Pre-Existing Conditions and High Risk Pools: A Cancer Survivor’s Experience Purchasing Insurance Before the ACA

Post by Mike Kappel

NCCS Board Member
10-Year Cancer Survivor

My name is Mike Kappel. I’m from Atlanta, Georgia, and I’m a colon cancer survivor and a board member for the National Coalition for Cancer Survivorship.My story began ten years ago in April when I was diagnosed with Stage III colon cancer. The treatments were successful in that the cancer cells were eliminated, but my liver was damaged by the toxic effects of the chemotherapy and the radiation. My company was very supportive and I continued to work through my long recovery period.

But after several years I found that the travel demands of my job were taking too great a toll on my health. So I decided to retire early. This was late in 2010, before the Affordable Care Act was implemented, and I tried for the first time to test out the individual marketplace for healthcare insurance. Due to my cancer history, I was turned down by the four major health plans in the Atlanta market.

Unlike many survivors navigating the financial considerations of cancer treatment and survivorship, I had the benefit of understanding the complexity of insurance coverage. But I underestimated the amount of research required to find out about my insurance options. There was simply no information locally on how to find health coverage. I finally came across a web publication from the Cancer Legal Resource Center at Loyola University in Los Angeles and it pointed me to the resources in Georgia that helped me understand the stringent requirements to participate in Georgia’s assigned risk pool. Since I had been covered under an employer’s self-insured plan, I had to prove 18 months of continuous credible coverage, exhaust my COBRA benefits from my previous employer and not be eligible for coverage under any insurance policy or my wife’s policy.

My COBRA payments were $1,100 per month to cover me and my wife. I was fortunate that I could afford the high premiums, and I knew that it was worth the expense for the future opportunity to participate in the assigned risk pool. Once my COBRA benefits were exhausted, I tested the individual market again since I was now more than 5 years post cancer diagnosis but I was turned down again by all the major insurers in the state.

So I applied to the State of Georgia and was assigned to a Blue Cross Blue Shield indemnity plan. The premiums were reasonable—about $465/month for a 70/30 cost sharing with a $2,500 deductible—and coverage was adequate, though not as good as I had under my employer-sponsored plan. My family was not covered under this plan, so my wife had to purchase a separate policy on the individual market.

I continued coverage under the assigned risk pool for almost two years until the ACA went into effect on October 1, 2013 and I received a notice that the program was being terminated since it was no longer considered necessary. I was able to purchase a good plan, with the elimination of pre-existing conditions exclusions. I remain on an ACA plan and plan to continue purchasing coverage through the individual market until I am eligible for Medicare.

The high-risk pool helped me bridge the gap between employer-sponsored insurance and an individual plan under the ACA. But navigating the system to fulfill the requirements and the administrative burden were both time consuming and costly. I am fortunate that I was in a position to be able to afford the interim COBRA coverage and to understand the system, but I think about the people who were not as fortunate and had to go without coverage.

For a cancer survivor, dealing with the collateral damage of cancer treatment and the continued surveillance for recurrence or secondary cancers, going without insurance is simply not an option. I am very worried that the proposed replacement for the ACA will harm cancer survivors, particularly people with low incomes and people over the age of 50. We simply can’t go back to the days before the ACA when cancer survivors could be denied coverage, and we must ensure people have access to quality, affordable health insurance.