of non-coverage for pre-existing conditions and with a deductible that met my specific criteria. That plan has met my needs very well over the past year and I was recently contacted by a representative to be certain that my needs WERE being met. i guess I have just simply been lucky with my personal experiences in purchasing health insurance upon the open market. I admit to expecting to pay more for a policy than my 26 year old healthy nephew, but is that truly discrimination, bias, or prejudice, or simply a matter or business practices?

You were able to acquire affordable health insurance in the individual (nongroup) health insurance market despite your age and having RA?  What insurance company is that?  I would like to share that with a woman recently diagnosed with RA who will be losing her insurance in November.

It is a business practice, in the "individual" health insurance market, to charge more for an older person than a generally healthier younger person.  I choose to use the word discriminatory, though I'm sure an insurance executive would deem it "good business" to sell health insurance to those that probably won't need it rather than those that do.

But again, I'd like to point out, this "business practice," charging more or denying insurance to older, less healthy people does not apply to the "large group" health insurance market nor government programs, like Medicare, Medicaid, TRICARE -- but only to the "individual" health insurance market.

I recently purchased insurance for my son and daughter in law.  I started by helping them apply for policies on the open individual plan market but they were both rejectected for pre-existing conditions.  My son I can understand since he has a history of chronic illness...but my daughter in law was rejected because of a recent UTI which required one doctor visit and a round of antibiotics.  At any rate, California has a high risk pool called MRMIP which is available for people who have been rejected on the open market.  They require a rejection letter from one insurer to qualify.  My son and DIL now have an excellent policy which costs 5 per month with a low deductible and co-pays and even includes maternity coverage.  I was amazed.  It's not cheap but still pretty reasonable.  Other states have similar high risk pools so it's worth checking as an option if you can afford it. Alan2009-09-24 12:35:28 Hi Alan,

I'm glad your son and dil were able to find reasonable health insurance after being denied insurance in the individual health insurance market.

California's MRMIP is a state government health insurance program isn't it?  So does part of the cost of the program come out of the general fund -- from taxpayers?

It is such government health programs that are the safety net for people denied health insurance by for-profit health insurance companies, who enhance their profits by "cherry picking" the healthy and leaving the "sick" (and your dil, who had a UTI) to state health programs or taxpayer-subsidized government health programs.

I'm glad California has the MRMIP program, only about 35 states have high risk programs, and often there are waiting lists.
 
Joie2009-09-24 13:54:20I'm sorry Joie, but you aren't making your point. Look at the profit margins for the Evil Health Insurance companies. they aren't all that high. So how would YOU run the company? Cherry pick all the high risk cases and not charge them a dime more, so that the company runs out of business? and then who's better off? Medicare forcing providers to take less just makes the rest of us in the private sector have to pay more, I believe that's part of the reason costs keep going up. The costs have to be covered by someone. They can't get it from Medicare or other "public" source, they raise the prices on the rest of us... You seem to be under the impression that the government can just force providers to take less and less and they'll just sit idly by while they are driven out of business.... How many doctors do you think you'd have left if you did that?...It is true, that insurers haven't made the profits they've had in the past -- rising health care costs are impacting everyone.  But insurance companies still manage to pay their CEOs multimillionaire dollar salaries, dividends, lobbying expenses, advertising, administrative and underwriting costs.

I look at the "group" insurance market and the "individual" insurance market, and ask why can't the individual insurance market operate more like the group insurance market?

How would I run an insurance company?  I would offer a basic policy, that I would not expect to profit from, but offer additional coverage that would be profitable.  I might not have a multimillion dollar compensation package but I would sleep better at night knowing that someone is not suffering because of my "business practices." 

But insurance reform is only part of the health care problem, making health care delivery more efficient and effective is a bigger part of it, examples are the Mayo Clinic and other integrated health care systems that provide quality health care yet keep health care costs from spiraling upward.

I am fully aware of the difficult challenges our country faces in fixing our health care system, its a complex problem, but in the process of working it out, we can't overlook the millions, especially those with health problems like "our disease" RA, who can't find affordable health insurance -- while Congress and the public debate this issue -- people suffer and become sicker. 
       Here's an excerpt from the MRMIP website.  Yes, it is subsidized by the state...don't know by how much. Joie, I agree with almost everything you said... I thin k we all want to help those that can't help themselves... But again, the devil is in the details... [QUOTE=Joie]
You were able to acquire affordable health insurance in the individual (nongroup) health insurance market despite your age and having RA? [/quote]
Yes, that is exactly what I said: I shopped around and found a reasonably priced health insurance policy that met my needs. However, it must be said that what I find reasonable and affordable would not be for someone else.
[quote] What insurance company is that?  I would like to share that with a woman recently diagnosed with RA who will be losing her insurance in November.[/quote]
Insurance packages and plans are, unfortunately, not the same from one location to another. If the woman lives in Arizona I would be glad to share additional information with her, however attempting to find a similar policy plan at an affordable price in a different environment might prove to be the proverbial fool's errand.

Many medical schools offer a variety of healthcare plans and if the woman lives near a teaching hospital she may qualify for a plan through therein.

Good luck to your friend and to everyone who is looking for coverage.

Edited to correct formatting.
Spelunker2009-09-25 10:47:19<>The woman that would be losing her health insurance in November, is not a friend of mine, but a 20 year old college student that posted on another arthritis website that she was "kinda freaking out" cuz her doctor, after an exam, said its very likely she has RA -- given her symptoms and family history of RA. She posted a second time, and explained because she is turning 21 in November, she will no longer be eligible for her state's Medicaid program, TENNCARE.  Tennessee's medicaid program covers only children, low-income disabled and pregnant women.  Her state does not have a high risk program -- health insurance for those turned down because of a pre existing condition, nor do I think she is eligible for SSDI, since she hasn't worked that long.  She was waitressing, but had to quit because of her RA-like symptons, she is awaiting RA labwork to confirm a diagnosis.  I passed on your suggestion, to check with a teaching hospital in her area, but she has not posted again.  I will also suggest she check with Social Security if she might be eligible for SSI or to check with any charity organizations, but I fear, as she wrote, "There aren't many options."
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