1258 - Health care (or not)

This is from columnist Bill McClellan at the St. Louis Post-Dispatch. It's about a guy that missed a health care payment and may have destroyed his life. It was partially his fault but the system has gotten him so far. This is our "free market system" at it's worst. And not because this guy messed up, because there is no alternative.



Bruce is a 59-year-old businessman who finds himself on the front lines of the health care war.

There are two reasons for that. First, he has some medical issues. Second, he recently missed an insurance payment.

"It's my fault," he said of the missed payment. "It was really stupid of me. I thought I had paid it."

He pays most of his bills online. A few he pays by check. Maybe that is part of the confusion. At any rate, he thought he had paid his July premium. That was an online bill. Maybe if he had a paper relationship with the insurance company, it would have sent him a monthly bill. As it was, he was supposed to remember to pay.

Ironically, Bruce is a computer person. In fact, he has a document-scanning business. He takes paper records and converts them into electronic records. The business is not booming.

"People don't want to spend money right now," he said.

So he is financially strapped. Not broke, but strapped.

He had a good deal on his insurance policy. It came through his wife's job. Actually, his ex-wife's job. They were divorced late last year, and he opted to keep the insurance through a COBRA policy. He got a 36-month plan.

He paid $368 a month for a policy with low co-pays and excellent prescription drug benefits.

That was important because he takes a lot of medicine. He has high blood pressure, Type 2 diabetes and hepatitis C.

He went to his local pharmacy in mid-August to get a prescription. The pharmacist told him his insurance was no longer in effect.

He rushed home. He found records of payments for February, March, April, May and June, but nothing for July. His payments are due on the first of the month and there is a 30-day grace period.

He went online to make his July and August payments, but the site would not allow him to make a payment because he had already been terminated.

He called Tri-Ad, the company that administers the COBRA plan. He told me he offered to pay a penalty to be reinstated. He said he offered to pay in advance for the rest of the year to be reinstated. The representative said she was sorry, but there were no second chances. He said she suggested he call the U.S. Department of Labor.

I called Tri-Ad and told a representative what Bruce had told me. Yes, these COBRA regulations are very strict, the representative said. There is a 30-day grace period and that is that, he said.

I asked if an appeal were possible. Who should somebody call?

Call the Labor Department, the representative said.

That is what Bruce said he did. He spoke to a person in the Employee Benefits Security Administration. He said the man's name was Mike. (You get into the telephone world and everybody has a first name, but no last name.) Bruce said Mike was sympathetic and told him this was not an uncommon problem.

People get COBRA policies because they are a good deal. Why would insurance companies want you to have a good deal? Mike suggested Bruce call his ex-wife's employer.

I called the Employee Benefits Security Administration. I told a woman what Bruce had told me and asked to speak to Mike. The woman said somebody would call me back. No one did.

Bruce said he called his ex-wife's employer and spoke to a woman in the Human Resources department. He said she was sympathetic and professional but said there was nothing she could do. Something about federal regulations and company policy.

So Bruce is without health insurance. This is not the first time. He has had a series of jobs, and when he has worked for larger companies — most often as a salesman — he's had insurance. But he has tried some entrepreneurial things, too, and in those periods, he has sometimes been without coverage.

But that was when he was younger.

It's tougher when you're 59, and it's especially tough when you have pre-existing conditions. He has contacted insurance agents, and he showed me some of the policies he might be able to get. One would cost a little more than $500 a month and has a $5,000 deductible. The prescription drug benefit isn't nearly as good as the one he used to have.

"I know I screwed up," he said. "I'm not pretending it wasn't my fault. But if you make a mistake with the IRS, you're allowed to pay what you owe with interest and a penalty. Why can't it be the same with this?"

He wants health insurance. He's just not sure he can afford his new policy.



59 years old, preexisting conditions, working for himself. Good luck Bruce. Pay up or die.