The Plank

The Rise Of 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

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

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.

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.

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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