|Santa Cruz Sentinel -Oct. 26: Santa Cruz – A program launched by California on Monday aims to insure 23,000 people with pre-existing conditions, but it won’t help Soquel resident Michael Rosenberg.A self-employed marketing consultant and tech writer, Rosenberg has a chronic nonlife-threatening condition that he says is under control with inexpensive drugs. In 2001, he was paying $570 a month for health insurance for himself, his wife and his two daughters.
He knew he would pay more when he turned 55 in September, but he didn’t expect the PacifiCare premium to go up to $2,391 a month for himself and his wife.
“That translates to a 400 percent increase in costs in 10 years, with just two on the plan now instead of four,” he said. “Even worse, we still pay 30 percent of all medical costs.”
He tried to switch to a PacifiCare plan with a higher deductible and a lower cost, but was denied. That’s when he called an insurance broker to see if he had options.
The state’s pre-existing condition insurance plan, known as PCIP, is open to people who have been without health coverage for at least six months.
So Rosenberg doesn’t qualify. “My choices are now to either let coverage lapse or pay a ridiculous $30,000 a year,” he said. “I just paid off my daughters’ college. I thought I was going to be free and clear.”
Just as people who turn 55 start thinking about retiring, they enter the age bracket where health insurers consider them a higher risk. “I’m a baby boomer,” Rosenberg said. “There must be a million like me.” He’s loath to drop his coverage, saying, “That’s Russian roulette if you have something major happen.”
Tyler Mason, a spokesman for UnitedHealthcare, PacifiCare’s parent company, said he could not comment on Rosenberg’s situation because of the federal privacy rule, but UnitedHealthcare public relations director Will Shanley issued a statement explaining that insurance premiums reflect the cost of care, which is rising due to hospitals charging higher prices, drug prices going up and increasing demand for services such as MRI and CT scans and knee replacements.
Gov. Arnold Schwarzenegger announced the PCIP plan as “a major milestone in health care reform,” funded by $761 million from the federal government. The idea is to bridge the gap between now and 2014, when federal health care reform will not allow insurers to decline to cover people with pre-existing conditions or charge them higher premiums.
“Unfortunately, these people have to make a choice,” said Jeanie Asajian of the state’s Major Risk Medical Insurance Program, noting the six-month gap was written into the federal law. “That was a surprise to the state as well. We didn’t have any input on that.”
She suggested Rosenberg and others in a similar situation look at the state’s high-risk pool, MRMIP, which stands for Major Risk Medical Insurance Program. “He doesn’t have to drop insurance for that,” she said. “It’s not nearly as expensive as what he’s paying.”
The MRMIP handbook posted online lists two options in Santa Cruz County: Kaiser, a health maintenance organization with facilities in San Jose, at $631 per month per person, and Anthem Blue Cross, a preferred provider organization, at $982 per month per person.
The state agency pays insurance brokers a fee for enrolling people in the program, Asajian said. “I had already looked at the MRMIP program,” Rosenberg said. “It sounds like I’d be eligible, except that I have been able to secure adequate coverage.’ It’s just gone through the roof in terms of cost.”
He got more bad news Monday: A rejection notice from Anthem. “There is no other carrier I can go to,” he said.