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Brooks man caught in healthcare limbo

I am a resident of Fayette County and own a small business located near Brooks, Ga. My company, Prima Music, operates a website that sells educational books to music teachers throughout the world. I employ eight to 12 employees.

Until September of last year, I have maintained a group health plan for my employees (most recently with Humana).

Contrary to the promise of President Obama, our healthcare premiums have not gone down. In fact, they have been rising 10 percent to 25 percent annually for the past three years.

When our Humana renewal was to take place in September, the cost for my family had risen to almost $25,000 a year. This was for a very high deductible policy. Our out-of-pocket costs would have easily been over $30,000 in 2013.

At that time, I was forced to make a very difficult decision and drop our group plan. I simply could no longer afford to pay over 50 percent of my annual income in health insurance premiums.

Determined to make sure that my family had a major medical plan in place, I began an extensive application process to purchase an individual policy.

I completed lengthy applications with Blue Cross / Blue Shield, Coventry, Assurant, and through my State Farm agent. Every application was denied.

I have Type II diabetes. It is extremely well managed and my blood results are always very good. However, just being diagnosed with diabetes is the kiss of death when applying for individual health insurance.

My wife has marginal high blood pressure. This is managed with medicine. However, a diagnosis of high blood pressure also causes immediate rejection for some, or all, individual health insurers in Georgia.

In the course of researching options, I was told about the Pre-Existing Insurance Plan (PCIP) that was a part of the Affordable Care Act.

I contacted the PCIP (www.pcip.org) and was told that I could apply, if (1) I had been denied insurance within the last year (which both my wife and I had), and (2) we had no insurance coverage for six months.

It seemed like this was our best option to have a major medical policy, but the thought of going with no insurance for six months was alarming. The risk for catastrophic loss was very large.

Ultimately, we had little choice. My wife and I started counting the days from Sept. 1, 2012 to March 1, 2013, praying every day that we would not need medical care.

Months ago, my wife’s medication ran out. Our family doctor would not refill the prescription without expensive lab work. I have been rationing my diabetes medicine in order to make it until March 1.

Last week, I spoke to the PCIP customer service department to make sure that we knew the exact process to follow on March 1. I was told that I could not apply before the six months without insurance was complete, or they would reject the application. Only a few weeks to go. I thought we were going to make it.

On Monday of this week, I visited the PCIP website and saw this: “Beginning Feb. 16, 2013, the federally-run Pre-Existing Condition Insurance Plan (PCIP) is suspending acceptance of new enrollment applications until further notice.”

I called PCIP and was told that the program had been suspended because they had run out of money. I was told that I would need to wait until Jan. 1, 2014 before I could apply (over 10 more months with no insurance).

So, here I am. No insurance for my wife and children. A dwindling supply of medicine to treat our existing medical problems. No insurance company will write a individual policy because of well-managed conditions that are listed on their “no way” list.

Not only is my entire estate at risk of a catastrophic loss, my company is also at risk. If forced to close my business, all of my employees would lose their jobs.

This is perfect example of what government-run healthcare will be for all citizens of the United States in the coming years.

Our healthcare system is severely broken in this country and socialized medicine is not the answer for fixing it.

I am begging you, as my representative, to bring this situation to the forefront, before it is too late for us all.

Robert Mitchell

Brooks, Ga.

Location: 

Comments

Mr. Mitchell describes his problems with receiving reasonably-priced health care insurance because he has diabetes. His medical condition is well-regulated, and he seems to be the type of person who will work hard to maintain positive health and avoid unnecessary medical bills.

Yet, his applications to the major insurance carriers were denied outright because they refuse to assume even minimal risks.

I'm no personal fan of Obamacare; however, Mr. Mitchell's mistreatment by the private insurance companies is what gave the President the ammunition to pass the Affordable Healthcare Act in the first place. The private insurance companies were cherry-picking healthy insured, refusing to take any risks, and charging exorbitant premiums to anyone with even a minor malady.

Mr. Mitchell is actually making the case FOR Obamacare.

Liferfrom65's picture

[quote=stranger than fiction]
Mr. Mitchell is actually making the case FOR Obamacare.[/quote]

Then why can't he get it? Do yo understand what he said?

You bet I understood exactly what Mr. Mitchell said! He was jerked around by all the private insurance companies so he applied for a government program for relief. That program was out of money, so now he awaits the insurance exchanges set up through Obamacare so he can obtain some coverage in January, 2014.

Mr. Mitchell has been failed by the private market, so now he turns to the government-mandated exchanges for relief. This is precisely why I think he is making the case FOR Obamacare.

Personally, I am very wary of the government solution; however, I understand Mr. Mitchell's predicament and why he is turning to the Obamacare solution. I only wish that the non-government health insurance market would respond in some reasonable manner so that Obamacare would be superfluous.

Georgia hasn't signed on to the plan. Your local friendly Governor doing his best for the people. Of course, he has his health insurance funded by the US Taxpayers from when he was in Congress. We get to care for him for life!

NUK_1's picture

Notice how terribly they have worked already? Yeah, all insurance is regulated by individual states and has been for decades and that's one of the main reasons why health insurance is such a disaster for patients and why "Obamacare" even passed. The problems is: you're going to try and solve one problem with the same problem that existed before? Oh yeah, the Federal Gov't is going to "help" this time temporarily and then all the states participating will have to fund a ton of $$$ they don't have. What can go wrong?

Free market insurance is a concept that has never been tried in the modern USA. Instead, we have insurance companies setting up multiple plans in each individual state to comply with that state's mandates and regulations and you cannot obtain coverage across state lines. Depending on which state you reside in, this can cost you a ton of money because your home state may have certain demands that others don't. You also setup state-sanctioned monopolies with each state that drives prices way up since they don't have to compete and also there is little "ease of entry into the marketplace" by those companies who may want to try and compete. You also create gigantic health care companies that franchise their operations to each state like Blue Cross/Blue Shield and become near-monopolies because they are the beneficiaries of crony capitalism because they are state supported monopolies.

Is it any wonder that health insurance companies are making huge profits and denying more and more treatments and applicants? NO....the states and the feds are both ENCOURAGING it already. It was a rigged game before, but Obamacare was a pathetic answer that doesn't address it all.

The whole system was broken before and now it's going to get even worse somehow by placing more government and more regulations and more mandates in between the people that want insurance and companies that provide(or could) provide it.

S. Lindsey's picture

Every time Government comes in to "help" and puts more Police on or builds a new this or that... after the taxpayer money flow stops the State has to pickup the tab.

Many States simply cannot afford the upkeep and expenses and either try to keep it putting the State into financial debt or they cancel it..

We can't fix every persons individual issue. Yet those here willing to use the power of government and the supposed deep pockets of the taxpayers to try to.
Everyone knows someone with a sob story... It is not the purview of Government to wipe their tears...

"Whoever claims the right to redistribute the wealth produced by others is claiming the right to treat human beings as chattel."

-Ayn Rand

NUK_1's picture

I don't blame the letter writer for being highly frustrated and very concerned. He's the pawn in a chess game that was setup to where he started with no Queen and missing a Bishop also. That has to change.

Health insurance exploited, and I mean EXPLOITED in the literal sense, the monopolies given to them by the states and the feds and will keep on doing it as long as they possibly can. While Obamacare or universal health care was once highly promoted by National Review and others like Newt not that long ago seem like a possible avenue to some, I say open it up to competition first and see what happens then. That approach hasn't been tried because it would involve Congress exerting the power of "interstate commerce" over the states; something that states don't like too much generally, but they have failed miserably and collectively have brought on the situations the writer spoke of.

As libertarian as I am, it is way past time to get all the states of this country the hell out of health care because they have proven they are the problem even more than "greedy" profiteers that they encourage and back 100%. Maybe they can be persuaded to do it on their own and open up, but barring that, I would definitely support the federal gov't moving in and dictating from on high that they no longer get to pick and choose winners/losers, regulate, mandate and collect big bucks from insurers that they license in only their own state. This is a horrendously failed model.

S. Lindsey's picture

... Government both State and Federal need to back out of healthcare and stop allowing the big corporate junkies to run the Pharmacy.

If we had real Free Market Capitalism smaller enterprises could enter the market and interstate competition might lower cost.

"Whoever claims the right to redistribute the wealth produced by others is claiming the right to treat human beings as chattel."

-Ayn Rand

.

You get a "part true--app 50% of his premiums are Govt paid as part of the retirement program he participated in--it's a benefit he lawfully earned.

STF, you DID read the entire article, didn't you? So how could the PCIP be "out of money?" Oh yeah, that's really making sense out of the transition allright. So here's a citizen trying to take care of his family needs and finds doors shut in his face. I emphatize with him as just this year, after two years of 32% premium increases, I ditched Aetna for another plan--and if you check Aetna's earnings, they're doing quite well, thank you. And they're one of the Corps that got a waiver for AHC mandates.
So just who is looking out for Mr. Mitchell??

I read the article thoroughly, and I empathize with you and with Mr. Mitchell. I agree that it is dreadful how the private insurance carriers have been gouging the public for years with impunity.

The reason I say that Mr. Mitchell is making the case for Obamacare is not because I like Obamacare. Rather, the private insurance companies have so grossly mistreated the public, that the government has stuck its considerable nose into the business. Mr. Mitchell is now waiting for the health exchange to be set up in January, 2014 so he will be assured a chance to buy health insurance. This is the ultimate aim of Obamacare, not the PCIP.

I see the private insurers as the culprits, and they have pushed us down that slippery slope toward socialized medicine with their excessive greed.

Robert W. Morgan's picture

This Obamacare thing doesn't seem to be working. Can you tell us how it is? Or is asking racist? Chime in babe. Wanting to hear your sweet voice.

Live free or die!

PTC Observer's picture

Naive to think it should be working, don't you think?

Robert W. Morgan's picture

Not me. Never did.

Live free or die!

Who said Obamacare was working? Mr. Mitchell is clearly saying that the private insurance options are NOT working and that he is waiting for the Obamacare solution in January, 2014.

I am merely saying that the private insurance companies are complicit in a national governmental response because they have been so egregious.

Maybe Mr. Mitchell will get his insurance next January through the Obamacare exchanges, but I strongly distrust a government solution to his problem.

Isn't attractive. Sad

This is a nation wide problem facing all small business owners and those who are self employed owning individual health insurance policies.
Private insurance companies have been raising rates, turning away people for all sorts of conditions and stripping coverage to be only major hospitalization plans for 10+ years.

And the greed of insurance companies isn't a surprise,

Check out implementation of Obamacare:

http://www.healthcare.gov/law/timeline/

The only thing more ridiculous than the cost of healthcare are those that think that getting government involved in the administration of it will somehow improve the situation.

Fred

The government has been involved for decades.
Medicare, Medicaid, VA Hospitals, government employee medical plans.
The government is the largest buyer of health care!

You just mentioned all of the broke, mismanaged, failing government programs.

Good Job!

You're right.

Just wondering.... You have insurance? Do you pay for your own personal plan or covered under a jarge group plan?

Recognizing that you loath government intrusion into healthcare insurance, what would you advise Mr. Mitchell to do? He has been rebuffed by all the private insurance companies. What should be his strategy now?

I totally understand Mr Mitchell's plight. As a small business owner I was forced 8 years ago to abandon a group policy.
As one who does not have the luxury of a large corporate plan, Medicare or some government coverage I have seen my family rates increase 5 fold over 8 years and benefits decline to only major hospitalization. My 21 child was recently refused a personal Blue plan for the pre-existing condition of shin splints, yes shin splints.

With the US government being the largest buyer of health care and small businesses being the largest employer of Americans, we have a problem.

When someone throws "the government" term at this issue, I want to know the coverage they have first and foremost!
You have to walk in the shoes of Mr. Mitchell to appreciate and understand.
Frankly, I favor government regulation of certain industries, health insurance and banking are 2 that come to mind.
Not health care but health insurance, big difference! It's easy to be critical of my point of view, especially if you are covered under a large plan whether employer or government which includes Medicare. I believe in free markets, so much so I work for myself but government regulation is needed when the public is at risk. The banks showed us that in 2008 and private health insurance is moving in the same direction.

As for Mr. Mitchell, $25,000 is alot. I had borderline type 2 and high blood pressure 2 years ago.
I lost 40 lbs and eliminated both conditions and my rates were adjusted downward after requesting a review. Now I can't get an independent plan for my 21 year old runner in excellent health because of shin splints.... Lol

Even though I strongly favor the free market, I find myself agreeing with you that regulations must be implemented when the free market so blatantly and arbitrarily discriminates against U.S. citizens.

Since Medicare is already in place, why not give any American the right to pay premiums and gain this coverage? It would be strictly voluntary and would not require a new government program. The program is large enough to absorb new members without breaking the bank. What other options are available short of Obamacare's health insurance exchanges?

Perhaps, it would help if Gov. Deal got off the political bandwagon and signed on to the ACA. I just don't understand how any public servant can do things which are detrimental to the taxpaying public!

And her needs NOW. keep shopping for a Major Medical policy with a HIGH deductable...

http://www.healthcare.gov/marketplace/about/state-marketplace/index.html

I noticed that Georgia is missing from the list!

Citizen_Steve's picture

I understand the need for insurance against catastrophic healthcare expenses.

But I do not understand why you cannot get lab care or medication for your wife. Sure it may be expensive, but by not having to pay for insurance you now have an extra $25,000 per year to pay for medical expenses such as hers.

S. Lindsey's picture

"What the Obama administration has named, the “Affordable Care Act,” is quickly being realized and even promoted as anything but affordable. Now, according to a final regulation put in place on Wednesday, the Internal Revenue Service (IRS) says that the cheapest health insurance plan under Obamacare for a family will cost $20,000 per year, beginning in 2016."

To all you Big Government let them take over out Healthcare and take care of us types..... THANK YOU

"Whoever claims the right to redistribute the wealth produced by others is claiming the right to treat human beings as chattel."

-Ayn Rand

RKS's picture

[quote=S. Lindsey]"What the Obama administration has named, the “Affordable Care Act,” is quickly being realized and even promoted as anything but affordable. Now, according to a final regulation put in place on Wednesday, the Internal Revenue Service (IRS) says that the cheapest health insurance plan under Obamacare for a family will cost $20,000 per year, beginning in 2016."

To all you Big Government let them take over out Healthcare and take care of us types..... THANK YOU[/quote]

Since I am paying 36,000 a year in health insurance premiums for my family with PRIVATE insurance, I think paying 20K a year would be a good thing for my wallet.

Eating aloe may help you treat or cure both of these problems. Look at the site Natural News. I am sorry. Our health coverage has gone up to about $12,000 per year already.

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