I said in the first post of this series that there aren’t too many simple, good stories of healthcare in America. Who’s the good guy? Who’s the bad guy? Sometimes it’s hard to tell the difference.
B. (as in B hopeful) is a part-time teacher at a private school. She was thrilled a couple of years ago when her school offered benefits to everyone who qualified by making the hourly requirement. It was a much better deal than she was able to get as an individual.
There are millions of people who are paid hourly wages rather than a salary, and therefore are not eligible for the company’s group insurance plans. Often, the hourly people work almost the same hours as their salaried counterparts. The person at the next desk or in the next classroom may be working just as hard as you (or maybe harder), but is getting paid by the hour with no benefits (saving the company money). And because we know that getting insurance through the individual market is expensive (or completely unaffordable), being offered the company plan is the holy grail of hourly and freelance workers.
So B. was happy to be offered the group plan at her school. In the past, B. had changed plans many times in an effort to find something affordable. One result of that is that she didn’t always have continuity with her doctors because they might not be a part of whatever her new plan was. Now she would have consistency and it was affordable. B. was happy.
In the middle of last year, B.’s doctor discussed the benign, yet expanding growth in the lining of her uterus that would require a D&C and endometrial ablation. B. dutifully checked to make sure everything was fine with her insurance, that everything was in order and would be covered. She talked with three different people at her school (people who were supposed to be in charge of such things), to double check that her insurance policy ran until January. They all assured her that her policy did in fact run until January, and there was no problem with her coverage even though, as an hourly teacher, it was possible her work load might drop below the minimum hourly requirement. The agreement was by the year, not the fluctuating hourly changes per quarter.
So B. had all the necessary tests, and with her doctor, decided to wait to schedule her surgery for October or November.
On August 12, B. received notice from her school that her policy was being dropped, effective September 1.
It would be easy to say that’s not fair, can’t be legal, and she should fight. But fighting takes time, and fighting raises the specter of losing the job. With the debilitating symptoms caused by the rapidly expanding fibroid growth, B. did not feel like she could put off her surgery. She got a COBRA continuation plan that would cover her surgery. The problem was the COBRA plan was double the cost of her employee plan, an increase she could not afford. She was now paying around $800 a month. But it would cover her procedure, so she scraped by for a few months.
In November, B. had her surgery and one follow-up visit at which everything looked fine. December 1, B. dropped her COBRA coverage. Because this is real life and not a spreadsheet, there were also unexpected expenses of apartment damage, repairs, and theft. It was simply not possible to continue paying $800 every month.
B. is now among the uninsured. She has spent the last four months hoping that nothing serious happens. She’s been lucky so far.
She has not been sitting idly by, though. She has searched around and found a plan that is marginally affordable, although it does have a deductible. The new plan goes into effect April 1.
So in these last days of March, B. is feeling a little nervous about something going wrong. But at she counts down the final five days of her uninsuredness (yes, I made up that word) she is looking forward to being covered once again.
I am wishing B. a very safe end to March. I hope she looks both ways when she crosses the street, and is careful in the kitchen with knives or pots of boiling water. B well, B.