My Health-Care Story: Over 50 and Out of Luck

By John Hewko
Sunday, October 18, 2009

I am a Republican who did not vote for President Obama, but I support his health-care initiative because I have just experienced first-hand our system's dysfunctional wrath -- and it isn't pretty.

Recently, I left my job with the federal government -- I was a political appointee, so my tenure was limited -- and became an independent consultant. Although I have access to health insurance under the COBRA law, the premiums are extremely high and the coverage expires after 18 months. So I applied for individual (nongroup) coverage with CareFirst BlueCross BlueShield, the carrier that covered me while I was a federal employee.

I am a healthy 51-year-old. I am an avid cyclist and play in an over-50 hockey league. I don't smoke or drink. During my last physical, my doctor told me that my blood test, EKG and other screenings had been "perfect" and that I was one of his healthiest patients in my age group. Apparently, being healthy and physically fit is not good enough for CareFirst. To my surprise, the company denied my application.

I have borderline hypertension that is well controlled with a minimum dose of medication and mild stiffness in my left shoulder and right hip, for which I take an occasional Advil. This combination of "pre-existing conditions" -- conditions that millions of Americans my age experience -- was the basis for a complete denial of coverage. Not slightly higher premiums (which I would be happy to pay), not a short-term exclusion for the preexisting conditions, but a flat-out denial. However, CareFirst was kind enough, in its rejection letter, to send me an application for a guaranteed coverage policy for twice the premium, with astronomical deductibles and out-of-pocket maximums, and a $1,500 annual maximum coverage for prescriptions. In other words, even though I am healthy and can afford and am willing to pay high premiums, I can't get comprehensive individual medical and prescription coverage with this company at any price.

So I am forced to roll the dice with my health. What happens when my COBRA runs out (coverage might be available under the Health Insurance Portability and Accountability Act, but CareFirst's premiums for my family would be $3,000 a month and annual prescription coverage is limited to $1,500)? Will I again be denied when I apply for coverage after 18 months, particularly since my "pre-existing conditions" aren't going anywhere and many companies ask whether a previous application has ever been declined? Should I cancel my annual physical for fear that some new condition might pop up? Or, do I take a job, any job, so that I can get covered through an affordable employer group health plan?

And, even if I am able to get nongroup coverage, will my policy be rescinded later because I forgot to list a medical condition on the application, however minor or unrelated the omission was to the illness being treated?

William Kristol, in a recent commentary in The Post, stated that "there is no health-care crisis." He either has a cynical hidden agenda or he's ignorant of what millions of Americans who don't have access to employer-based plans face. The system is broken. I'm one of the lucky ones, because I have the means to pay for COBRA and to cover any catastrophic prescription costs and high deductibles under CareFirst's guaranteed coverage policy. But what about the laid-off factory worker or office clerk who cannot?

No silver bullet will solve all our health-care problems, but four measures would address one of most glaring weaknesses of our system: mandatory insurance for all; subsidies for those who can't afford the premiums; a prohibition against denying or rescinding coverage for "pre-existing conditions"; and meaningful tort reform. Yet Congress continues to make the ideological perfect the enemy of the desperately needed good. Democratic ideologues reject tort reform and insist on a public option that many suspect is a Trojan horse to a single-payer system, while their Republican counterparts deny that a crisis exists, decry any reasonable attempt at reform as a government takeover and fail to articulate an acceptable alternative.

Meanwhile, millions of honest, hardworking, self-employed or laid-off Americans continue to play Russian roulette with their health. Maintaining the status quo is unacceptable. A failure to adopt at least these four measures would be a national disgrace.

And to those Americans who are insured through their employers and are puzzled by all the buzz about a health-care system in crisis. Just remember: You are but a pink slip and a minor pre-existing condition away from insurance hell.

The writer, a lawyer, is a public policy scholar at the Woodrow Wilson International Center.

© 2009 The Washington Post Company