Do you have pre-existing woes? You could lose health insurance

Under Obamacare, many with chronic pre-existing conditions could find they cannot afford coverage if their incomes are too high to quality for government subsidies.
TNS Regional News
Nov 21, 2013


The spotlight has shone brightly on Americans being kicked off cheaper private health insurance plans recently and forced to buy more expensive insurance through health-care exchanges established by the Affordable Care Act.

President Obama even reversed course last week and urged private insurance companies to keep offering cheaper, less comprehensive plans to consumers for one more year instead of canceling those plans.

But concern is mounting for another group of vulnerable consumers who were supposed to benefit most from the Affordable Care Act, also known as Obamacare.

Although the market reforms enacted by the health-care act will provide the poorest Americans with unrestricted access to private health insurance, many with chronic pre-existing conditions could find they cannot afford coverage if their incomes are too high to quality for government subsidies.

On Dec. 31, thousands of Ohio consumers with pre-existing conditions will be forced to move off a government-sponsored health-care plan that was meant to be a temporary fix for those considered high-risk by insurance companies.

Ruby Jean Stamper of Toledo is one of the 3,527 in Ohio who enrolled in what was originally called the Ohio High Risk Pool. She now must switch to new coverage next year as the federal government and states close down this special program for individuals with pre-existing conditions.

Mrs. Stamper, 63, had a freak accident in 2011 that left her with a herniated disk and chronic pain.

“I was going out to my car a couple of winters ago when it was like a sheet of ice. I went sliding on my butt and and it damaged a nerve. I always considered myself in good shape so I didn’t think I needed it [health insurance], but accidents happen,” Mrs. Stamper said.

Mrs. Stamper said suffering with the pain that went down her back and across her foot was “living hell.” During this period that she called the worst time in her life, she did what she could to get by, but with no health insurance she sometimes resorted to buying pain medication on the black market.

Then she heard about the Ohio High Risk Pool. The federal government allocated $5 billion in funding to the states for the pools’ creation, of which Ohio received $152 million to set up a safety net for people who have been denied or priced out of coverage.

Those enrolled in this program were later transferred to the federally run Pre-existing Condition Insurance Plan. It took Mrs. Stamper six months to enroll in the program, but she eventually found a health-care plan she could afford.

“That really saved me. I was able to sign up on Friday and I got the surgery the following Monday,” she said.

She has been paying about $384 a month for coverage under the Pre-existing Condition Insurance Plan and about about $15 a month for prescriptions. But when the program terminates at the end of next month, Mrs. Stamper will have to buy coverage through the new health-care exchange.

Like many others, though, she had trouble gaining access to glitch-plagued, so she turned to an independent insurance agent for help. With a Dec. 15 sign-up deadline looming, Mrs. Stamper anxiously contacted Rich Craig, an agent at the Pinnacle Health Group, and the price of the new coverage being offered was much higher than she expected.

Mr. Craig estimates Mrs. Stamper’s cost for health care through the exchange will range from $525 a month for a "bronze"-rated plan with a $6,000 deductible to $994 a month for a premium “platinum” plan just a $500 deductible. She also would have to pay for pain medication out of pocket.

Mrs. Stamper, who runs a small day-care center out of her home, and her husband, who retired after being laid off from his job at Textileather in North Toledo, make too much money to qualify for federal subsidies for their premiums.

“I’m not rich. I make a decent living and I sure didn’t expect that I would payer higher premiums than the Ohio High Risk Pool. I thought that would be in line with Obamacare.”

The federal government has no plans to extend the Pre-existing Condition Insurance Plan past Dec. 31, Mr. Craig said. “But many people that are on the program do not qualify for subsidies and many of these people are looking at premiums that are outrageous,” he said.

Just as Mrs. Stamper was about to give up and risk going without insurance again, while paying for prescriptions out of pocket, Mr. Craig found a temporary solution.

One of the cheap health plans slated to expire before the President made his announcement last week became available, Mr. Craig said. For at least one more year, Mrs. Stamper will be able to pay about the same health-care premium she had with the Pre-existing Condition Insurance Plan plan.

“I couldn’t believe it. I’m so thankful,” she said. “I still believe the President is on the right track, but they just have to work all this out.”


By Marlene Harris-Taylor - The Blade, Toledo, Ohio (MCT)

©2013 The Blade (Toledo, Ohio)

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Distributed by MCT Information Services


JMOP's picture

She is thankful and believes the president is on the right track? Yet she was paying $384 a month to a possible $500-$1,000 a month?
This lady better stop buying all that Kool-aid, and start saving for her health costs next year.

Dr. Information

She will change her mind when old can kicker Obamas 1 year promise runs out next year and she will be forking out double if not triple in costs and have to pay 100% out of pocket for prescriptions and anything else until she hits that sweet old $6000 deductible mark.


This article is bogus – way to spread untruths and deceptions Norwalk Reflector. First of all, in order for Mrs. Stamper to be ineligible for the subsidies under the ACA that would bring down the cost of her premiums, her household income would need to be more than $62,000 or 400% of the poverty level. As she runs an in-home daycare and her husband is not working, I doubt this is the case.
Secondly, under the ACA, a policy premium for a silver plan needs to be less than 9% of annual income to be considered affordable, which is why it is called the Affordable Care Act. So, let’s just say her annual income is $48,000 (the medium household income in Ohio), a silver plan would not be affordable if the cost is more than $360.00 a month, which is less than she is paying a month now.
Lastly, the headline is an outright lie. One of the main components of the affordable care act is that insurance companies can no longer deny coverage or charge a higher premium for individuals with pre-existing conditions as they have in the past.
I can understand that Mrs. Stamper is upset that she is losing her subsidized, high risk insurance that she has now but on the bright side, she only has 2 more years until she is eligible for Medicare.


news flash.. my son had a kidney transplant in 2003.. when the hubby went to put him on his policy (blue cross & blue shield) we got a letter that states due to pre existing conditions.. he would have to go 267 days before the policy would cover him.. so yes they are still penalizing people with pre existing conditions


We just got the same letter. We don't have a kidney transplant but I have a few conditions. My husband has NONE. We will go about 9 months. We have Anthem BC/BS also. Have you called and had it explained. We were told that will the letter we have from our old insurance that they will just "ask" us about it and if we show the letter from the old insurance it will be covered. After the 9 months they will quit asking. (It is some kind of waiting period, not sure how much I believe). Good luck to you.

Joe Centers