This involves my pursuit of health insurance (HI) for my wife, Lynn, and some bad bad news about it. (Not her health . . . at least not right now, but I DID have the rug pulled out from underneath me by none other than . . . drum roll . . . you guessed it . . . BHO. Talk about adding insult to injury . . .)
Before I get into the details of my dilemma, let me quickly 'splain my decision to post on it here.
I had decided to quit posting on RO, because I didn’t want to become embroiled in what to me seemed, and still does, like some pretty abrasive exchanges in a lot of threads. Yes, I have the requisite thick skin and am pretty immune to confrontation and certainly expect that behavior on a political board (with overtones of religious contention.) But the abrasiveness and contention here is a little over the top for me. It’s just not my style.
Moreover, I have bigger fish to fry (as you’ll see further on), and need to maintain a positive outlook as a caregiver for an Alzheimer’s riddled person (my wife.) The atmosphere here on RO made it difficult for me to maintain that optimistic approach so necessary to 24/7 caregiving, consequently I decided that since I didn’t need to add hurdles (have enough already), I’d just discontinue participation.
Don’t misunderstand . . . I’m NOT bashing RO. It’s just something that doesn’t enhance my approach right now. However, for all the abrasiveness and lack of civility in some of these threads, there ARE some pretty sharp people here, whose counsel I value.
Hence, after agonizing over making this post, for several weeks now, I’ve decided to make this plea for advice.
Apologies to RET though, because I made my swan song departure without extending him a courteous reply to a well thought out and lengthy reply he made to me ( http://www.republicanoperative.com/forums/f22/question-christians-39962/index36.html#post580815 ), and thought that if I ever come back, the first thing I’d better do is extend that courtesy. I’m not doing that here though, and I’m not particularly proud of breaching my own standard of good manners . . . my mommy taught me better, and would whack me if she were above ground.
Nevertheless, I’m here asking for any advice ANYONE might have.
To grasp this dilemma, I first need to give you some background:
Lynn is two years younger than me . . . she just turned 64, and I am 66. She was born on March 20, 1949, and my birth date was April 3, 1947.
We both were covered by commercial HI under the group plan from my former employer (“Aetna”, at a cost to me of $1000/month . . . a bit outrageous, but one needs HI these days.) However, AND THIS IS CRITICAL TO AN UNDERSTANDING OF THE SITUATION, the former employer’s coverage automatically canceled when I turned 65 and was eligible for Medicare.
(I am retired, and have been since 1999 . . . yes, early retirement, but the deal the former employer offered was sweet.)
The cancellation when I turned 65 was fine for me (I went on Medicare of course), but left me in a lurch for Lynn, since she was not yet eligible for Medicare and lost coverage when mine canceled.
She was diagnosed with Alzheimer’s in 2007 (while still covered under my commercial HI at that time.) Consequently, she has a “pre-existing condition” in the eyes of any new insurer.
Not necessarily a problem I thought, since all I wanted to get for her, 'till she was eligible for Medicare, was “catastrophic” (high deductible) HI anyway. I expected the cost would be high (since she would be judged “high risk”), and I was prepared to bear the outrageous “day-to-day” costs of her care (things like Mammograms, Colonoscopies, drugs, etc.), but I at least wanted her covered for the extended costs if she ever had to be hospitalized, got something like breast cancer, stroke, appendicitis, etc.
So I went out “on the street”, looking for something for her. I soon found out that Arizona was one of the states in the union that DOES NOT maintain a high risk pool, and consequently HI companies licensed in the state can DENY coverage for “pre-existing conditions”, and DENY catastrophic coverage on that basis too.
So no matter how much I was willing and able to pay, I couldn’t even get catastrophic coverage for her here in Arizona.
Enter a program called “PCIP” (pronounced “Pee’ - sip”), “Pre-existing Condition Insurance Plan”. PCIP is part of Obamacare. I made a post on it here at RO . . . see: http://www.republicanoperative.com/forums/f10/obamacare-presumptively-unconstitutional-says-court-38784/index3.html#post564879 and the responses to it. RET, Jazz, and johnwk very kindly made some enlightening comments, particularly johnwk’s. To get a handle on the situation, I would definitely recommend reading those posts, and that entire thread (it’s only four pages.)
Now I’m not a fan of Obamacare (or anything originating from BHO, for that matter), but the PCIP program is only one small part of Obamacare, it solved my problem, and I didn’t feel guilty taking advantage of it. Indeed, Romney said in one of the debates that though he would get rid of Obamacare, he would MAINTAIN the pre-existing condition provisions.
Now I DID have a COBRA option and I could have taken that (at a substantial cost increase and only for 18 months). But I didn’t.
In one of the posts in that thread I just cited, I said that COBRA was not an option. That’s true, but perhaps misleading. I was offered COBRA, but at a substantially higher rate than I had been paying (over $2000 versus $1000), PLUS it would have expired and left a 6 month gap on the BACK END before Lynn was covered by Medicare.
At about that same time, I began to learn about PCIP. The rate for PCIP was less than $500/mo, plus eligibility required 6 months of NO coverage on the FRONT END.
I remember corresponding with the PCIP folks and I specifically asked them if accepting COBRA would disqualify her for PCIP coverage (getting that answer was tedious at best). They finally responded that “Yes, accepting COBRA coverage would perpetually disqualify her for coverage under PCIP.”
So, the decision. Take COBRA and suffer a substantially higher premium and a 6 month gap (i.e. NO COVERAGE for her) on the BACK END, and eliminate PCIP as an option forever, or hope for PCIP coverage and have a lower premium, suffer the 6 month gap on the FRONT END, and eliminate COBRA as an option forever.
You might think that the premium difference was the deciding factor, but it wasn’t. It was either suffer the gap on the FRONT END or the BACK END that was the deciding factor. I agonized over the decision, but finally figured that since her health is declining (in addition to Alzheimer’s, she has diabetes and high cholesterol), there’s a greater chance that she’s going to need the coverage on the BACK END, so I turned down COBRA and gambled on PCIP (a bad bet as I found out on . . . get this . . . MY BIRTHDAY.)
So now fast forward to that day.
I had finally gathered the necessary documentation (things like a doctor certified letter confirming the diagnosis and when it was made, a letter from an Arizona licensed carrier denying coverage, and more, all things dependent on third parties and NOT on my time line), and applied at the end of February, 2013. She was well beyond the six months without coverage requirement for PCIP (more like 10 months, since her commercial coverage canceled in April, 2012), and I purposely took the risk of letting SOME of that time go by (never mind the fact that I had little to no control over the timing of the required documentation), because a PCIP guy warned me that applying “too soon” after the six month “no insurance” requirement would result in a perpetual denial of PCIP (I have no idea why that would be, but it doesn’t surprise me knowing that bureaucrats would be rendering a judgment.)
While I didn’t want 10 months to pass (more like 7 was my preferred timing, to MAKE SURE I didn’t give anyone at PCIP cause to deny my app), the extra three months was consumed by the third party documentation. Since I didn’t feel rushed, I didn’t hassle the doc (her neurologist) or Arizona carriers on their support for my documentation (in hindsight I should have felt “rushed”). Plus, every month that went by without paying a premium was something I viewed as an advantage.
Granted, I could have gotten the legwork done on the documentation in the time I allowed to pass, but again, I never felt rushed.
But 10 months was pushing the law of averages, and I thought it was time to get this thing in gear BEFORE Lynn really DID need catastrophic coverage, so I applied for PCIP at the end of February 2013.
On April 3, 2013, I called PCIP, thinking that I could light a fire and get this thing moving. My app had been in well over the “two week” review and approval time that PCIP estimates. I just assumed it was the usual bureaucratic red tape log jam.
OK . . . now for the bad news. I was informed over the phone by a PCIP guy that PCIP was no longer enrolling anyone and had, in fact, stopped reviewing applications on February 16th, 2013. To see the notice, go to https://www.pcip.gov/How_to_Apply.html
A good article on this fiasco is at Daily Kos: Discovered You Have Cancer Today? Sorry! PCIP Closed Enrollment Yesterday.. A detailed reading of that article (don’t worry, it’s short) will answer a lot of questions. (Though that site has a liberal bent, the article IS accurate.)
Scroll down some, and toward the end of the article it speaks to the funding issue, which is CRITICAL to understanding this. Seems as though the BHO administration allocated some 5 Billion to subsidize the PCIP program (the “bridge” to Obamacare, intended to provide coverage for people with pre-existing conditions from August 2010 'till January 2014 when the pre-existing condition provision of Obamacare was enabled and would compel insurers in EVERY state to offer coverage for pre-existing conditions and disable denials).
However, as common sense might predict, people with pre-existing conditions make a heck of a lot more claims than the typical HI population. Consequently, the BHO people made a significant underfunding allocation (common sense NOT being a characteristic trait of BHO people.) When HHS did some financial and claim projections, they discovered that the original allocation was only sufficient to service existing PCIP enrollee claims, and that to do so they would have to discontinue accepting applications for NEW enrollees. Hence the announcement at https://www.pcip.gov/How_to_Apply.html and the rug being pulled out from underneath me!
Estimates to continue the program for new enrollees for the remaining 9 months are around $500 Million. (I’ll come back to this later, because this is an important number.)
Yes, it was my fault for not checking on this periodically, and had I done that I certainly would have put a rush on the effort. I never imagined the rug would have been pulled out from underneath me.
So now, as it turns out I should have taken COBRA . . . but that option is gone now. I argued with the PCIP guy on the phone, and asked things like “Why didn’t you guys tell me when you got my app?”
His answer: “It wouldn’t have made any difference . . . you applied after the February 16th deadline.”
He was right, but that infuriated me all the more.
So now I’m screwed. I don’t have any choice but to just hope Lynn doesn’t have any catastrophic illness 'till January of next year, when Arizona carriers will NOT be able to DENY coverage for pre-existing conditions . . . and then in March of that year she will be eligible for Medicare anyway.
So, at the very least, I have another 9 months or so of puckering.
For example, my sister had breast cancer ten years ago. With her surgery (radical mastectomy), chemo, and radiation treatments, the total cost was north of $750,000 dollars. Fortunately, she DID have HI, and though I don’t know what her out-of-pocket cost was, it was significantly less than $750,000 dollars. I’m by no means wealthy, but I DO have substantial investment income and am able to afford REAL food and don’t have to eat dog food, can afford day-to-day medical costs for Lynn, etc. However, a $750,000 dollar bill would break me, and I’d soon be out on the street.
I guess I could write to my congressman and Senators. Something like, “If Obama took less vacations, spent less on welfare fraudsters, etc., the thing might have been funded for another 9 months . . .”, or go to the “On Your Side” news segments. I might really do both, but right now I’m so furious it’s not a good time to compose anything. I’ve always restrained myself when in the heat of anger, and responded only after I’ve cooled down and a cooler mind prevails . . . but here time is of the essence though. However, it’s been a month now since I got the bad news, and I’m still hot. Looks like I may have to leverage the anger, because it may not diminish.
Three more things, and then I’ll close.
I mentioned above the $500 Million dollar number to extend the funding for new PCIP applicants 'till January 2014 . . . another 9 months. That number is significant when you compare it to some fraud and waste numbers. For example, in 2011 the GAO estimated that fraudulent Medicare claims accounted for . . . get this . . . a whopping 48 Billion. Outside expert estimates are north of . . . 60 Billion. Just a fraction of that, if recovered, would fund the continuation of PCIP. Add in things like pork barrel spending and other wasted spending (the NIH funding to study why lesbians are obese comes to mind), and pretty soon it becomes apparent that priorities are wayyyyyy out of whack. This upside down picture just makes my blood boil more.
Essential to any letter complaining about anything, IS including WHAT YOU’RE REMEDY WOULD BE. My suggested remedy would be for my congressperson to introduce/promote IMMEDIATE legislation to divert “wasted” funding to PCIP so that applications can once again be accepted. For example, McClame is one of my senators. He decries earmarks (“pork barrel spending”, “special interest giveaways”), and he is also Ranking Member of the Senate Committee on Armed Services. So, I might tailor my message to him to sponsor legislation to divert monies frivolously spent in the DoD toward PCIP.
My strategy is to tailor each message to the congressperson’s “pet peeve”. As another example, my other Senator is Jeff Flake ®. HIS pet peeve is “Agricultural Subsudies”. So in my message to him, I might suggest diverting the wasted monies on subsidizing corn crops for ethanol production to making PCIP viable for more applicants.
Make no mistake though . . . I am under no illusions that letters will bring any results. They’ll either hit the can or some staffer will fire off the customary form that says, “Thank you for your interest . . . blah, blah, blah.” and blow me off. That would be a good bet. But I’m so enraged right now that this is all I can think of. That’s why I’m making this post. I’m hoping that some folks here can suggest something more productive.
- And finally, there’s my negative feelings about BHO for this situation. In my spectrum of negativity, there’s “disagreement” at the low end (pretty benign really), then there’s “discomfort”, then “contempt”, and at the high end there’s HATE. HATE to me is actually wishing bad things to happen to an individual. Consequently, HATE is not a very Christian sentiment to me, and I very rarely go that far.
As far as BHO, he’s in the plain vanilla “contempt” category . . . I just wish he would go away. But you can be sure that if Lynn suffers a hospitalization catastrophe while not covered, I will be cursing him as I walk down the hospital hallways on my way to being homeless. He will approach the HATE category.
I served in the USMC in the late '60’s, VietNam, etc. My wife and I have worked hard all our lives and paid our taxes. I’ve socked away dough and made “financial planning contingencies” (costs of catastrophic coverage was one of them) for these “Golden Years.” At this stage of the game, I never expected to be facing a real threat of living in a box under a bridge.
So, thoughts . . . recommendations . . . advice?