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."