In 2003, I was completing graduate school in Ohio and moving back to Maryland for a new job. One of my concerns in relocating was health insurance. I had been on the student health plan at my university, so I was not able to extend my coverage when I left the area. My new job did not offer benefits so I would have to find insurance on my own. Rather that try finding a policy before I moved, I purchased a “gap policy” that would cover catastrophic emergencies for a couple of months so I could have time to find a comprehensive policy when I was settled.
When I got to Maryland, I decided to apply for an individual plan through Kaiser Permanente. I had been covered through Kaiser of Maryland several years previously through an employer-based plan and I liked their system. I also thought they would be happy to regain a lost customer.
At the time I was applying, I was 30 years old and a non-smoker. I had no major health issues in my history. I was single, with no children.
That is why it came as such a shock when Kaiser rejected my application and denied me a policy on the basis of pre-existing conditions. Their stated reason was that I took two prescription medications: I was on a generic version of Adderall for ADHD and I periodically took Allegra for seasonal allergies.
Moreover, I had no recourse to appeal. I had assumed that, because I had had uninterrupted insurance coverage for several years, that I would be exempt from pre-existing condition exclusions throughout HIPPA. I learned, however, that the gap policy I had bought rendered me non-compliant with HIPPA rules. A step I had taken in an attempt to be responsible at a time of transition backfired badly.
Eventually, I was able to obtain coverage through another provider but the plan I bought came with a rider that excluded all mental health services. My ADHD was going to be my own problem. Come to find out, all preventative services were my own problem, too. The policy didn’t cover my routine OB/GYN visit that year. And as for vision and dental care? Forget it. My insurer didn’t even offer those options. But the policy was what I could get so I took it.
When people talk about pre-existing condition exclusions, there’s an underlying assumption that the only sort of conditions that trigger those are major illnesses so people who are healthy are going to be able to get insurance no matter what. I am living testimony to the fact that that isn’t true. I have known for 14 years now that I am persona non grata in the universe of unregulated individual health insurance.
As I have aged, I have collected more black marks on my health history – a surgery here, a biopsy there. Nothing out of the ordinary for a woman over 40 but also nothing that a underwriter would be willing to overlook. Were it not for the reforms of the ACA, I am certain I could never obtain insurance that was not part of an employer-based group plan.
If the ACA rules on pre-existing conditions are rolled back, I am once again one pink-slip away from being unable to obtain health insurance at any price.
Before 2010, the insurance industry operated under its own set of rules. The health and welfare of patients was secondary to corporate solvency and the entire business model was built on denying as much care to as many people as possible. The ACA changed the landscape of the individual insurance marketplace to make it more equitable and to open access to all consumers, not just those hand-selected by actuaries based on criteria of cost-efficiency. Dismantling the ACA will return us to that model. Not only will insurance become unaffordable if the subsidy program evaporates, insurance will be literally inaccessible as insurers put up barriers to access, such as the ones I faced in 2003.
My story is not unique and it did not end in tragedy so perhaps it’s easy to brush off. But the message I am trying to convey is how vulnerable we could all be to the whims of the insurance industry without the ACA. It’s not just the very sick and the very poor who will be hurt. It could be any of us.