No other group awaits the Supreme Court’s decision on the national healthcare reform law and the proposed alternatives to it more nervously than the uninsurables — individuals unable to purchase health insurance because of a medical condition prior to an application for a policy. The pre-existing conditions that have rendered them uninsurable in some instances include pregnancies, injuries, diabetes, asthma, cancer and heart problems.
Kathy Watson, the owner of a patient transportation company in
Florida, has two — an elevated blood count detected in 2003 and an
incurable non-Hodgkins lymphoma diagnosed in 2009. She had gone without
insurance since 2003, relying on visits to the emergency room to
control her lymphoma, every request for a policy denied even through a
small business plan via her self-owned company.
When the Affordable Care Act passed, its Pre-Existing Condition
Insurance Plan (PCIP) became Kathy’s lifeline by allowing her to
purchase health insurance for the first time in nine years. Nationally, 27 states administer PCIP for 62,000 enrollees that meet
these requirements: six months or more without health insurance,
rejection by insurers because of a pre-existing condition and US
citizenship or permanent residency status. The typical enrollee is
middle-aged without employer provided insurance and chronically ill with
cancer, heart disease, degenerative bone disease, organ failure
requiring a transplant or hemophilia.
PCIP is a temporary fix until 2014, when insurers will be required to
sell policies to applicants without regard for their health history. But Kathy and other PCIP enrollees live with the worry of losing their
coverage if the Supreme Court, in its decision expected later this
month, strikes down the health insurance mandate requiring everyone to
purchase health insurance. The mandate is a concession to the insurance
industry for covering the chronically ill such as Kathy.
"It’s scary," Kathy said in this Associated Press article introducing
her story, the primary source of this entry. "They need to look at
this carefully because it is going to affect a lot of people with a lot
of bad conditions who are not going to have any health care coverage."
Adding to her concerns is an announcement this week by Republican
presidential candidate Mitt Romney that only individuals with a history
of uninterrupted health insurance should be guaranteed coverage by
private insurers. "Gov. Romney supports reforms to protect those with
pre-existing conditions from being denied access to a health plan while
they have continuous coverage," said his campaign spokeswoman Andrea
Saul to ABC News.
Kathy and other chronically ill individuals qualify for PCIP because
of lengthy breaks in their coverage. Their next alternative is
high-risk health insurance pools now operating in 35 states. The pools
have their own issues with limited funding, enrollment caps and
waiting lists. If the Supreme Court finds the healthcare reform law
unconstitutional and nixes PCIP, some states are considering them as
the next best choice.
These tiers of options only escalate the complexities and instability
tied to health insurance coverage for individuals deemed medically
uninsurable. Apprehension consume their lives as they wait on decisions
that could end their coverage this month, if and when there are major
shifts in national politics in the next months, in 2014 when PCIP
sunsets or beyond when legislators revise the laws again. The
uncertainty of looming policy changes that could all cut their lifeline
compounds the stress of disease management.