U.S. Health Insurance: It’s a Trap!
Let me preface this post by saying, thanks to a clause in the ACA and a significant amount of luck, we’re all right.
The default in the United States is that you’re supposed to get insurance through your employer. The employer picks up some/most/all of the cost, and that coverage is considered one of the benefits of employment.
As you may recall, back in December, my wife was diagnosed with an aggressive stage 4 lymphoma. She spent about six weeks in the hospital, and if everything goes well and the chemo and bone marrow transplant both work, she might be able to go back to work at the end of the summer.
Fortunately, we have relatively good health insurance coverage. According to the benefit statements, her treatment has cost somewhere between half a million and a million dollars so far. We’ve only been responsible for a very tiny fraction of that cost.
Jump to last week, when we got a letter from a benefits management company. Because my wife hadn’t been working since late November, her benefits were being cancelled. The official reason was “reduced work hours.” Our options were to either pay for COBRA coverage to continue on the plan we had, or we could go to the Health Exchange to find a new plan. Either way, we were now responsible for the full cost of our health insurance. In addition, if we chose a new plan, we’d be responsible for any new deductibles.
Here’s where the luck kicks in. Back when I tried to quit my day job a few years back, they created a part-time position for me, one I could do mostly from home. And as a result, I could continue to receive health insurance (but not vision or dental) through that job.
The benefits management letter was telling us our family’s dental and vision insurance were no longer covered by my wife’s company. But we still have health insurance.
COBRA costs to continue dental and vision are about $150 a month for our family. We can handle that. What would have been a lot harder would be paying probably $1000-$2000 per month so we could continue getting health insurance through COBRA.
Think about it.
- You get health insurance through your employer, just like you’re supposed to.
- You get really sick. Fortunately, you have health insurance! Well done, you!
- Because you’re sick, you can’t go to work. A few months later, you lose your health insurance.
- Surprise! Not only are you on reduced income from not working, you’ve got to cover a couple thousand dollars of new expenses every month!
We’ve designed a system that abandons people when they need it the most. Is it any wonder we see hundreds of thousands of families declaring bankruptcy every year because of medical expenses?
If my employer hadn’t really wanted to keep me on – so much that they created a new position for me, and if the ACA hadn’t allowed me to continue receiving health insurance through them, I would currently be A) panicking like a cat in a cucumber field, and B) looking into GoFundMe and other ways of making sure we can continue to afford to keep my wife alive.
That we put people in this position when they’ve done everything “right” in terms of finding a job and working for years for their benefits – hell, the fact that we put anyone in this kind of position, period – is obscene. The whole for-profit approach to health care in this country is literally killing people.
My family is very fortunate in many ways, and we’re all right for now. But as a country, we have got to do better.
Morgan Hazelwood
April 8, 2019 @ 4:55 pm
I’m very relieved for you and your wife — re: health insurance. And I hope that the treatment is effective and the side effects are on the mild side.
I’m enraged at the state of health care. I think we’re ready for a “can’t drop due to ongoing condition” clause for insurance companies. I like to think of it as the flip side of the denial for ‘pre-existing conditions’. If you get something that qualifies as a pre-existing condition elsewhere, they legally shouldn’t be able to change your rates or drop you. Because
Mike
April 8, 2019 @ 5:19 pm
Had the same thing happen to me after going on Long term disability. Got this nice letter from my company saying I had to pay to stay on my health care plan. Now, the beauty of a high deductible plan is that I’d met the deductible before the end of July and the plan cost is cheap. Also, my HR folks told me this was coming.
Yes, there should be some sort of requirement that companies need some way of picking up healthcare plan costs when folks are on medical leave. Perhaps it’s part of the insurance contract and premium, or an offering of a low interest loan to cover the cost until the disabled person can work. Don’t know what the answer is, but it’s quite a shock when you’re sick.
Moira J Moore
April 8, 2019 @ 5:48 pm
My jaw is just dropping over the possibility that your wife’s treatment so far could cost as much as one freaking million dollars.
Lou J Berger
April 8, 2019 @ 5:54 pm
Imagine how tough this is for we who are NOT married anymore, and also own a business.
I have no health insurance and, at 52, I’m a broken arm away from destitution.
Laura Resnick
April 8, 2019 @ 6:18 pm
So glad your family is still covered.
So enraged, terrified, and sick to death about our corrupt, broken health insurance system. THIS =HAS TO= change. We cannot go on like this.
linda dunn
April 8, 2019 @ 6:19 pm
This happened to multiple co-workers while I was employed with the federal government. At that time, co-workers could donate their sick leave, which counted as time employed and this is how we kept several people covered. A few, unfortunately, simply rant out of hours and after a certain amount of time, were terminated. Note that this was pre-Trump and I heard the administration wanted to eliminate that ability to donate sick leave to co-workers. I don’t know if the policy has been changed yet.
Kari....Mom
April 8, 2019 @ 6:23 pm
I hear loud and clear! I was on my now ex husband’s insurance when Inwas diagnosed with stage 4 sarcoma (GIST cancer). 3 weeks, 2 major surgeries wrapped into 1(total gastrectomy and liver resection) a few complications, 1 additional minor surgery at U of M hospital was over 34 grand before insurance. The chemo pill that I will be on for the rest of my life is 10 grand a month. I got very very lucky that just at the time that “Mr. Wonderful” left me because I wasn’t recovering fast enough, from a disease that has no cure, I became eligible for Medicare, and because I could only work part time, I also qualified for Medicaid. Now, because of this, I am disabled, but I am limited from working as much as I am able, and have to maintain a low income or I could lose both. I was offered a work from home position, that I could do at my leisure, but I had had to turn it down in order to keep my health coverage. There has to be a better solution for all of us, there just has to be!
Spider Perry
April 8, 2019 @ 7:03 pm
My family just finished our bankruptcy. We had to declare bankruptcy after I had a tumor removed from my spine in 2013, which left me unable to continue my day job.
Disabled, but not disabled enough for SSDI. Stuck in between. Bills we could never pay.
And so here we are.
Stuart Clark
April 8, 2019 @ 8:14 pm
I’m glad you are OK and your wife is doing well. As someone who came to the US from the UK, I really don’t understand the health insurance system over here (or why anyone would want to keep it). As you rightly say, it seems that when you are most likely to need it (when you get sick or elderly – both times when you will not be working), a system that you have paid in to for all of your working life basically does it’s best to rob you of your life’s savings. When my father was diagnosed with mesothelioma in the UK, he had emergency surgery to remove a tumor that was pressing on his spine and limiting his ability to walk. He then had 3 months in hospital and six months of daily physical therapy as he learned to walk again, followed by two years of chemo. He didn’t “pay” a penny. You can’t tell me the US can’t go to a single payer system, there’s just too many parties with too much of a vested interest in maintaining the status quo. I wish you continued good luck and your wife continued improvement. All the best.
Deborah Makarios
April 8, 2019 @ 8:43 pm
My best wishes to your wife, in her battle against the lymphoma; and to all Americans, in your battle against the Powers That Be. It is a hard fight y’all have ahead of you, but I feel it may become easier when more Americans realize that they are fighting for their lives.
The NZ health system isn’t perfect (seriously under-resourced in the area of mental health, for one thing) but compared to the U.S. system it’s heaven on earth. Possibly because the underlying belief here is that the health system is meant to produce health, rather than profit.
Alice Mac
April 8, 2019 @ 10:50 pm
As a Canadian, I continue to be boggled by stories like this.
Out system is not perfect, but it is available to everyone and paid for by our taxes! An excellent use of them.
Von
April 8, 2019 @ 11:18 pm
Thank you for sharing your story. One reason I so support the ACA is because of the stories Obama told about his own mother’s struggles with cancer — that the paperwork was an unwelcome challenge on top of the please-don’t-die treatment. But the ACA isn’t enough (because, politics) and is under attack. We need better, and the Robber Barons need to stop profiting off of the hard luck of others.
Best wishes for your wife’s full and glorious recovery.
Domynoe
April 9, 2019 @ 3:31 am
If I was diagnosed with cancer, I’d be dead. We couldn’t cover even a small portion of deductibles and out of pocket costs. I remember being a kid and my parents never worried about any of our medical care. Now days, even the ACA coverage can’t provide that, and people like myself have to hope and pray they never get hit with anything catastrophic even when they do have insurance.
Richard Gadsden
April 9, 2019 @ 7:08 am
If you’re not going to get a universal healthcare system (single-payer means something specific; there are some very good universal systems that aren’t single-payer, like the French and German systems), then the least you should do is have a law that sorts out “pre-existing conditions” and situations like this by saying that your insurer when you were diagnosed is responsible for all costs relating to that condition, not just the ones incurred in the time they were your insurer. That way it wouldn’t matter if you lost your job and insurance after the cancer diagnosis, because your insurance would cover your cancer until you’re entirely well.
I’m still appalled that any Americans think that the system you’ve got is acceptable, much less the far worse system you had before ACA.
Michelle
April 9, 2019 @ 9:17 am
I’m horrified by the idea that can happen to people and so, so glad you and your wife have managed to sort something out anyway.
Hopefully that will be the last big hurdle your family faces for a while!
Mary Kit Caelsto
April 9, 2019 @ 3:06 pm
Oh I can’t imagine the stress that put your family through and just when you need to NOT stress about the healthcare system. Our health care is so broken in so many ways. Very happy it worked out for you and sending lots of positive energy for you and your wife.
Chris Tate
April 9, 2019 @ 3:45 pm
I so glad you still have some coverage. We’ve been lucky ourselves, so far. The irony about Republicans wanting to get rid of the ACA is that the whole concept of it was their idea to begin with(i.e., RomneyCare). Even the individual mandate in the ACA was a conservative idea(Heritage Foundation, 1988). This is also the reason why they don’t have anything to replace it with. Now, every time someone says “Medicare for All”, they scream “Socialism!”
At this point, I’ll take Western European Socialism over anything they offer.
Fraser
April 10, 2019 @ 7:00 am
” This is also the reason why they don’t have anything to replace it with. Now, every time someone says “Medicare for All”, they scream “Socialism!””
I had a long argument with someone on FB who insisted that sick people were gaming the system because their coverage is partly paid for by premiums from healthy people. I asked if he was planning to pay for all his future medical bills without insurance to avoid being a parasite himself. He protested that wasn’t the point, then gave up and went away.
But no, ACA is quite different from the Heritage Foundation’s plan (http://www.lawyersgunsmoneyblog.com/2013/12/the-aca-v-the-heritage-plan-a-comparison-in-chart-form)
Fraser
April 10, 2019 @ 7:01 am
I’m glad you’re covered Jim.
Daria
April 10, 2019 @ 10:29 am
I’m glad to hear that at least for you and your wife things worked out okay.
My father-in-law was diagnosed with a brain cancer eight months ago, and we have all been devastated by it. Thanks god, we live in Sweden, so the total cost of visits, scans, brains surgery, radio and chemo-therapy has been something around 250 dollars total (the max annual co-pay in the Swedish system). I don’t even want to think what it would have been if we had also to worry about insurance. It’s barbaric.
As someone who was born and lived all her life in Europe (where healthcare in a way or another is guarantee to everybody) I just can’t understand how a democracy can tolerate such a system.
Best wishes
Joe Clement
April 10, 2019 @ 5:53 pm
For an American, the best way is to avoid anything really expensive until you are old enough to retire and collect Medicare. Add in Parts B thru D (These cost you extra but can be well worth the cost). My doctor told me my PSA (Prostate screen) had finally hit the big time and I would have to do something. I chose a Cyber-Knife radiation treatment over surgery and chemo. Everything went well and it didn’t cost me a dime. There are some advantages to getting old.
solecism
April 12, 2019 @ 3:03 pm
This is exactly why I continued working through 3 years of cancer treatment. Slowly, and with much patience and accommodation and support from my boss, but no extended leaves of absence over 3 years, just days and half days scattered about. It’s also why I waited to get a diagnosis until I had a job that offered health insurance benefits, so I was stage IIIb when I finally had a new doctor.
I loved the work I used to do (and miss it!), but it couldn’t offer health insurance and is too physically demanding for me to ever do again. Even a full-time office job is kinda too demanding for my ongoing disabilities and neverending appointments even 10 years out from original diagnosis.
I hope your wife responds well to treatment and recovers with minimum residual effects, Jim. And I hope you too are getting support as you support her.
Ahnaqsh
April 23, 2019 @ 10:20 am
I am deeply sorry about this, Jim. I sympathize deeply. As a non-American (I’m Syrian), I’ve had to jump through hoops to get health insurance and keep it. The system is complicated and full of traps. I really don’t understand how you can live like this. A few months ago my son got hurt and needed stitches; that cost $7000, out of which I paid a few hundreds in deductibles. In my country, harsh as it is in so many ways, I could’ve gone to a public hospital for free, or even a private hospital and had the stitches for an affordable $50. Now add the health insurance headaches and pain on top of the already difficult time dealing with cancer, and you have … what? pain + stress + financial hardship.