Feared COBRA Lapsing. Knew She'd Be Uninsurable. (Before Affordable Care Act passed)


(Interview 6/2010. Oil on canvas, 40 ins. x 30 ins.)


How the painting started.

Update 2021

I wasn't sure about this painting after I finished it. I knew I captured the sitter's soul. On that score, I had to keep it.


But did I like the painting? Ten years on, I can answer. I love the way she looks at us in this portrait. I see a life lived without the kindness drummed out of her by the complexities and difficulties living can wreak.


In reviewing this story for the new website, I am struck by how many times I've written,

"COBRA allowed the subject to continue her job-based insurance through her previous employer..."


The subject stayed at a previous job she did not like for 15 years longer than she wanted to for the health benefits.

This country puts out fires when it comes to crafting healthcare policy. In 1986 a new law said employees could no longer be kicked to the curb and lose their employer-sponsored health insurance when they lost their jobs. Former employees could pay for the health benefit themselves. But too many could not afford to pay the premium in full. Very often the former employers paid most of the premium costs as a benefit to the employees.


The COBRA law was a half measure that left healthcare reform limping along until the Affordable Care Act (ACA) passed in 2010. The ACA goes a long way in giving people like this subject access to health insurance notwithstanding the distance health policy still has to go.


The subject recently told me, "I am completely free of the Hep C and doing well."


 

A study. Oil on canvas, 24 ins. x 20 ins.

(from a 2010 interview)

Programming Director for Small Non-Profit in a Major City, Age 48, COBRA Insured


The subject stayed at a previous job she did not like for 15 years longer than she wanted to for the health benefits.


She has severe asthma (since 6 months old), allergies and hepatitis C. She stays healthy when she takes care of herself.


COBRA allowed the subject to continue her job-based insurance through her previous employer after she left her job. COBRA is a federal law Congress passed in 1985 and signed by President Reagan in 1986. The law allows employees to continue with their employer-sponsored health insurance for a limited time. The employee very often pays the premium's full cost.


This subject availed herself of COBRA and was responsible for the entire premium with no employer contribution after she left her job.


Setting up COBRA was delayed. The insurance company told her their new computer system with glitches suspended her prescription plan. Getting COBRA proved to be complicated, and caused the subject great stress.


The subject knows that if her coverage lapses, her preexisting conditions make her uninsurable.


Before the Affordable Care Act (ACA) insurers delved into an applicant's medical history. If they found preexisting conditions, they could refuse to sell insurance to a person needing a single policy for herself. The ACA opened up access to health insurance without regard to a person's medical history. The ACA also made the 1996 HIPAA law's complicated way a person's preexisting conditions figured into their future group and individual coverage inconsequential. The new healthcare law made a person's medical history irrelevant.)


If the insurance company did not process the subject's COBRA premium payment on time, her coverage could be cancelled. And then what? Did non-payment of the COBRA premium mean her right to continue with her former employer's health plan would end? She did not expect an insurer to sell her a single policy with her preexisting conditions.


The subject sends her COBRA payment early, and follows up with a phone call to make sure her premiums are recorded as paid. She fears the insurance company will cancel her policy for lack of payment due to a clerical or some other kind of error.


The subject lives is a state that no longer recognizes common law marriages. She and her partner married to keep him insured as a dependent/spouse on her insurance policy. COBRA payments for the couple are over $1000/month ($1,242.66 in 2021 dollars). When the subject worked for her previous employer, her contribution for coverage for the couple was $200/month. Her employer paid the rest of the insurance premium.


A new employer, a start-up nonprofit, pays the subject's COBRA premium now. The new employer is shopping for group insurance.


The new employer admitted to the subject, "It’s cheaper to hire somebody younger."


The new employer has 14 months to find a group health plan before the subject's COBRA benefit expires. The subject will need a new policy and is looking to her new employer to provide it.


About half the population gets their health insurance through their jobs. World War II wage and price controls incentivized employers to offer health insurance benefits to attract talented workers. The practice continues today. A 2001 Dept. of Labor analysis said cost, administrative complexity and employee dissatisfaction were the cracks that could buckle the employer-sponsored health insurance system, In 2021 those cracks are canyons. Average annual premiums are up to almost $8,000 for an individual and $23,000 for family coverage.


Employees are paying a larger chunk of their premiums than ever before. Rising employer premium costs also come out of wages in the form of lower compensation.)


The subject has used and is grateful for affordable gynecological services provided by Planned Parenthood.