There are millions of Americans who do not have insurance because they cannot afford it but what about the Americans who can afford it but cannot obtain it? am one of those. I am a very active 56 year old male who has been self employed for the better part of the past 35 years. I have employed many others, paid for their and my health insurance through my companies and have paid taxes as an employer and as a wage earner.
After selling my entrepreneurial ventures, I went to work for a higher education learning institution. While I enjoyed these experiences I decided I would start my own consulting business in hopes of continuing the ‘teaching’ of individuals and students who want to start their own businesses.
My dilemma is this: in order to stay active and healthy I decided to have a knee replacement to correct an osteoarthritis condition in my right knee. The operation was successful and soon I was back playing golf, hiking and cycling. Inevitably my left knee also suffered from the same osteoarthritis condition. This time I opted for a partial replacement. Again, a successful operation and I now enjoy walking a round a golf, hiking and cycling.
My heart rate is excellent, my cholesterol is well in the acceptable range and I take NO drugs, prescription or over the counter regularly.
Why is it that in the state of Kentucky as a self-employed individual who can afford to pay for his own insurance, my knee replacements preclude me from obtaining health insurance in the traditional manner? This is the question I cannot answer. Currently there are three major insurance companies that insure individuals in Kentucky; Anthem Blue Cross Blue Shield, Humana and United Health Insurance. Prior to my Cobra expiration of January 7, 2008, I contacted all three companies in an attempt to obtain an individual insurance policy and was rejected by all three. The reason given by all three was the fact that due to osteoarthritis I had replaced both knees. The fact that I was healthy and active apparently did not bear on their decisions. When I asked about insuring me with exclusion for my knees I was told that the State of Kentucky currently has legislation in place that precludes long term body part exclusion.
I am aware of the program offered by the state of Kentucky known as Kentucky Access. This program offers insurance to the uninsured. It is very expensive; most likely because the individuals who qualify are “high risk” individuals with conditions such as HIV, MS, transplants, cancer and the like. I believe this is wrong and suggest that the insurance companies only want to insure the healthy unless they are dealing with a company policy where they are not allowed to exclude individuals. If you look at their pools of individual policies I suspect you will find very few sick persons in the pool. Why do knee replacements that allow an individual to remain an active healthy individual disqualify for traditional coverage and put an otherwise health individual in the same category as life threatening or debilitating diseases?
If I go to work for someone I can get insurance coverage whether I am seriously ill or not. If I move to most other states, I can get insurance coverage through an employer or as an individual. As a former business owner I understand risk and profits. However, it seems a travesty that unhealthy persons can obtain insurance through their workplace while I cannot obtain insurance when other than the knee replacements I would be considered in the top percentage of healthy persons.
P.S. Following the expiration of my Cobra coverage (ended 1/7/08) through the educational institution I worked for previously, I found an Anthem agent who could write two consecutive 6 month partial coverage plans with exclusions from Anthem. This coverage could only continue for the two six-month consecutive periods. On 12/4/08 I was rejected for continuous coverage under a normal individual policy past 12/31/08. I am currently applying for Kentucky Access coverage.
An excerpt from the following article: http://www.heritage.org/Research/HealthCare/BG1119.cfm
The Kentucky Health Care Reform Act, known originally as House Bill 250, originated during the 1994 general session of the Kentucky state legislature.
Unintended Consequences: Higher Insurance Rates, Lower Coverage
Not only has the original goal of “universal coverage” not been met, but neither have the more modest objectives of increased availability and affordability for individuals and families. In fact, the problems worsened. Although it is true that those who were very sick were eligible to purchase health care insurance for the first time, the cost of health insurance for individuals and families skyrocketed, forcing many small businesses and healthy individuals out of the market altogether. The result: By January 1996, at the opening of the General Assembly, fewer Kentuckians were covered than before the ambitious reforms were passed.
Even though critics of the Kentucky plan have been concerned about its effect on the state’s ability to attract and retain physicians, there is little debate about the effect of the law’s regulatory regime on the state’s ability to retain insurance providers: Midway through the 1996 General Assembly, the last of over 40 commercial fee-for-service providers pulled out of Kentucky. Only a state-run program is left: Kentucky Kare. With insurance rates at record highs and personal choice of plans at an all-time low, pressure has been growing in the General Assembly to repeal or substantially revise the plan, and there is considerable pressure on the Governor to call a special session on health care reform in 1997.6