Sometimes you can’t win for losing.
A family member and long-time Colorado resident recently found himself working in a restaurant that paid health benefits (not always the case in the food service industry). All was well until a) management messed up and closed down, and b) my relative was diagnosed with a form of throat cancer. No problem: He had switched to another insurance plan when the restaurant closed, so he was covered.
Except that he wasn’t.
Being well-known by Denver restaurateurs as a heck of a good chef, my relative had the reasonable expectation of soon regaining employment, so the plan he paid for was a short-term limited duration insurance, or STLDI, plan. There’s another term for these plans: junk insurance.
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They give the impression that they will cover routine medical visits and procedures. In reality these plans are exempt from many Affordable Care Act requirements, including in many cases pre-existing conditions and preventive services. They also spend in the order of 15% less on health care than the ACA requires. So while desperately looking for work to support their families, policyholders often face out-of-pocket health care costs much higher than they were led to believe.
Can you imagine an insurance instrument describing itself as a health plan but leaving out of its offering the treatment of a life-threatening form of cancer? It sounds like a perfect vehicle on which would ride the principle of Republican-favored health plans: Don’t get sick. In my relative’s case, he must now confront the possibilities of radiation or surgery with little help from the system.
STLDIs would be invidious enough if they truly worked as intended, as a stopgap safety net between jobs, but the Trump administration allowed insurance companies to extend the “limited duration” of the plans to 12 months, renewable for up to three years. This led to a 27% increase in the number of holders of these policies, largely from those who could not easily afford the surreal costs of fully-fledged health insurance in this country.
A foreigner reading this article would probably by now have asked why provision of health care is so stringently connected to employment.
The phenomenon of surprise billing is not limited to junk insurance, however. When a patient finds only retrospectively that part or all of the treatment they were just given was performed by out-of network providers they can be faced with bills of many thousands of dollars that they were not expecting.
Nor is this limited to commercial insurance bodies. Medicare can be just as inconsistent. My wife, a Medicare patient, was prescribed with a steroid inhaler to treat breathing difficulties. When Medicare recently refused to cover this expense she had no choice (in order to keep breathing) but to pay some $450 out of pocket. In the same month her prescription for the Type 1 diabetes-fighting Victoza, normally costing $47 a month, suddenly and without explanation rose to $400, forcing her to discontinue its use.
Doing so while needing to continue with the steroids caused her blood sugar levels to elevate dramatically, with concomitant implications for eyesight deterioration, loss of limbs, dementia and possible stroke. It also led to a 10-pound weight gain that threatens to exacerbate her cardiac health issues and will take months to reverse.
A foreigner reading this article would probably by now have asked why provision of health care is so stringently connected to employment, why health care and insurance are an indissoluble dyad, why billing for health care is so inconsistent and unpredictable, or why sickness in America represents a marketplace for for-profit industries. Perhaps this foreigner’s government considers it their duty to be responsible for the health of its citizens. Setting aside the apparently impermissible question of why, in a world in which 200 or so nations and territories enjoy some form of universal health care, a country that expects others to follow its lead cannot imagine modeling itself on their example, let us visualize how that would work here. If our government genuinely felt a responsibility for our health care it would, perhaps, take such steps as:
- Outlawing junk insurance
- Establishing rules to obviate surprise bills and balance billing
- Decoupling health care provision from employment status
When legislators in government, candidates for such positions, and party platforms trumpet their concern for the well-being of the American public, the notes come out of the instrument flat and painful to the ear when they do not address the gross inequities of our health care system.
Government at all levels must accept responsibility for ending the toxic billing practices that do no less than jeopardize the lives of Americans.