National Nurses United

Single-Payer 2/14/07 3:53 PM Page 13 The Pain of Rejection David Welch thought he understood the plight of the uninsurable, until he suddenly became one. by lucia hwang A s a cna/nnoc board member and longtime registered nurse, David Welch is painfully aware of the crisis of uninsurance among nearly 47 million Americans. He never thought he would be one of them, though. The number of uninsured consists predominantly of low to moderate-income working people whose employers don't provide affordable coverage and who can't shell out the monthly premiums for plans not really worth having anyway. Increasingly, however, stories have surfaced about relatively healthy people willing and able to buy medical coverage on their own, but who are flatly rejected by insurers for the kinds of drugs they take, their line of work, or for minor, past ailments. Welch knew all of this as he applied for an individual Blue Cross plan this past November. Just three months before, he had switched to a per diem schedule. At age 56, he had worked his entire 25-year career at Enloe Medical Center in Chico, Calif. as an ER RN, and was looking to slow down and have more free time to do volunteer work with his union and travel. When he first went per diem, Welch started paying for COBRA coverage (COBRA stands for Consolidated Omnibus Budget Reconciliation Act, the 1986 law that mandated this insurance option). Since COBRA is quite expensive and only available for a limited time, Welch knew he had to start researching to find his own health insurance. Welch ultimately decided that some kind of high-deductible insurance plan linked to a health savings account was probably the best route for him, even though he does not support these types of plans because he believes that everybody should be covered under a national, single-payer system. Welch is an active 56 – he's not overweight, he exercises regularly, he doesn't smoke. The only medical issue he has had recently was for a dermatologist to remove a bit of basal cell carcinoma and melanoma from the skin on his nose. The plan wasn't cheap; the annual deductible would be $2,500 and monthly premiums $235, meaning Welch would need to spend at minimum $5,320 each year before insurance would pay for anything. A month later, he was shocked to receive Blue Cross' answer: denied. "They basically said that they won't insure me at any price because of this little thing on my nose," said Welch, still in some disJA N UA RY/ F E B R UA RY 2 0 0 7 belief. "They won't even give me coverage that excludes preexisting conditions. I'm uninsurable." Suddenly, Welch became one of those statistics that he so often reads about. In January, the Los Angeles Times got its hands on some health insurance broker guidelines that exposed just how far insurers go to cherry pick healthy customers. Common cholesterol-lowering drugs, such as Lipitor, and occupations such as roofer or firefighter could make you ineligible for individual coverage with the big four companies. These revelations, coupled with his own experience, just reinforce Welch's belief that the United States needs to switch to a singlepayer system where everybody is automatically covered by a national health insurance plan funded by monies that everybody – individuals, employers, the government – contributes. Though some recent reform proposals, such as Gov. Arnold Schwarzenegger's plan, would prohibit insurers from rejecting people for preexisting conditions, there's no guarantee that the plans offered to them would be affordable. Sure, we'll cover a diabetic, they could say. That'll be a $10,000 annual deductible and $1,300 a month in premiums. Besides, says Welch, none of the proposals that still depend on private insurers for coverage avoids the wasteful middleman fee – studies put it at about one-third off the top of each dollar – that the industry charges for all the administration, billing, authorization, payment, and other paperwork necessitated by multiple insurers. In fact, many of them would just provide feed for the monster by forcing uninsured individuals to buy private insurance or be penalized. Critics say it's time for a system like Medicare to be extended to everyone. Welch certainly thinks it's high time. He says he's going to try to apply for insurance with a couple of other big-name companies, but if he doesn't find an affordable plan and his COBRA runs out, he may have to give up his dream of working at his own pace and his travel and volunteer goals. "This is just one microexample of the kinds of problems we have with the open market," said Welch. "I'm not poor. I'm not unhealthy. I'm eager to buy health insurance. But the insurance industry wants to have it both ways. They only want to insure people that they don't have to spend any money on. Their goal is to make money, not spend money." ■ Lucia Hwang is editor of Registered Nurse. W W W. C A L N U R S E S . O R G REGISTERED NURSE 13

• Cover