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Self-Employed, Uninsured and No Way to Get Health Insurance (Before the Affordable Care Act)

Theresa BrownGold's painting "No Way to Get Insurance Before the Affordable Care Act" for her art project, Art As Social Inquiry.

(Interview 3/2010. Oil on canvas 40 ins. x 30 ins.)

Update 2021

The Affordable Care Act (Obamacare) created a safety net for people like this sole proprietor. Before healthcare reform, individuals submitted to an insurer's medical underwriting when they wanted to buy a single policy -- the process of reviewing an applicant's medical history. Insurers looked for preexisting conditions they determined would result in unwanted claims. If so, the applicant was denied a policy. The new healthcare law banned the practice.

In 2010 about 50 million were in the same predicament as this subject -- working, uninsured and uninsurable. As a writer, I am usually reluctant to state the obvious, leaving the readers to connect the dots. In the case of healthcare, there is not a lot of dot-connecting going on in this country. Access to healthcare has somehow become a political issue.

Common sense cannot penetrate an ideology that says government intervention is the devil when it comes to healthcare.

Yet, the uninsured being denied single, affordable insurance policies because their medical records contain reports of cancer, diabetes, acne, arthritis, sleep apnea, herniated disks, eczema, broken bones, and on and on... the practice of denying people access to healthcare because they are/were sick isn't savage? Thank you, Obamacare for outlawing this practice.

The when-it-happens-to-you often cracks one's hardcore politics. I've seen it in this project. I admire Jeff Jeans's courage to be honest with himself. His abandoned his libertarian zeal against the Affordable Care Act when he desperately needed the law to save his life.

Artist Note (2010 with some 2021 notes)

As is the case over and over, sole proprietors of very small businesses find themselves priced out of the individual insurance market. In the individual insurance market, the customer essentially is knocking on the door of insurance companies hoping one of them will sell a single policy to an individual who is not part of a group.

Employers, who provide health benefits to a number of employees, form “groups." Group coverage means the insurance companies will collect premiums for people (the employees) in the group. The risk (the cost of claims) is spread out over more people. Larger employers pay less in premiums than small group employers. Insurers charged small groups higher premiums if the overall health of the group resulted in many claims.

The Affordable Care Act made group insurance somewhat less fraught for smaller employers. But cost is still a problem. explains small group plans before the ACA put consumer protections in place. "But HIPAA did not prohibit insurers from adjusting premiums based on the group’s medical history or industry type." The ACA says small group premiums can only vary based on age, family size, location, and industry type.

To put it simply, when my husband and I were small business owners I always worried about an employee's health status. If the employee actually used the health benefit we provided, would the insurers make our group rate unaffordable?

Individuals looking to buy directly from insurance companies do not have the buying power of groups. The insurance companies look at the individual’s medical history and decide whether this ONE individual will be profitable. Will they be paying claims for more than the premium dollars they are collecting from this one person? People with even the smallest pre-existing conditions are often denied coverage on the individual market because the companies do not want to take the chance that they will pay out more than they are collecting.

I have not heard from this subject. I will update this post once I do.


(interview from 2010)

Jewelry Designer, Self-Employed, Age 55, Uninsured

The subject works full time.

He had been insured as a dependent on his first wife’s health plans. His wife's employer-sponsored coverage changed when his wife changed jobs.

The subject lost all health insurance coverage 3 ½ years ago after a divorce.

The subject is uninsured. He has skipped all check-ups since he lost his health insurance.

The subject's second wife is also uninsured. She works full time at a day care. She is studying to be a teacher. The subject hopes he and his wife will be insured through a government insurance plan available to his wife as a teacher once she is certified.


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