When the health care reform law passed last year, I was both pleased (some action! Something at least marginally progressive!) and disappointed (let’s pick on women’s necessary reproductive health care and on immigrants! This is all about abortion! – because everything is, apparently). And of course, it’s no surprise that we have spent much of the last year hearing how the Affordable Care Act will bring on the death of America, democracy, our financial system, and of course, us (death panel, anyone?). Still, at least parts of it will likely survive to be implemented in 2014.
One of the most contentious aspects of the debate over reform related to insurance, and who should/could/must be covered under the new law. Should employers have to make sure all their employees are covered? Should insurance companies be prohibited from turning people down for coverage? And so on.
Being a history geek, I’ve long been intrigued both by how insurance came to be, and by how it used to operate compared to its current reality. I’ll spare you most of the details, though you can find some here, but what always impressed me was that when insurance was just becoming big business, out of the London coffeehouse of Edward Lloyd (yes, that Lloyd of London), it was a way for merchants and early venture capitalists to pool their money and cover the risks of a ship being lost at sea, with each participant deciding how much of the risk on a particular voyage he wanted to insure. Practical, fairly efficient, and quite workable. Notably, when ships were lost, the underwriters paid up.
Not so anymore. Now, insurance seems to be a way for corporations to make vast amounts of money and become ever more clever about not paying out. Yes, a generalization, but stick with me here. The insurance industry made $9.3 billion profit in just the first nine months of 2010, up an average 41% over 2009.
As the director of a non-profit with only nine employees, which is basically a small business (we just put any ‘profit’ to work carrying out our mission), I have always been proud that we offer health care coverage to all our employees. We regard it as a basic worker right, much like paid sick and safe days, for which we are advocating in the City of Seattle. And we work hard to make sure it’s decent coverage, with women’s reproductive health care well-covered, a not-entirely outrageous deductible, reasonable co-pays, etc. We contribute to that $9.3 billion profit: $468 per month per employee for medical, plus $58 per month for dental, which adds up to more than $60,000 per year. And it’s worth it. Our colleagues are worth it.
You can imagine, then, how horrified – no, outraged – we all were to discover that our plan imposes a 9-month waiting period for any employee who starts working for us and has a pre-existing condition. For those of you wondering, the nine months is not a coincidence: it’s a common waiting period, and yes, companies do adopt it to avoid providing coverage for women during pregnancy. (Oh, to have that $9.3 billion to spend on women’s reproductive health care!)
Our employee who needs health care is not pregnant. My colleague has a long-standing condition that she manages carefully, working very hard to avoid getting seriously ill, having to go to the emergency room, or experiencing any of the other events that drive up the cost of health care. You would think our carrier would want to keep that responsible behavior going. Nope. Instead, my colleague must wait the full nine months before she gets any part of her ongoing health care management covered, paying out of pocket for her needed visits and medication. And as her employer we will pay $4,734 for ----------- NOTHING.
But wait: there’s more. A recent report by the Kaiser Family Foundation ranked states by the price of insurance rates per individual. Washington is in the third-highest paying group, though it’s ironic that the average in this state is still much lower than what we actually pay per employee. Even more ironic: the study’s authors conclude that some states have higher premiums because they make it easier for individuals with pre-existing conditions to get coverage. Except we pay more than the average in the most expensive states, and still, our colleague gets ---------- NOTHING.
Do I have the solution to this? I have several, and among the more printable are 1) universal health care/single payer system; 2) prohibit pre-existing condition exclusions sooner than 2014; 3) get another carrier. For now, we’re working on #3. How about you?