Ledge Counsel News > A Personal Note on Healthcare Reform

Thursday, April 08, 2010

A Personal Note on Healthcare Reform
President Alan Lopatin shares his own struggle to navigate the healthcare system in the wake of the landmark legislation. I wrote the following piece in August of last year. Seems that my own health story did not end there. Another chapter opened in November, when I was diagnosed with early stage Parkinson's disease. While I'm hopeful for better news with a second opinion, it makes the need for reform even that more important for me. I have careened through the health insurance system, seeking coverage that would not leave me bankrupt in the event of a critical illness. We can never anticipate that illness. A matter proven every day. This legislation could be the first step in stability in the marketplace for us all. I am a Washington lobbyist, and probably not the most sympathetic poster child in this town. But my story is real. As someone who had a hand in staffing the House Committee on Post Office and Civil Service in the Committee's work on the Federal Employees Health Benefits Plan and supporting the work of the Committee on Education and Labor during its consideration of the Health Security Act in 1993-94 (and serving on the President's Health Reform Task Force), I wouldn't imagine having such a tortuous time in the health insurance arena. In 1989, while working on the Hill, I went to the doctor on the Friday before Labor Day (August recess is when Hill folks tend to the things they put off). I had complained to the urologist of pain. He told me there was a "better than even chance" I had a tumor. The diagnosis of testicular cancer was confirmed after testing. We moved the family down to Houston for two weeks while I underwent surgery and treatment at M.D. Anderson Cancer Center (having heard that their protocol had been the most effective, and where my wife's family could help with psychological support and help with our two boys, then ages 6 and 4). I was enrolled in family coverage in Blue Cross under FEHBP. We were covered. I was treated and our co-pays were limited. In 1993, my back went out in the midst of work on health reform. Despite physical therapy and chiropractors, I eventually needed back surgery in the fall of 1993, at the same time as the First Lady was testifying before our Committee. My last meeting before going under the knife was on health reform at the White House. After 6 weeks out, I was back to work and supporting the Committee on Education and Labor during their successful markup of health reform. When I left the Hill in 1995, my family depended on continuation coverage under FEHBP (something I'd worked on as staff as a parallel to COBRA in the private sector) for 18 months. With the expiration of my coverage looming and having started a one-man government relations practice, I sought out coverage for the firm. I was able to secure a Blue Cross plan, with family premiums over $800/month, with no mental health coverage, no dental or vision coverage, and significantly less generous benefits than the FEHB plan I'd had on the Hill. Within a short period, our premiums rose to nearly $1,000/month. In an effort to keep the family covered, but curb costs, I sought out alternative insurance. Responding to an email from the American Association of the Self-Employed, an insurance broker contacted me, visited our home, and told me of their reasonable plan, low co-pays, and broad coverage -- boasting that folks who are self-employed rarely take time off (true) and were a low-risk group (thus keeping premiums low for those whose applications were approved). I had become a gym rat, getting into shape working out 5-6 days a week and working long hours (and through sickness and health). We were approved for a family plan at less than $800/month. In time, it became apparent that the network of providers to which we had access was significantly smaller than the Blue Cross network I had known. We changed doctors, but were still satisfied until one fateful morning when my youngest son was in high school. Asa was a star wrestler. But in a state championship match in his sophomore year of high school, he had suffered a concussion. It was the first of several. Eventually, recurring problems warranted further evaluation. We had scheduled an angiogram at a participating hospital in Northern Virginia (we lived in DC). On the morning of the procedure, for which Asa had finally gotten himself mentally ready, the hospital called me with the insurance company on the phone. They wanted to be sure that I understood my benefits under the plan. The procedure was to cost $6,000. "For the first $1,000 in charges, your co-pay is 20%. After that, it is a 100% co-pay." "Excuse me?" I stopped them. "Let me get this straight. Of the first $1,000, you pay $800 and I pay $200. After that, it's all on me??" "Yes," they replied." "So," I continued, " you mean that on this $6,000 procedure, I pay $5,200 and the insurance pays $800??" "That's correct." "Well," I asked, "what about your catastrophic limit?" "We don't have one." "How do I get one?" "We don't sell one." We went ahead with the procedure, having few other options for what could have been a life-threatening ailment. Asa turned out to be okay. But my insurance problems were not over. Once we got the event behind us, I contacted Blue Cross. I wanted back in. My oldest son had turned 23 and was now independent for purposes of insurance. The broker for Blue Cross sat with me, filling out the application for coverage and explaining that the community rate was to be roughly $220/month for my oldest son and $630/month for me, my wife, and my youngest son. Ten days after submitting the application, I received a call from the insurance broker. "The underwriters gave you a 2% HIPAA load." Well, I figured, 2%? That shouldn't be so bad -- $12-13 a month for the family and $5/month for Jonah. "How much are we talking about?" I asked. "Your son's premium, instead of $220 will be slightly more than $600/month." "What?!" "And the premium for your family is just over $1,700/month." More than $2,300 per month! $25,000+ in insurance premiums per year, with no mental health coverage, no dental, no vision, a great deal of "no." "I want to appeal the underwriting," I said. The broker was taken aback. "I don't know that that is possible," replied the broker. Eventually, she called to let me know I would be receiving questionnaires for our doctors to complete. The mail arrived not much later. No questionnaires for my youngest son. One for my wife. Two for my college son. And NINE for me. Cancer, back surgery, a hernia, all the way back to an appendectomy in my freshman year of college. I went through the process of getting the docs to complete the paperwork. Time elapsed. And the insurance broker never called back. I got too busy with work. We were locked in our spotty insurance plan until the circumstances warranted that I join a larger firm, mainly to get health insurance in their group plan. I'd been out of pocket thousands or dollars in premiums, co-pays, and countless hours of stress and tumult. And I was the experienced one. I was the one who "knew" the system. But we are ALL at its mercy. A lesson learned. That we ALL have something to gain in health insurance reform. Better doctoring. A more sensible system. The right incentives. And healthy families as well as a health economy. Each of us has a personal story to tell. When I worked on health reform back in 1993-94, I sat on many a panel to discuss Congress' work on the issue. While the doctors, public health professionals, academics, and other experts sat on those panels, I suppose I was something of an expert myself -- a consumer. And one with limited experience, better informed AFTER leaving the Hill. Those attending the panel presentations had been sent to find out how health reform would affect their companies or the groups they represented. But as each person in the audience say through the presentations, I knew that they were asking themselves, "How will this affect my life? Will I have access to the doctors of my choice? Will I be able to afford the premiums? And what if I were to face a health catastrophe?" We must get this job done. For all our sake.