wind up in the hands of friendly members of Congress and conservative pundits who would use the statistics as part of their propaganda campaigns to keep comprehensive reform from ever happening. I also knew that the statistic about a fifth of the uninsured being noncitizens would really rile them. I knew that many people would interpret that to mean that they were all illegal aliens, while in fact many of those noncitizens were people in the United States legally, on either study or temporary work permits, who could not get or afford coverage. Many were performing jobs that U.S. employers had hired them to do because there were not enough Americans interested in or capable of doing them.
Probably the one sentence in the Kingsport newspaper story that had compelled me to go to Wise in the first place was this one: “Two-thirds of the people who avail themselves of free health services at the annual RAM event have jobs but no health insurance.” I did not really believe (as I was implying in the paper I was writing) that the folks attending the expedition were lazy, irresponsible bums. So I think I went to prove to myself that they really were hardworking people who either couldn’t get insurance or couldn’t afford it. I knew—although I didn’t mention it in my paper—that the median household income in the United States was just slightly more than $50,000. 2 (In Wise County, it was just a little more than $26,000. In Johnson County, it was just $23,000.) Another important fact I didn’t include in the paper was that the average cost of a family health insurance policy had risen to $12,106 in 2007. (By 2009, it had increased to $13,375. 3 The average income for a minimum-wage employee, meanwhile, was just $11,500 in 2009.) 4
Most of the employers in the southern Appalachians are small businesses—the Wise County Web site lists only four private employers in the county with more than sixty employees—and, as elsewhere in the country, more and more of them are dropping coverage for their employees because of the exorbitant rate increases that insurance companies have been imposing in recent years. Thousands of small businesses across the country have stopped offering coverage to their employees over the past fifteen years, in many cases because profit-driven health insurers have “purged” them from their rolls.
SCALES BEGAN FALLING FROM MY EYES
Among the many reasons I finally left my job at CIGNA was that with each promotion, I got a better understanding of how insurers get rid of enrollees they don’t want—the very people who need insurance—when they become a drain on profits. I could no longer in good conscience continue serving as a spokesman for an industry whose practices, I had come to realize, were swelling the ranks of the uninsured. Instead of being part of the solution to the crisis of the uninsured, as I had long tried to convince the public they were, insurers had become the leading cause of the crisis.
To help meet Wall Street’s relentless profit expectations, the for-profit insurers that now dominate the industry routinely dump policyholders who are less profitable or who get sick. Insurers use several techniques to cull the sick from their rolls. One is policy rescission, the common but until recently largely unknown practice in the insurance industry of retroactively canceling policyholders with large medical bills. Los Angeles Times reporter Lisa Girion stumbled upon the practice as she was gathering information for a story about a lawsuit that had been filed on behalf of a self-employed scrap metal hauler who was suing Blue Cross of California for canceling his policy retroactively after he underwent a procedure to clear blockages in his arteries. The insurer (now called Anthem Blue Cross) claimed that when he’d applied for coverage, he’d failed to disclose that he had suffered from heartburn in the past. After canceling his policy, Blue Cross told him he would be responsible for
C. J. Cherryh
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