The Treatment

This Cobra Doesn't Bite


Anthony Wright is executive director of Health Access California, the statewide health care consumer advocacy coalition. He blogs daily at the Health Access WeBlog
and is a regular contributor to the Treatment. 

Of the health provisions in the economic recovery package, we’ve written about the need for Medicaid funds to prevent gruesome cuts that would deny coverage for millions at the state level; and about the hope (now only in the House version) of temporarily expanding Medicaid for newly-unemployed adults, beginning to close the gaping hole in our current safety net. Another major provision (in both bills, although the House version is more expansive) are subsidies for COBRA, the option that workers have when they leave a job to continue their group coverage through their employer--as long as they pay 100 percent of the premium, plus 2 percent administrative costs. For those “between jobs,” that’s a hefty price--for example, it would be a ridiculously large portion of unemployment benefits. But COBRA doesn’t just provide workers continuity of care, the security of the same level of benefits they previously enjoyed, and access to their previous employers’ group discount—it’s often the only choice many have. For those who don’t have other access to group coverage (like, through a spouse), COBRA may be your only option. Outside of five Northeast states with guaranteed issue requirements (Maine, Vermont, Massachusetts, New York, New Jersey), individuals buying coverage by themselves are at risk of being denied coverage--at any price--due to their health status. If you think that doesn’t concern you, think again. I used to joke that living over 45 was a “pre-existing condition.” But I’ve seen folks in their 20s with denial letters, and seemingly healthy people of all ages get denied coverage for relatively minor ailments.

Check out the intense standardized questionnaire to get coverage in Washington state, which at least has put some oversight over the process. In California and many other states, insurers can ask their own questions, and can have different criteria of who is denied or not. Here’s the basic disclosure in California for the many reasons you can be denied coverage--even for ailments you may not know you have. In the wild west of the individual insurance market, anybody can be denied. So group coverage through COBRA is the last hope to ensure that many who lose their job don’t lose their coverage, but it only will really work if it can subsidized to a point to be affordable. For some, a Medicaid expansion would be more affordable and make more sense, which is why the House version includes that option as well. Both are needed to be included in the final package. And then we need to move on to overall health reform to end the practice of allowing insurers in the individual market to play Russian Roulette with consumers’ coverage.

--Anthony Wright 

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