Colorado’s open enrollment is open season on patients
Ahh, the crisp days of autumn are upon us and winter and its holidays are right around the corner. But just as you start to feel cozy and whimsical about the season, you get the doom-inspiring notice: It’s open enrollment time!
More like open season on the masses who must decide about health insurance coverage. Before even clicking on the “what’s new this year” or the side-by-side comparison of what you have now and what the new plan offers, we pretty much know we’re going to either A) pay more or B) have less coverage.
As if we need something new or different. A plan that provides some basic services and will cover us if we get sick or break a bone will do nicely, thank you. The only reason for these annual changes is to ensure profits for the insurance companies.
There will be notable exceptions year for the 250,000 Coloradans who buy plans through the state’s market for individuals. Prices are expected to drop by an average of 20.2% for the same plans because of a new reinsurance program that uses state and federal money to cover some of the most expensive medical bills.
That’s a good thing as families in western Colorado have some of the highest health insurance premiums in the nation.
Regardless of that positive news, we still are faced with the annual ritual of reviewing our choices and weighing how much risk we’ll take on coverage.
For about 55% of us, much of the decision is based on what insurer our employer selects and the plans it offers. Most employers pick up at least a portion of the tab as a benefit. The rest are covered by: Medicaid, 19.3%; Medicare, 17.2%; individual purchase, 16%, or the military, 4.8%, according to the U.S. Census report for 2018 coverage.
If you’re buying it through the state marketplace (Connect for Health) you can talk to a broker about options. That can be a crapshoot, although I have friends who found it helpful.
When I was shopping for a Medicare plan, I spent a couple of hours with a broker who walked me through the alphabet soup of coverage plans that I’d already familiarized myself with because she was “required to.” She didn’t think a PPO plan that I was interested in was available in my county, but finally looked it up and discovered it was.
She also couldn’t help me with the two-month gap between when my COBRA expired and Medicare kicked in. Neither could Connect for Health Colorado. I called twice because I thought surely someone there should be able to give me general health insurance advice; but no, they merely help people enroll for a year of coverage. The rep for my COBRA provider, Anthem Blue Cross, was no help either.
Frustrated, I went uninsured for two months. Which brings me to Jeff Allen’s story. We were friends in high school and gradually lost touch until Facebook reconnected us. Jeff, who lives in Michigan, had a career in the broadcast and music industries and was doing well until he was laid off during the recession. He had coverage through COBRA for 15 months and then tried to buy private insurance. This was just before the
Affordable Care Act went into effect, and he was denied coverage because of his pre-existing hypertension.
His prescription ran out and his doctor wouldn’t see an uninsured patient. He applied for Medicaid and was denied.
By then he had another job lined up that offered insurance coverage so he risked going without the meds.
He had a brain bleed — a stroke — and went into a coma for several months. The bills approached a million dollars. Fortunately, Medicaid was approved and retroactively paid the tab. It would’ve been much cheaper had they covered his doctor bill and prescription that likely would’ve prevented the debilitating stroke.
I thought of Jeff every single day that I was uninsured.
The ACA brought positive changes, but the United States had 27.5 million uninsured people in 2018, up for the first time in a decade.
This is not a new issue. We’ve debated how to provide equitable health care since the early 1900s and have repeatedly failed miserably. Interestingly, the ACA resembles a bipartisan plan that President Richard Nixon and Sen. Ted Kennedy were collaborating on in the early ’70s before Kennedy bolted under union pressure and Watergate erupted. Other countries figured it out decades ago; we managed to get the Medicare and Medicaid systems running by the mid-20th century, but they constantly are under threat of cuts.
Next year’s open enrollment period will coincide with the 2020 election. It would be awesome if our frustration was reflected at the polls and we seated a president and a Congress that would prioritize health care reform, as we tried to do in 2008.
After all, we’ve had a century of mostly political failure on this issue and we can count the toll in unnecessary deaths, disabilities and medical bill bankruptcies. You likely know someone who has suffered because of our system. Remember their story — or remember Jeff’s.