Insured vs. Uninsurable?
February 25, 2008 | General
Here are some interesting stats: of the so-called 47,000,000 uninsured in the US (and I truly believe that is a bit exaggerated, but we will use those figures), please understand that uninsured does not mean uninsurable. Also, let’s please assume that those figures relate to citizens and legal residents…. Here is what I have found over the last 16 years as a high risk and hard to place specialist:
- one third of the uninsured who call me – or who I call – tell me they think someone one should pay for it. Can they get it? YES. Can they qualify for it through decent health? YES. Can they afford it? YES. Do they believe they should pay for it? NO
- one-third have the erroneous belief that since they haven’t seen sick or needed it, insurance is a waste of money and they will get it “when they need it.” I ask them if they believe they can wait till they have a car accident to get auto insurance? They usually say “that’s not the same.” Yes, it IS the same. Insurance is about covering you for a risk that hasn’t happened, not one that already has. Otherwise, no one would ever buy homeowners insurance, car insurance, travel insurance, life insurance… it’s insurance
- one-third have truly fallen through the cracks. They tend to earn a low level of income and have many health issues and their employers do not provide group coverage. Or they earn a decent income but not enough to cover the $1800 in medications they take every month for that unusual diagnosis that no one expects (MS, Parkinson’s, Alzheimer’s, rheumatoid arthritis, etc).
OK – so one-third of that 47,000,000 is about 15-16,000,000 and those people simply can’t get health coverage. So instead of being 20% of the US population, the truly uninsurable comprise about 7%.
Let’s be pro-active here: how many of these people got sick because they:
(1) didn’t watch their weight and are now over-weight, which statistically leads to high blood pressure, elevated cholesterol and triglycerides, elevated sugar (weight and sugar are at an epidemic level with those under the age of 30, due predominantly to the consumption of processed and junk foods and sitting in front of TVs and video games and not getting and real exercise), and degenerative disk disease? In the world of auto insurance, we would call this self-inflicted injury.
(2) left a job in one state and moved to another, didn’t continue their insurance and take it with them because they assumed they would get another job right away that would offer coverage? This is one big assumption to make with one’s health! Murphy’s Law says that in the uninsured interim, something catastrophic happened and now there is a health coverage issue
(3) forgot to make a payment, deliberately let their policy lapse or cancelled one plan before they had another one approved, and then couldn’t get approved? Once you have cancelled a policy, if there have been any new medical conditions, you generally cannot get it back.
(4) lost their job and couldn’t afford COBRA, or there was no COBRA and they couldn’t afford HIPAA? Granted, COBRA isn’t cheap – but many employees do not understand that the COBRA rate is dollar-for-dollar what the employer was paying for that employee’s insurance and I know no one ever told their employer they thought he or she was paying too much for their health insurance! (Guess it depends on who pays for it….) All other things being equal, group health insurance has the most expensive premium per person. On average, the employee has maybe 25% of the total withheld from his paycheck, but the employer is paying the rest. And very very few employers pay for the employees’ family members, so if you find one who does, you know he is paying a pretty penny and should kiss the ground he walks on for being willing to do so.
Currently, 33 states have high risk pools, whereby if you apply for coverage and get declined by two or more carriers, the high risk pool must take you. This is not cheap – it can run from $400 to over $800 per month depending on the state. Generally, and for obvious reasons, this is a form of high risk coverage – otherwise, those people on it wouldn’t be taking it.
In states that do not have high risk pools (and in some that do), we have a form of Medicaid, based on gross income. These income levels are low, and if someone who is on Medicaid applies for and is awarded social security disability, they will usually lose their Medicaid as they now have more income than the Medicaid guidelines allow. This is truly a problem.
So, now we can break down that 7%, totaling 15,665,000 into maybe three more groups: those who had it and got rid of it (i.e., lack of knowledge), those who had it and it was taken away (i.e., lost job, etc), and those who – over time – did it to themselves. Gaining weight, drinking too much, not exercising….. these are not behaviors thrust upon us by the government: they are things we do to ourselves. And ultimately they are things for which we pay.
No amount of money can buy insurance if one’s health has been seriously impaired through behaviors that could have been avoided (other than through a group plan – and even those can have one year waits on preexisting conditions). And, many of those behaviors could have been and still can, in many cases, be reversed. Losing weight is the best thing to do for one’s health. A person weighing 250 lbs at 5′8″, they are carrying nearly 100 lbs of extra pressure on their vital organs – this is what the carriers are concerned about, this is why the health carriers will not cover these people. They may not [yet] have a blood pressure or cholesterol issue, but statistically they will. But they can avoid it. There are many things we can do to prevent illnesses and injuries, and health insurance companies just don’t want to be baby-sitters for those who could have prevented their own medical issues. Not a warm and fuzzy thing to read, but true.
So, what are we really looking at? Maybe 15-16,000,000 people without coverage with less than one-half of those people uninsured through no fault of their own…. so maybe 5,000,000 who are truly in crisis at any given time. Not having insurance does not mean one will die without coverage - it means that there is a risk if their health worsens and they cannot afford necessary attention. I am often asked by someone if they are just supposed to die? And of course, I have to ask the obvious question: Is anyone terminal now? The first thing to do is try to take care of yourself – better diet, more exercise, fresh air, vitamins/supplements…. and really, be willing to pay for the inexpensive health care called maintenance: pap smears, mammograms, prostate, blood pressure and cholesterol checks, etc. This is the small stuff. Be willing to invest in yourself.
Need medications? Check out Canadian mail order. Short on cash? Negotiate with a doctor – the average doctor gets maybe seventy cents on the dollar when paid by an insurance carrier – ask for the self pay fee schedule. I have seen doctors lower their rates by half for cash-paying patients. Many places in AZ, like Bashas, offer low-cost clinics for many routine tests – check them out on the web. Find out what is available. There are also many pharmaceutical companies that will virtually give away medications to people with low incomes. Call the manufacturer of the medications you take and ask what kind of assistance programs they offer.
Maybe you are one of those who have simply said, “Nah, don’t need it, don’t want it, don’t want to pay for it.” That is your choice. Maybe you are one of those who would do anything to have it and have never been able to afford it – check out what are called limited liability plans, find a high risk specialist, find out what your employer is doing about a group plan, see if your local government has any assistance plans you might qualify for, call your Dept of Insurance to see if they know of any, write your Congressional representatives, talk to your doctor about less expensive medications or treatments and what you can do to help yourself…. Check out low-cost clinics and ask for recommendations. Also, not all insurance carriers are the same; some allow more negative medical history than others when it comes to what they will accept. As a broker with over 124 products, I am amazed at what some carriers will take and what others won’t. If you can get coverage, even if not for all your preexisting conditions, take a higher deductible to keep your premiums down (you can always negotiate the payment of a deductible with the hospital).
Remember: just like uninsured and uninsurable are two different things, so are health care and health insurance. You are responsible for your care, first and foremost; the doctors intervene when things go wrong, but that is not health insurance – which is what helps you pay for the health care. While hospitals and doctors don’t work for free, they can negotiate. Ask – always ask. If you ask and they say No, well, now you know. But if you don’t ask, then they may as well have said No…. but they might not.
Health care should never be an option – but it is always a choice. And it starts with the consumer – be aware, be pro-active, take care of yourself, try to improve your health, check out your options…. and there are options.
June – Arizona Life Lines
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