‘Uninsurables’ live with the constant worry of losing their lifeline

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.