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Utah's Uninsured


“Surviving is my first priority. I just can’t think about how to pay for my care right now."

Uninsured Cancer Patient is Now Uninsurable

After several years of being uninsured,
Sean Hennefer decided to do the right
thing and purchase health insurance.
This decision was both a blessing and a curse. He met with a broker who told him that since he was young and healthy, he should easily qualify. Instead, Sean was denied coverage because a year earlier he went to the doctor for a swollen lymph node. Originally the doctor thought the swelling was caused by strep throat. But after being denied insurance Sean asked his doctor to take a closer look. The diagnosis was cancer: a rare form offollicular lymphoma. 

After his diagnosis, Sean racked up over $25,000 in medical bills—and that was before he even started treatment! This was much more than he could ever afford to pay on his income. Half joking, Sean says, “When this is over, I’ll either be dead or bankrupt. Surviving right now is my priority and I just can’t think about how to pay for my care right now.”

Post script: Fortunately, Sean has responded well to treatment; however, Sean is now completely uninsurable. But he still needs health care. To stay cancer-free, he would have to pay approximately $21,000 out of pocket for PET scans alone. Any further testing or treatment would only add to these costs.

 


The Patient Protection and Affordable Care Act stopsthe insurance company tricks that allow them to deny health insurance to Utahns with pre-existing conditions:

Beginning immediately, an interim high-risk pool will provide immediate access to insurance for Utahns who for at least 6 months have not been able to get coverage because of a pre-existing condition. This pool will operate until 2014 when the full health reforms come online.

In addition, lower income Utahns will be eligible for subsidies to help them purchase coverage through the high-risk pool.  This interim high-risk pool has consumer protections to ensure Sean gets quality insurance.  The plan must cover at least 65% of patient care costs and cap out of pocket charges at $5,950 a year for an individual or for a family, $11,900.  The plan cannot exclude coverage of pre-existing conditions or charge older Utahns more than younger people.

By 2014, Insurers cannot discriminate against anyone based on pre-existing conditions. At that point premiums will no longer be based on health status.  By then there will also be more choice available through a new online marketplace called an Exchange.