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Cancer History. Uninsurable on the Individual Market before the Affordable Care Act

Theresa BrownGold's painting "Uninsurable with a Preexisting Condition" for her art project, Art As Social Inquiry.

(Interview 6/2009. Oil on canvas, 40 ins. x 30 ins.)

How the painting started

Update 2021

My sweet friend died in May 2012. Rest in peace, Nick. Forgive me.

Nick's portrait is one of my very first for Art As Social Inquiry. In these early stages I was gobsmacked by every personal revelation.

Nick was only just putting cancer behind him. He took a part time job with us. Then he asked me to let him buy into our small business group health plan. I said no.

Only full time employees were eligible for health benefits in our small business.

I said no because I was afraid. If Nick actually used the health insurance -- and it was likely in my mind since he had had cancer -- then the insurers would raise our premiums for the whole group to the point where we would not be able to afford health insurance for any of us.

I was also afraid we could lose our group plan if we lied about a part-time employee being full time just to get him on our business's group plan.

Before the Affordable Care Act passed in 2010, insurers had much more freedom to discriminate against small groups and individuals. Nick would have options today. He could have bought a single policy on the Affordable Care Act's online exchanges. He many have even qualified for financial help to pay his premium. He would not have had to grovel to whomever. All he wanted from me is a way to get medical care if he got sick again.

Please forgive me, Nick. Knowing what I know now, I would have said yes. Forgive me.


This portrait is magical for me. It's an early one. I can still remember the chill up my spine when I saw Nick jump on the canvas. It's a thrill when an artist captures the sitter's essence, the specialness that makes a person unique. I value the trust subjects put in me. They let me see them.

I exhibited my sense of the dramatic in the story -- two sentences??? Really? I just thought readers would be as flabbergasted as I was that a man's health insurance premium was almost as much as his mortgage.

It's been a long haul since 2009. As I learned more through researching my subjects' stories, I wrote more. A portrait explaining the Dutch healthcare system is over 5,000 words. This story is 11 words.

ARTIST’S NOTE (3/2012)

This is one of the early paintings of this series healthcare series. It is obvious from the portrait story that I recorded a fact, and not a personal story.

In 2009 when I painted this portrait, The Affordable Care Act wasn’t a law yet. I had not understood the gravity of our national problem. The for-profit, private insurance system was penalizing people outside the employer-based market for being sick. They did not want to insure them. All that learning was to come.

I couldn't believe it. How could a man’s health insurance premium be almost as much as his mortgage? I found that startling. I just recorded the fact, and put a face to it because I did not grasp our insurance system’s complexity.

Healthcare in the US is a gnarled ball of string that took many decades to knot up. It took a big law to start to untangle the health insurance mess. Slogans rally people’s enthusiasm, but are short on vision and solutions. The solutions proffered – tort reform, selling across state lines, health savings account – are, as I have said often, thin.

Obamacare and my stand on it didn’t come into the picture until much later. I had painted 30-plus paintings by the time I started to understand the new law when I finally came out in support of it. I had seen so much pain in the lives of the people I painted. I had come to understand rescission, medical loss ratio, shareholders’ interests, preexisting conditions, and so much more. I knew none of that when I painted this portrait.

May, 2012. I have discovered that my friend is in hospice care. I love you.


(From a 2009 interview)

Waiter, age 62, Insured

The subject reimbursed his employer $505/mo. for a policy on the employer's group plan. His mortgage payment is $643/mo.

(Nick must have gotten an arrangement like the one he wanted with me. It looks like he was paying in full for a policy on an employer's group plan. Before the Affordable Care Act, an individual with serious preexisting conditions would have a hard time getting a single policy from a health insurer. Employers, on the other hand, could add employees to their group plans without the same scrutiny.)


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