Ensuring that one can’t be insured

Last month, we dealt up-close-with the broken, ill-conceived system that is supposed to be helping people get health insurance.

N.B.  This is not an advertisement for/against either Democrats or Republicans.  I am philosophically committed to the notion of not being a proponent of any political party or system.  This rather succinct diatribe comes after multiple, personal (non-partisan) experiences of how inept the current health care system can be. 

The Department of Human Services in the state of Arkansas has a seriously disabled ACA-associated arm, we found out.  The end for us came a year after we moved away—and after multiple letters and phone calls over a period of months.  We had moved out of the state, told them so several times, and they repeatedly missed that key fact and were trying to charge us thousands of dollars for insurance for which we could not have qualified if we tried.  Arkansas simply could not get its records straight, and we were eventually told we had a hearing, and we had to retain an attorney who rolled his eyes along with us and shut them up.  One sensical soul at the AR DHS, a foreigner who had a clear head and could communicate realities far better than the native Arkansans we dealt with, finally helped put the matter to rest.  I think Arkansas DHS should pay our legal expenses and have asked for same, so far without response from the appropriate sub-department.

On the other hand, the state of Kansas did its job well, as far as we could tell.  We got a single-coverage medical policy cheaply for a year and a half, but the degree to which Federal red tape and impossible processes were involved was impressive—even to one who starts from a point of skepticism about any government’s or big business’s ability to do much of anything well.

We were informed by letter, smack-dab in the middle of our 2nd year of a policy for our son, that we no longer qualified for that policy.  We had anticipated that we’d have to pay more after a year in order to keep the same plan for our son, but we were renewed, so it came as a shock that were booted out altogether about five months later.  The letter said, and I quote, “You can reapply at any time, but the “anytime” part turned out to be false.  We quickly found that the “Marketplace” (which is fettered, not free) actually prohibited us from applying until after the first policy had expired.  Yes, you read that right.  We had to wait eight more days, on the first day our son would be uninsured, in order to apply.  In other words, it was not possible, within the system provided, to satisfy the requirements of the same system.  This scenario is as illogical as it is frustrating, in case you were wondering.

Upon investigation on the day after the first policy had expired, my wife found that the options available to us began with a policy that (a) cost nine times as much as we had been paying and (b) covered almost nothing.  Specifically, an insured person would have to pay the full price, “out of pocket,” for any service, including prescriptions or doctor visits, until the massive deductible was met.  There were no better options for sale in this marketplace.

Next step:  I went back to my employer’s plans, one of which covers my wife and me.  Currently, we pay approximately 1/3 of the total cost of our own insurance, and my employer covers the rest of the group-rate premium.  The rates for adding an additional family member increase dramatically, though—to the point that the deduction from my paycheck to insure three people would be equivalent to half of my take-home (net) pay.  This is a non-starter for us.  (I do not lay the blame at the feet of the benefits plan devised by the employer.  In general terms, I would tend to blame corporate greed and medical litigation for the now-insane costs of medical insurance and services.)

Next, I made a couple of calls to local insurance agents.  One didn’t answer.  No message left.  Another referred me to yet another who did sell the type of policy we needed.  I was already thinking about having our son go uninsured and paying the penalty, but, in talking to the next agent, we learned that President Trump’s administration had done away with the penalty.  Okay, that’s good, but we’d still rather have our son insured if we can.  We were then faced with choosing from among 36 three-month policies that feature various combinations of high deductibles, out-of-pocket-maximums, and premiums that were relatively affordable but still 2-5x more than we had been paying.  In our case, we will almost certainly never reap any benefits from this medical insurance unless we have a catastrophic need—an event that would surely bankrupt us, anyway.  We now have to reapply every time the three-month policy expires, to boot.

Now, to put this insurance product in perspective with need and perceived worth.  All three of us have been to a physician for sickness precisely zero (0) times in 18 months.  Our son went to the doc for a free children’s checkup last summer, and I “took advantage” of insurance for physical therapy.  The insurance covered about 40% of the total bill.  Not very good insurance, I would say, but we are blessed with the ability to pay the rest, so it was OK.  Yes, 40% is better than nothing.  I only hope that if any of us is ever hospitalized, the insurance will pay more than 40% of that bill.¹

In going through all this in my mind, I do wonder about the potential benefits of socialized medicine.  I’m not interested in moving to Canada or Europe or wherever they have different systems, but if any of us ever need surgery, I imagine we’ll investigate international travel.  In the meantime, until something breaks, it appears that we’re stuck with paying too much for two “major medical” policies that we’ll likely never use.


¹ I also hope the bills come from one place if services are rendered in one place.  In the case of my physical therapy, I saw an orthopedist, had an X-ray, and had the physical therapy itself in the same building, and separate bills came from three or different offices.  There was a separate fee for the outsourced radiologist “reading,” which could have been accomplished just as well by the orthopedist but had to be sent out to another because of some insurance-related agreement.

4 thoughts on “Ensuring that one can’t be insured

  1. Sherry Kirkland 02/25/2018 / 6:54 am

    I had a bad experience with health care also. I retired from work 2 years before qualifying for Medicare. I was required to be insured or pay the penalty, so I picked a plan that had a very high deductible and really not affordable at all. I ended up getting Lyme Disease, which took two trips to the emergency room and three trips to my regular doctor to be diagnosed. Since my deductible was so high, I had to pay every dime of those bills. All I got free with that policy was one well visit, which would have cost me less than $200 to pay out of pocket. That was only half the cost of one month’s premium for the terrible plan I had. To make a long story short, I am still paying off those bills in small monthly payments. The second year I just decided it would be cheaper to pay the penalty and went without insurance. Fortunately, I didn’t need the doctor for the year and now I am on Medicare. It is definitely something that needs to be fixed.

    Like

    • Brian Casey 02/25/2018 / 6:59 am

      Sounds like you had it worse than we did. I’m sorry. I’m sure that many people are in fact being helped by the ACA, but many are not. That, assuming it’s correct, in itself means it’s a system that needs to be fixed!

      Like

  2. Steve Kell 02/26/2018 / 12:03 pm

    Brian,

    It is a very complex issue and a conundrum to try to understand…a Gordian Knot to attempt to untangle. I hits home more when you have friends or (especially) your own family attempting to utilize–and afford–our health care system–and we see more acutely up close and personal what a tangled mess it is.

    I have not been a Clinton voter or supporter–him or her, but I recall Hillary at least attempting to bring this national sore spot to the forefront during her husband’s administration (it did not go very well) some 20+ years ago, and despite ACA’s best intentions–which have more nobility in intent than in functionality, we are still wallowing in a quagmire of ill-advised prescriptions for this critical issue. When Canada, Mexico, and European health care options provide more affordable–and at times, more effective treatments/medicines than our own, we should realize there has to be a better way forward than what is in place in our country now.

    Thanks for your insightful comments more in line with observation and suggestion contra blanket vitriolic outrage or condemnation–neither of which serve us well.

    If someone actually came forward with a viable solution (Republican or Democrat), it would provide some much needed leadership to the betterment of our country and the relief of so many in need.

    Like

    • Brian Casey 02/26/2018 / 3:25 pm

      Although we’ve been irate at times, we do recognize that ours is but a tiny sugar crystal in the filling of a slice of this massive “pie.” I didn’t remember/know that Mrs. Clinton had tried to do something about this, but “quagmire” is what most systems of this scale turn into (in my view). Although I don’t find this system a very good answer, I do agree that most healthcare plans and ideals, including this one, are of good intent. In my limited knowledge, this one seems slanted, but probably no more so than some aspects of the tax code has seemed slanted to certain people groups. My cynicism says that no better way forward will likely be found, but that’s a commentary on human nature, not on the two major parties or even on the U.S. as a whole.

      The focus on betterment and relief are worthy ideals.

      Like

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