Betting on an apple a day

Insurance pricey for residents who’ve fallen between cracks

By SHARON SALYER

Herald Writer

For nearly seven years, 64-year-old Beverly Shadbolt has lived without health insurance, getting by on hope.

Her strategy: hoping a combination of exercise, good diet and healthy lifestyle would provide an alternative kind of "insurance."

Even though she tries to walk two miles three or four times a week through her Everett neighborhood, "I’ve been in a vulnerable state," she said. "I know I’m running a risk."

Shadbolt is in a health care "no man’s land," one year shy of qualifying for Medicare.

So news that Washington’s freeze on sale of health plans to individuals will be lifted by the end of the year grabbed her attention.

"For some reason, I’ve got this feeling that I’ve handled it that way for a long as I feel comfortable," she said of life without health insurance. "I’d really like some backup support."

Shadbolt’s story is typical of those who need individual health plans. She took early retirement, paid for her own health insurance for nearly two years, then dropped it when it hit $265 a month.

Individual health plans also are popular with consumers who are self employed or between jobs.

Yet in the fall of 1999, consumers seeking individual health plans were caught by one more falling domino in the unpredictable world of health care.

Group Health and Regence, the two remaining organizations that sold the plans, abruptly announced they would no longer sell them to new customers, blaming the move on escalating financial losses.

While recent action by a state board has cleared the way for individual health care plans to go on sale in early December, some question the new rules that will govern their sale.

So far, Group Health, Premera and Regence have announced they will offer the policies.

Tanis Marsh, state health care director for the League of Women Voters, said she worries about the new health questionnaire required of anyone applying for the individual policies.

It is designed to screen out the costliest 8 percent of medical conditions, assigning them to the state’s high-risk insurance pool. While medical coverage is still available for these applicants, it will be more expensive.

Conditions that would cause consumers to be assigned to the high-risk group include: congenital and congestive heart failure, coronary artery disease, kidney failure or being on kidney dialysis, an HIV or AIDS diagnosis, and being on an organ transplant waiting list or being a transplant recipient.

Yet there are pages and pages of other conditions that "when taken in tandem, will put quite healthy people in the pool," Marsh said.

The cost for medical coverage for those in the high-risk pool "will probably be quite difficult for many," she said.

Theoretically, the new state rules also could mean that a liver-transplant patient who is a regular jogger and in good health would end up in the high-risk pool while an overweight smoker who never exercised but with no serious diagnosed heart or lung conditions could buy a regular individual policy.

"It’s just the way the (questionnaire) was designed," said Greg Scully, Group Health’s individual and family sales director.

"Its uniformity is the point," he said. Applicants will be treated the same regardless of which health care organization they submit their individual health care plan application to.

How much flexibility will Group Health allow for individuals whose health history means they exceed the points that guarantee they can get an insurance through private health care plans?

"At this point we’re going to stick with the scoring tool and see how it works," Scully said.

Meanwhile, Shadbolt said she is waiting until pricing information is available before she decides whether she can afford an individual medical plan.

Shadbolt, who formerly worked as director of graduate admissions for Seattle University, said the problems in the individual health plan market in Washington are just one example of larger health care issues facing the nation.

"What kind of topsy-turvy situation do we have that makes people need to live with anxiety or uncertainty, (and wonder) if they would be OK if there was something catastrophic?" she said.

"I’m sure there’s many, many other people who don’t have the good health I have who need medical attention, and it’s going by the board," Shadbolt said.

"I hope we can find some solutions that are really helpful to all Americans," she added. "We’ve talked about it so long. We don’t solve it."

Talk to us

> Give us your news tips.

> Send us a letter to the editor.

> More Herald contact information.

More in Local News

Customers enter and exit the Costco on Dec. 2, 2022, in Lake Stevens. (Olivia Vanni / The Herald)
Costco stores could be impacted by looming truck driver strike threat

Truck drivers who deliver groceries and produce to Costco warehouses… Continue reading

Two Washington State ferries pass along the route between Mukilteo and Clinton as scuba divers swim near the shore Sunday, Oct. 22, 2023, in Mukilteo, Washington. (Ryan Berry / The Herald)
Ferry system increases ridership by a half million in 2024

Edmonds-Kingston route remains second-busiest route in the system.

Fernando Espinoza salts the sidewalk along Fifth Avenue South on Thursday, Feb. 6, 2025 in Edmonds, Washington. (Olivia Vanni / The Herald)
Think this is cold, Snohomish County? Wait until Tuesday

Tuesday could bring dangerous wind chill during the day and an overnight low of 19 degrees

The Washington State Department of Licensing office is seen in 2018 in Seattle. (Sue Misao / The Herald)
Drivers licensing offices to close Feb. 14-17

Online services are also not available Feb. 10-17. The Washington State Department of Licensing said the move is necessary to upgrade software.

Robin Cain with 50 of her marathon medals hanging on a display board she made with her father on Thursday, Jan. 2, 2025 in Lake Stevens, Washington. (Olivia Vanni / The Herald)
Running a marathon is hard. She ran one in every state.

Robin Cain, of Lake Stevens, is one of only a few thousand people to ever achieve the feat.

People line up to grab food at the Everett Recovery Cafe on Wednesday, Dec. 4, 2024 in Everett, Washington. (Olivia Vanni / The Herald)
Coffee, meals and compassion are free at the Everett Recovery Cafe

The free, membership-based day center offers free coffee and meals and more importantly, camaraderie and recovery support.

Devani Padron, left, Daisy Ramos perform during dance class at Mari's Place Monday afternoon in Everett on July 13, 2016. (Kevin Clark / The Herald)
Mari’s Place helps children build confidence and design a better future

The Everett-based nonprofit offers free and low-cost classes in art, music, theater and dance for children ages 5 to 14.

The Everett Wastewater Treatment Plant along the Snohomish River on Thursday, June 16, 2022 in Everett, Washington. (Olivia Vanni / The Herald)
Everett water, sewer rates could jump 43% by 2028

The rate hikes would pay for improvements to the city’s sewer infrastructure.

The bond funded new track and field at Northshore Middle School on Thursday, Oct. 24, 2024 in Bothell, Washington. (Courtesy of Northshore School District)
Northshore School District bond improvements underway

The $425 million bond is funding new track and field complexes, playgrounds and phase one of two school replacements.

Pharmacist Nisha Mathew prepares a Pfizer COVID booster shot for a patient at Bartell Drugs on Broadway on Saturday, Oct. 1, 2022, in Everett, Washington. (Ryan Berry / The Herald)
Everett lawmakers back universal health care bill, introduced in Olympia

Proponents say providing health care for all is a “fundamental human right.” Opponents worry about the cost of implementing it.

Outside of the updated section of Lake Stevens High School on Thursday, Feb. 27, 2020 in Lake Stevens, Wa. (Olivia Vanni / The Herald)
Lake Stevens, Arlington school measures on Feb. 11 ballot

A bond in Lake Stevens and a levy in Arlington would be used to build new schools.

Support local journalism

If you value local news, make a gift now to support the trusted journalism you get in The Daily Herald. Donations processed in this system are not tax deductible.