Kathy Barry calls it “no woman’s land,” that time of life between the mid-50s and Medicare when many women (and men) find themselves without health care coverage due to job loss, divorce, or other economic crises — at the very time they may need it most.
Rosie Richter knows the territory well.
Over the past four months, both Clark County women have lost their state-funded Basic Health coverage because their modest incomes made them ineligible. Both have no affordable options, and with a three-year wait before major federal health reform provisions kick in, both are living without coverage — and crossing their fingers.
In Washington state, Basic Health until recently offered a life raft for people who are not quite poor enough to qualify for Medicaid or old enough for Medicare. Enrollees paid modest premiums for coverage provided by private insurance plans under contract with the state.
But as of March 1, the Health Care Authority, which administers Basic Health, cut its rolls by 28 percent, leaving nearly 15,400 people without coverage, including 858 whose incomes exceeded a new eligibility ceiling.
Before March 1, people with an income below 200 percent of the federal poverty level — about $1,800 per month for a single person — were eligible for Basic Health. But in order to deal with a multi-billion-dollar budget shortfall, the state changed the eligibility rate to 133 percent of the federal poverty level — about $1,200.
Rosie Richter, 57, got eight days’ notice that she would lose her coverage.
Richter moved to Clark County from Southern California in 2006 after retiring from her job as an employment specialist for San Bernardino County, where she spent 16 years helping welfare clients and former prisoners find jobs.
She would like to keep working, but she suffers from disabling back pain that makes it hard for her to sit or stand for long periods. She has been diagnosed with scoliosis, spinal stenosis, a herniated disk and advanced degenerative osteoarthritis.
Richter’s move to Washington cost her the COBRA coverage she had been paying for out-of-pocket. She and a friend bought a house in Vancouver’s Hearthwood neighborhood. At first, she lived on what was left from the sale of her California home.
In 2007, she enrolled in Basic Health. Her initial monthly premium was $17, but it jumped to $285 after she began drawing her $1,400 monthly pension in 2008.
Basic Health paid for her colonoscopy, a mammogram, and an epidural injection to ease her back pain. It didn’t pay for physical therapy.
She applied for Social Security Disability benefits, hoping to get more comprehensive coverage. The exam, she said, was an agonizing experience. “I was in extreme pain for a couple of weeks.”
Her disability claim was rejected. “I’m going to apply again,” Richter said, “but I’ve put it off because it was so hard on me.”
On March 1, the state cut Richter from Basic Health. Her pension put her over the new $1,200 monthly income threshold.
None of her options are good.
Her retirement plan offers health coverage at $668 a month, with a 50 percent deductible and high co-pays. That would eat up nearly half her pension, she said. Ironically, it would also reduce her income to well below the federal poverty level, to a point below the qualification level for Basic Health.
Meanwhile, her car needs $2,000 worth of work, her refrigerator is on its last legs and the plumbing in her house needs to be replaced.
“My options are to give them half of my retirement to get health insurance or not get insurance,” she said. “I’ve chosen not to get it.”
Instead, she tries to alleviate her back pain with exercise, water therapy and a special lotion that gives her some relief. She chooses not to use prescription pain-killers for fear of addiction. And she watches the congressional debate over health care unfold on television.
The federal Affordable Care Act would create a health care exchange with a range of private insurance options and subsidies for low-income enrollees. But three years is a long time to go without coverage, Richter said.
“I’m scared to wait until 2014.”
Over income threshold
Kathy Barry is a 62-year-old part-time music teacher who lost her Basic Health coverage because her fluctuating income temporarily put her over the income threshold last year.
For most of her life, Barry was a stay-at-home mom and substitute music teacher. After her divorce in 2006, she landed a job as a band and orchestra teacher at McLoughlin Middle School, but she lost that job after a year due to program consolidation. She now teaches violin and viola to 30 private students at Beacock’s Music in Cascade Park, working three afternoons a week.
‘It’s my niche,” she said. “I absolutely love it.”
Except for the lack of health coverage.
Three years too young for Medicare, she’s also at the high end of all age-based insurance premium charts. Her income fluctuates, but on average she earns $16,000 a year. Though she lives modestly, she can’t make it on that. So reluctantly, she has begun drawing her Social Security benefit. That brings in an additional $855 a month — as long as she stays within a Social Security income limit for early enrollees.
She was cut from Basic Health at the beginning of December after her income exceeded the eligibility cutoff for a single month.
“I’m caught in no-woman’s land,” she said. “Basic Health was so perfect for me because substitute teachers don’t typically have health care. It was a wonderful program.”
Barry is slender and energetic, but she has a history of serious medical conditions. She is under treatment for congestive heart failure, caused by the chemotherapy she underwent to treat non-Hodgkin’s lymphoma in the late 1990s. She also underwent a lumpectomy for breast cancer in 2002.
She’s healthy and cancer-free today, she says, but in need of regular checkups.
“I absolutely have to have health coverage,” she said. “I get an electrocardiogram once a year. I’m not high-risk anymore, but I’m considered high-risk by Blue Cross of Oregon and LifeWise,” two companies that offer individual policies.
The coverage available to her through Washington’s high-risk pool would cost $588 a month, with a $5,000 deductible and a 20 percent co-pay on doctor appointments. She hopes to be able to afford it now that she’s drawing Social Security.
Without health insurance, she finds herself in a new and unsettling world. “I needed to have a routine blood exam,” she said, “but I don’t know how much things cost.”
New program
Last year, the Legislature created a new program called Washington Health to help some people who find themselves without coverage. It’s not cheap, and eligibility is not income-driven. Premiums can run from $100 to $800 or more, depending in part on age and health status.
The program requires applicants to fill out an extensive questionnaire unless they qualify for an exemption. For example, people who are losing their COBRA coverage qualify for the exemption, said Katherine Temlet, a Basic Health administrator. The program offers policies that cover either $75,000 or $100,000 in annual medical costs, with low deductibles.
The program involves no state subsidies. Enrollees pay a $7 fee to cover administrative costs.
In the meantime, state legislators hope to keep the 19-year-old Basic Health program alive until federal health reform takes effect in 2014. But it’s shrinking fast. Its rolls plummeted from 54,181 in February to 34,200 as of March 1. The majority of those dropped were non-citizens. About 3,300 enrollees have since been reinstated.
What hasn’t shrunk is the demand for affordable health coverage.
As of Monday, 142,000 people were on the Basic Health waiting list.
Kathie Durbin: 360-735-4523 or kathie.durbin@columbian.com.
