What would you do?
Posted March, 23 2012 by arianne
The ACA may have saved Raymond Owens’s life. Raymond and his wife Adele have owned a flooring contracting business for 25 years and their three children are the focus of their life. Their quest for a better life for their family became more difficult when Adele was laid off from Home Depot two years ago. They managed to keep their insurance by paying for COBRA until their eligibility ran out. They couldn’t afford to pay $1,600 a month for insurance on the individual market and hoped that Adele would soon find a job that came with coverage. “We didn’t want anything for free,” Adele said. “We just wanted insurance we could afford.”
Unfortunately, after six “nerve-wracking” months without coverage, their worst fears came true – Raymond was diagnosed with merkel cell carcinoma, a very aggressive and fast-moving skin cancer. They found surgeons at Memorial Sloan-Kettering Cancer Center in New York City who could treat him, but the hospital wanted the Owenses to pay $65,000 first.
What would you do if you were Raymond? Buying insurance on the individual market wouldn’t have helped him. Unlike many states, New York has consumer protections that ensure that he could have purchased insurance – guaranteed issue (an insurer has to sell insurance to anyone who applies, regardless of health conditions) and community rating (an insurer has to charge everyone the same premium, regardless of factors like illness). But Raymond’s treatment for cancer – a pre-existing condition – would not have been covered by insurance purchased on the individual market for twelve months. During the month that he spent looking for a way to pay for surgery, three more tumors grew. He couldn’t afford to wait.
Luckily, the ACA provided a solution. The NY Bridge Plan, New York’s ACA-funded pre-existing conditions insurance program, covered his treatment from the day his coverage began. And it only cost a fraction of what he would have spent on the individual market. Premiums are $421 a month for residents of downstate counties, and $362 for residents of upstate counties. So far, 2,600 New Yorkers have found coverage through the Bridge Plan. You can find more information and an application form here.
Raymond’s surgery was affordable with the new coverage, and he is now cancer-free. He and Adele can now focus on his health, rebuilding their business, and spending time with their kids.