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Lost Employer-Sponsored Insurance Pre-ACA. Died Needing Life-Saving Operation

Theresa BrownGold's painting "Lost Employer-Sponsored Insurance" for her art project, Art As Social Inquiry.

(11/2010 Interview w/ family. Oil on linen, 40 ins. x 30 ins.)

Update 2021

Billy's story gets me every single time I tell it. I always take his portrait to talks I'm invited to give about Art As Social Inquiry. His story illustrates so well the pre-Affordable Care Act discrimination people with preexisting conditions faced when they tried to buy a single policy for themselves.

Billy's story reminds me that while the 2010 healthcare law didn't not land fully formed, it has saved lives and would have saved Billy's. At the very least he would have gotten a life-saving operation to replace his implanted cardioverter defibrillator's (ICD) battery.

Billy took precautions not to injure anyone with his car before he died. He stopped at a stop sign and put his car in park. He slumped over the steering wheel and died.

I worked revisions into Billy's story with the benefit of hindsight. This story comes from my interview with Billy's sister, Georgeanne. Georgeanne has received recognition for her activism for healthcare reform. The Pennsylvania Health Access Network named an award after her, the Georgeanne Kohler Activist of the Year Award.

Read more about Billy at the Health on the Horizon blogpost, I am My Brother's Keeper: Billy Koehler's Story.


Theresa BrownGold's painting "Lost Employer-Sponsored Insurance" for her art project, Art As Social Inquiry.
A study. Oil on canvas, 24 ins. x 20 ins.

(from a 2010 interview with Billy's sister)

Unemployed Electronics Expert, worked as a Pizza Delivery Guy, Uninsured, Deceased in 2009 at age 57

Billy Koehler's work repairing electronics spanned 30 years in three companies.

Billy was diagnosed with Sudden Arrhythmia Death Syndrome at 39 years old. He was insured at the time and received an implanted defibrillator.

Billy spent his entire $25,000 pension on his out-of-pocket costs -- money he paid for medical expenses that his insurance plan did not cover.

Before Billy's previous employer went out of business in 2003, he asked Billy to contribute more than other employees toward the cost of his group plan. Billy had a serious heart condition and he thought his insurance claims were the cause of his employer’s rising health insurance costs. Billy was happy to contribute more. He didn't want the other guys he worked with to share the cost.

Billy's hope of continuing insurance coverage through COBRA ended when his company folded. COBRA is a program that allows former employees to continue group health benefits through their former employers' group health insurance plans. Without a former employer in business, there was no group health plan for Billy to buy into as per COBRA rules.

Billy, having just had his defibrillator replaced six months before losing his insurance, felt he had time to find insurance.

Billy with his sister, Georgeanne

Now uninsured, Billy collected unemployment compensation until he found work 30 hours/week delivering pizza. The job did not come with health benefits. Billy earned $12,000 a year.

Billy applied for traditional Medicaid but was denied. His $12,000/year salary was above the cap for traditional Medicaid eligibility. Billy's sister asked him to work less so he would qualify for the government medical insurance "for the poor“ she called it. Then he could get a new defibrillator. Billy said he wouldn’t lie.

Pennsylvania also did not offer high-risk pool insurance that predated the ACA like some states. But the state had in place a health insurance program for low-income individuals called adultBasic. Billy most likely would have been eligible. 42,000 enrollees got insurance through adultBasic but almost 500,000 people were on the waiting list. The program ended in 2011.

The Affordable Care Act's online marketplace coverage started January 1, 2014. But after the healthcare reform passed in 2010, uninsured people with preexisting conditions could apply for insurance called the Preexisting Condition Insurance Plan, a temporary measure put in place by the new law meant to serve as a bridge until ACA marketplace insurance became available in 2014. Marketplace plans could not factor in a person's medical history to determine eligibility.

PA adultBasic was available in 2009 but 500,000 people were on the waiting list. The ACA's Preexisting Insurance plan started in 2010. The Affordable Care online marketplace coverage started January 1, 2014. Pennsylvania expanded Medicaid in 2015. Billy died on March 7, 2009.


In 2007 Billy was rushed to a hospital after collapsing at work. A resident looked at his chart and blurted out, “Oh, you’re uninsured. I need to tell you that you won’t get the same tests as people that have insurance." The doctor was unwilling to replace his defibrillator during that hospital stay. He gave Billy instructions to see him in three months with conditions: have insurance or bring thousands of dollars. Or else the defibrillator would not be replaced.

When a local hospital for the poor closed after a 137 year history, Billy did not wish to incur large bills for emergency room care by running to the ER to have the doctors repeatedly restart his heart but never actually replacing the defective defibrillator. He would need insurance or cash to do that.

The family failed to get private insurance. No insurer would sell Billy a single insurance policy because he had a serious heart condition that would generate a lot of medical bills the insurer would then have to pay.

The family frantically but unsuccessfully lobbied state and national senators and representatives for help.

Billy's defective internal defibrillator finally gave out. The device signaled that his heart needed to be shocked to resume normal beating. Billy knew his broken device could not deliver that life-saving shock.

Billy took precautions not to injure anyone with his car before he died. He stopped at a stop sign and put his car in park. He slumped over the steering wheel and died.


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