The Plank

Coming To An Er Near You: The "pre-uninsured."


A few weeks ago, a friend who works at a major hospital mentioned that a different kind of patient was increasingly showing up at the emergency room. In addition to the uninsured and underinsured, who'd always been coming, he was seeing more patients who might be best described as "pre-uninsured"--that is, people who were about to lose their jobs and, as a result, their insurance coverage.

Sometimes, he said, they would request treatments not just for their medical emergencies but also for other, longer term problems--figuring they might as well get the treatment while they still had insurance. In other cases, though, they would actually avoid treatments--and tests--because they didn't want their files to show they had pre-existing medical conditions, making future purchase of insurance more difficult.

Either way, we agreed, it wasn't a terribly efficient way to administer medical care. But, then, when had American health care ever been efficient?

In any event, it turns out the story wasn't isolated. In Sunday's New York Times, Robert Pear turned up a few stories like that--along with some more familiar tales of people who had already lost their insurance and were suffering the consequences:

Starla D. Darling, 27, was pregnant when she learned that her
insurance coverage was about to end. She rushed to the hospital, took a
medication to induce labor and then had an emergency Caesarean section, in the hope that her Blue Cross and Blue Shield plan would pay for the delivery.

Wendy R. Carter, 41, who recently lost her job and her health benefits, is struggling to pay $12,942 in bills for a partial hysterectomy at a local hospital. Her daughter, Betsy A. Carter, 19, has pain in her
lower right jaw, where a wisdom tooth is growing in. But she has not
seen a dentist because she has no health insurance.

Ms. Darling
and Wendy Carter are among 275 people who worked at an Archway cookie
factory here in north central Ohio. The company provided excellent
health benefits. But the plant shut down abruptly this fall, leaving
workers without coverage, like millions of people battered by the worst
economic crisis since the Depression.

The headline on the story said "When a Job Disappears, So Does the Health Care." That may sound banal, but surprisingly few pundits and strategists seem to grasp this point. They tend to discuss the economy and health care as nearly distinct issues, apparently oblivious to the fact that when people lose their jobs, they also lose their insurance, creating a major new source of financial security. Hopefully Pear's excellent article can help fix that.

Update: In the feedback section, reader AMVHuck wonders why more people don't take advantage of COBRA coverage, like he/she did while unemployed. It's a good question.

COBRA allows you to pay, out of your own pocket, for the insurance you had at a former job. And, without question, it allows many people to keep coverage they'd otherwise lose.

But it's no substitute for universal coverage. For one thing, the premiums are very expensive, since you have to pick up both your share and the share your employer used to kick in. People without jobs often can't afford that.

In addition, COBRA--like virtually every health care assistance program in this country--has several key loopholes. As it happens, the woman Pear profiles his Times story falls into one of them, as he explains: "In some cases, people who are laid off can maintain their group health
benefits under a federal law, the Consolidated Omnibus Budget
Reconciliation Act of 1986, known as Cobra. But that is not an option
for former Archway employees because their group health plan no longer

--Jonathan Cohn 

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