Fourteen million Americans buy health insurance on the individual market. It's really not a market, it's a racket.
Until 2014 when the health insurance exchanges open for business, these self-employed Americans, will have to fend for themselves against the insurance corporations.
In California, insurers routinely turn down people applying for coverage in the individual market for virtually any reason. This is ongoing despite the passage of what is being called, health insurance reform.
The denial reason du jour in California: toenail fungus.
In 2014, when the exchanges are up and running, some Americans (depending on income), will qualify for subsidies. Since all of us will be required to buy private insurance--and insurers will get 30 million new customers, pre-existing conditions will be banned.
So you can sleep easy tonight if you have toenail fungus because in four more years, the world will be your oyster.
What were the politicians thinking? Why did they leave so many voters Americans in a ditch by the side of the road?
It's estimated that approximately one fifth of the American population under 65 has a chronic medical condition of one kind or another making them "medically uninsurable" outside of large group plans. Did the politicians willfully ignore this reality--all these voters, or did they just cave to in$urance indu$try campaign contribution$?
But let's return to California the home of the Anthem 39% premium increase which caught the attention of the president. What's happening to citizens of California who have to buy insurance in the individual market racket?
California: The toenail fungus state
The web site of Blue Shield of California provides the reason why this corporation considers someone with toenail fungus to be an American leper. "Antifungal pills give the best chance of curing a severe fungal nail infection, but they cost a lot and have serious side effects. You will need to see your doctor for regular testing if you take these pills."
One would have thought, but one would have been wrong, that at minimum the insurance industry lobbyists politicians responsible for this legislation would have given the HHS secretary the ability to issue regulations making certain conditions (like toenail fungus) no longer subject to the whims of the insurance corporations. But that didn't happen, so until 2014, they will continue their rampage of denial and egregious premium price gouging.
But just as meaningful cost control was not included in the PPACA, so too was the elimination of pre-existing conditions (except for children), until 2014. Any wonder why a lot of people think the insurers drove the PPACA bus--right over the cliff.
Just ask Ralf Burgert what's it's like to pay a 50% surcharge for toenail fungus.
Dianne Feinstein is gearing up to face the voters in 2012, she'll meet plenty of angry constituents, who may feel like they were totally forgotten by the PPACA.
Ralf Burgert had no idea how costly toenail fungus could be.
The San Rafael resident got rid of the common infection by treating it with the prescription medication Lamisil. It was the last thing on his mind when he applied for a health insurance policy on the individual market a short time later.
He could not believe the response: Because of the toenail fungus, an insurer informed him, he would be in a higher-risk insurance pool with a 50 percent jump in premiums. Burgert was flabbergasted.
"I'm in perfect health," said the 43-year-old nurse practitioner. "Except for the toenail thing, I haven't had any illnesses. Of all the diseases you can have, it's as close to a harmless one as you can get. All it does is make your toenails white and kind of thick-looking."
The insurers are "just doing it because they can," he said.
Consumer advocates say they are often perplexed by the minor health issues that can create serious problems for people seeking health insurance. Each company sets its own policies.
Common conditions such as asthma, sleep apnea, allergies, ear infections, mild depression, migraine headaches, and joint sprains can trigger denial of insurance or higher premiums, the state learned in 2006 when it required insurers to submit information on their underwriting policies.
"The things that people have been denied for raise the question if simply living is a pre-existing condition," said Anthony Wright, executive
director of Health Access California, a consumer advocacy group.
Will Ralf and sufferers of toenail fungus qualify for the California High Rick Pool? We don't know. Stay tuned.
So while insurers are still permitted to deny for nonsensical reasons, we're beginning to learn that the federal high risk pool mandated under the PPACA, will be expensive and if the template being proposed in Illinois is a clue, available only for the truly sick.
Some of you have asked for example, what if you haven't been insured, you have a pre-existing condition, but also haven't been turned down by an insurance corporation. Then what happens. Frankly, we don't know.
Illinois has a list of conditions which they call presumptive of being uninsurable ( strangely, toenail fungus isn't one of them). If you have a medical condition this serious, chances are good, if you can afford it, you'll get into the high risk pool. Keep in mind, in the United States, healthcare remains a privilege for those able to pay the steep entry fees.
In the meantime, here's a list of the immediate benefits of the PPACA. Yes, on the margins, there are some very modest improvements. It is indeed better than nothing.
Presumptive Medical Conditions for High Risk Pool - Illinois
Acquired Immune Deficiency Syndrome, Lupus Erythematosus Disseminate
(AIDS) or Aids Related Complex (ARC), Metastatic Cancer
Angina Pectoris, Multiple or Disseminated Sclerosis
Arteriosclerosis Obliterans, Muscular Atrophy or Dystrophy
Cerebrovascular Accident (Stroke), Myasthenia Gravis
Chemical Dependency, Myotonia
Cirrhosis of the Liver, Paraplegia or Quadriplegia
Coronary Insufficiency, Parkinson's Disease
Coronary Occlusion, Poliomyelitis
Cystic Fibrosis, Polycystic Kidney
Friedreich's Ataxia, Severe Traumatic Brain Injury
Hemophilia (Classical) Sickle Cell Anemia
Hodgkin's Disease, Silicosis Pneumoconiosis (Black Lung)
Huntington's Chorea, Syringomyelia
Juvenile Diabetes, Wilson's Disease
Kidney Failure Requiring Dialysis
Leukemia
And lest you think that a few "concern trolls" on Daily Kos are the only ones lambasting the administration, it should be noted that no one from the administration was invited to speak to the teachers' union convention this week in New Orleans. Why? Union officials feared they'd be heckled.
But despite the passage and eventual implementation in 2014 of the PPACA, there will still be millions left out. Who are these faceless Americans? Very low income people, and those who will be exempt
because they would have to pay a premium in excess of 8 percent of income. The problem here is that with premiums spiraling out of control, how many additional millions will find themselves in the category of confronting a premium in excess of 8% of income. Many, I fear.
These people will find their last hope on the floor of a convention center at a Free Health Clinic. And we Americans will continue to have a healthcare system based on your ability to pay, not your right as a citizen to healthcare.
This is why going forward we need to wage a fight for Allan Grayson's HR 4789, a four page bill which "allows any American to buy into Medicare at cost."
This is also why I will go to Washington DC on August 4th to tell the stories of Americans who cannot access healthcare and rely on the Free Clinics Association to provide them with something--anything.
If you want help us tell the stories of Americans who get healthcare at free clinics with a small donation, we're very grateful to you.
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