The ‘Pre-Uninsured’

THE ‘PRE-UNINSURED’…. The New York Times had a depressing report over the weekend on the ranks of the uninsured rising as more Americans lose their jobs. The NYT’s Robert Pear noted a point that should be obvious: “Most people are covered through the workplace, so when they lose their jobs, they lose their health benefits. On average, for each jobless worker who has lost insurance, at least one child or spouse covered under the same policy has also lost protection, public health experts said.”

But the crisis leads to a group of people who are not usually given a label. We generally have the insured, the uninsured, and underinsured. Now, we have the pre-insured.

The NYT noted, for example, a woman in Ohio named Starla Darling, who was pregnant when she learned her employer-based insurance was about to end. She worked for a cookie factory that provided excellent health benefits, but the plant was about to be shut down abruptly. Darling was “rushed to the hospital, took a medication to induce labor and then had an emergency Caesarean section, in the hope that her Blue Cross and Blue Shield plan would pay for the delivery.”

Jonathan Cohn noted that this anecdote points to a larger trend.

A few weeks ago, a friend who works at a major hospital mentioned that a different kind of patient was increasingly showing up at the emergency room. In addition to the uninsured and underinsured, who’d always been coming, he was seeing more patients who might be best described as “pre-uninsured” — that is, people who were about to lose their jobs and, as a result, their insurance coverage.

Sometimes, he said, they would request treatments not just for their medical emergencies but also for other, longer term problems — figuring they might as well get the treatment while they still had insurance. In other cases, though, they would actually avoid treatments — and tests — because they didn’t want their files to show they had pre-existing medical conditions, making future purchase of insurance more difficult.

Either way, we agreed, it wasn’t a terribly efficient way to administer medical care. But, then, when had American health care ever been efficient?

This should help spur some political will for reform. As Sen. Sherrod Brown (D-Ohio) told the Times, “This shows why — no matter how bad the condition of the economy — we can’t delay pursuing comprehensive health care. There are too many victims who are innocent of anything but working at the wrong place at the wrong time.”

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