Rather than add to the thousands upon thousands of words already written about how and why Scott Brown defeated Martha Coakley in last night’s Massachusetts special election (personally, I think it was the Schilling gaffe that sunk her), I want to spend a couple of minutes on two key elements of reform that few people seem to disagree with: people with pre-existing conditions and people who truly can’t afford to pay should not be denied access to health insurance and health care.
I often hear people in my industry (yes, that’s the health insurance industry) break down the numbers of the uninsured into three roughly equal groups of about 15 million each. From what I have read, the numbers seem about right:
- 1/3 – Uninsured by choice. This group is made up of “young invincibles” (e.g., recent college grads); healthy middle-class individuals who choose not to buy insurance; and people in transition from one employer-based coverage to the next (ask me sometime about how to maintain your COBRA rights for four months without actually paying premiums).
- 1/3 – Uninsured and unable to obtain coverage. This is the group that would have been most helped by the reform legislation. These are people who want to buy health insurance, but have pre-existing conditions which prevent them from being approved.
- 1/3 – Eligible for coverage and/or financial subsidies, but don’t know about it. This group doesn’t get a lot of press, but considering the patchwork of federal and state insurance laws and programs, confusion and lack of information is certainly understandable.
As an independent health insurance broker, I spend most of my time with the first two groups. I try to convince the first group that some type of catastrophic coverage — including HSA-compatible plans — are essential, in the event of the unexpected illness or injury.
The second group is the most challenging, but also the most rewarding for me (not necessarily financially). This group benefits tremendously from information and resources. We will go through everything — reapplying to alternate carriers, considering short-term plans, looking at COBRA, Cal-Cobra, HIPAA, and other guarantee-issue options, including a small group plan with as few as one or two people enrolled.
The third third doesn’t always find their way to me. But when they do (and if you know anyone in this group), I will often refer them to the Foundation for Health Coverage Education. This is a phenomenal resource, with multilingual support throughout the U.S. via web and phone. People can use the online quiz, or refer to the Health Care Options Matrix to find out if they (or their dependent children) qualify for any one of the multitude of federal and state health coverage resources.
While we all await the eventual fate of the health care reform bill, why not see if you can help reduce the size of that third group? If you know someone who may not be able to afford coverage, refer them to the FHCE. The resource is free, and they might discover that they qualify for a low- or no-cost health coverage option.