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Jessica O’Brien: There are big holes in our health insurance system

Op-ed by Jessica O’Brien

As an independent health- and life-insurance broker in Williamsburg, I deal with people looking for health-insurance coverage on a daily basis. It is very satisfying to be able to help folks find affordable, comprehensive coverage that offers them security in the event of a medical problem, and many of the health-insurance plans available in Virginia do just that. However, for many people, the search for affordable coverage is a painful process. There are several common scenarios which leave Virginians in very difficult situations. Here are some examples.

– Employees with employers who offer health insurance and who then pay a portion of the premium out of their own paychecks: Depending on the health rating of the whole pool of employees (including all insured dependents) assigned by the insurance company, the health-insurance premiums may have been increased to a level that is unaffordable to many employees.

When offered a job, wouldn’t it be a good idea to ask your potential employer about the cost of the company’s health coverage before accepting the job?

– Employees whose employers do not offer health insurance and individuals who do not have traditional employment: Depending on the health of the employees or individuals and any dependents they wish to insure, individually bought health insurance may be rated high (multiples of the “healthy” rate) or declined. Each insurance company has different criteria for accepting new clients and must be applied for separately. In the worse-case scenario, a “guaranteed-issue” policy is available from Virginia’s Blue Cross Blue Shield. This policy is often quite expensive and does not cover any pre-existing conditions for one year.

Does it make sense that the employee will be paying a high premium for a plan which, for the first year, will not cover the very condition which caused him to take the plan in the first place?

– Dependents of employees who cannot afford the employer’s group dependent coverage: These Virginians face the same obstacles as employees and individuals who are not offered employer coverage – their health determines what coverage they can get. A “healthy” dependent will be offered standard premiums, while an “unhealthy” dependent faces high rates or the “guaranteed-issue” policy with its high rates and a one-year wait on pre-existing conditions.

Isn’t that a risky and frightening situation for lots of families?

– Employees leaving their job: While federal laws such as COBRA exist (guaranteeing the availability of continuous coverage for employees who leave their employment or lose their coverage, and which help many people when they are between jobs), the cost of a COBRA plan is often beyond the reach of many families – often way more than what they were previously paying.

In the situation where an employee leaves his or her employment and has not found employer-group coverage by the time COBRA runs out (18 months), though continuous coverage is guaranteed to that person no matter what his health condition, do you think it is fair for the insurance company to charge its highest premium (which it often does)?

These are some of the difficulties facing Virginians today. In my practice, I often cannot help those people who most are in need of health coverage.

When I began working as a health insurance broker many years ago, my manager always said, “The only thing that buys good health insurance is good health.” While this is true and exactly the right message for an 18-year-old who doesn’t think he needs to bother with health insurance right now, being immortal, it is little comfort to those who are not so lucky.

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