Health Insurance at Work

I’m one of the 158 million Americans who get health insurance through our jobs. My plan is a decent one. I like my primary care physician, and she’s good about referring me to a specialist if I need one. Seven years ago, I faced a life-threatening condition that required major surgery. I got excellent care, and my insurance paid what it was supposed to without giving me any grief.

You may say, “Gee, texaslupine, you’re one of the lucky ones. Why would you want to mess with a system that’s working for you?”

Because even from where I sit, I can tell the system is broken.

Two weeks ago, I compared our current health care mess to a slow-motion train wreck. Let’s say I’m riding that train, in a Pullman car close to the back end. Somewhere up ahead, my train has collided head-on with another in the middle of a high trestle. Both locomotives are doing a swan dive into the gorge, with cars careening off behind them. The car I’m riding in is still on the tracks –- for the moment, anyway -- but there’s no reason to think it’ll stay there.

I’m a State of Texas employee. I’ve been with the state nine years. Before that, I spent a few years on staff at The University of Texas. Which means that since 1996, I’ve had health insurance through the Employees Retirement System. I know it’s a valuable benefit, way better than a lot of my friends have. But still, I’ve seen that benefit erode over time.

• When I worked at UT, and when I first signed on with the state, employees had a choice of health plans. Everyone had access to the self-insured plan administered by Blue Cross/Blue Shield, and depending on where a person lived, there might be three or four HMOs available. Nowadays, there may be one HMO in a given area; in many parts of the state, the self-insured plan is the only choice.
  
• In my job at UT, I was amazed to find that health insurance was in effect on my first day. Other places I’d worked had a waiting period of one to six months before new employees could enroll. Well, state employees used to be covered from day one, but not any more. New people coming in have a three-month waiting period. This doesn’t affect me personally, since I’m already in the system. But it’s another example of benefits being gradually chipped away.
  
• Earlier this year, state employees were notified that our health care plan was out of money and might be forced to make some changes. I was invited to fill out a survey, which basically presented a range of unhappy options and asked me to pick the ones I hated least. The result? Our monthly premiums will increase next month, and so will our co-pays for doctor visits, hospital stays and prescription drugs. And the ERS website ominously states, “More changes will be necessary in the near future.”

Yes, and with all the recent news about state budget cuts, there’s no guarantee that I’ll even have a job two years from now.

Somewhere out there, I hear the faint sound of a violin playing “My Heart Bleeds…” Okay, I’ll stop whining, and I really wasn’t asking for sympathy. I just wanted to share a story that is, I believe, representative of what’s happening everywhere. I suspect all Americans are paying more for less coverage than they were ten years ago.

… that is, if they can get any coverage at all. We’ll talk about that next time.

Health Care Reform: The Individual Mandate

When health care reform takes full effect in 2014, nearly everyone in the United States will be required to carry some kind of health insurance.

I have mixed feelings about this.

From a philosophical standpoint, I don’t like it. My gut says nobody should be forced to buy something, especially if he has to buy it from a private company. And since the “public option” got dropped along the way, that’s what many of us will have to do.

On the other hand, I can see that reform won’t work unless we all participate. Under the new law, insurance companies will no longer be allowed to deny coverage on account of pre-existing conditions or kick customers off the plan for getting sick. This is a huge improvement. Over the past decade, when I’ve thought about all that needs fixing in our current health care system, that thing about pre-existing conditions tops the list.

There are economic realities in this equation. A recent post on HealthBeatBlog explains it well:

"If the law didn’t insist that everyone have 'minimal coverage' (or pay a financial penalty), many young, healthy Americans might well wait until they were injured, or seriously ill, before signing up for a policy—safe in the knowledge that no insurer could refuse them, or charge an exorbitant premium. If that happened, insurers would find themselves covering a pool made up largely of the elderly, the disabled, and the chronically ill. Premiums would sky-rocket. If we are going to try to provide health insurance for all citizens, the healthy must join the pool…."

So, despite my distaste for the mandate, I support the health care act. And I confess that somewhere in the back of my mind, I’m hoping this will eventually work itself out. If the law works the way I hope it does, if it forces insurance companies to be better corporate citizens, if health insurance becomes more affordable and works better for the people who have it, maybe it will come to be seen as something everybody wants and needs, and a mandate will be unnecessary. Perhaps the changed playing field will give rise to non-profits, co-ops, or new types of health care/health insurance providers we haven’t even thought of yet.

There are some big “ifs” in those scenarios, but I can dream, can’t I?

In Defense of Health Care Reform

My home state, along with a dozen others, is suing the U.S. government over the Patient Protection and Affordable Care Act.

Yes, I’m talking about Texas, Our Texas, the place where I was born and raised. A state where one in four people has no health insurance; a state that’s home to more uninsured people than any other.

I don’t mean to say I just found out about this. The suit was filed last March, the same day President Obama signed health care reform into law. But I just got around to reading the 23-page document last night. Clearly, the chief attorneys for all these states are hoping to get the act thrown out before it fully takes effect.

Come on, people. The system we have isn’t working. Why not give this new law a try?

As I see it, the current state of health care in this country is a slow-motion train wreck. I’ve watched for twenty years at fairly close range: as a consumer of health services…a breadwinner with responsibility for other household members…a friend of working musicians who have played countless benefit concerts for sick and injured colleagues who can’t pay their doctor bills. It’s a tangled mess that ruins lives and warps our whole economy. And it’s steadily getting worse.

I have a lot to say about various aspects of this imbroglio. I’ll share some in future posts, and hope to get some additional comments from readers. For now, I’ll just say this:

If I knew how to fix health care, I’d have typed up my plan and sent it to our last four presidents. So I’m not going to point fingers at the members of Congress who spent a year debating this legislation, tweaking its provisions, making deals, and finally getting it passed.

I don’t agree with every single provision in the act, but I think there’s enough good stuff there to make a start on fixing some very thorny problems. I’m more than willing to give it a chance.